Wrist Pain and Injury Therapy
Wrist injuries are common among all walks of life, from computer users, to factory workers to athletes. Many people can’t tell the difference between a sprained wrist and a broken wrist, the wrist pain is similar, but these are very different injuries. Wrist tendinitis is the most common form of wrist injury for folks who use their hands and arms frequently throughout the day and comprises of 25%-50% of all sports injuries. The elderly are most at risk for wrist injuries because of decreased forearm and grip strength, along with weakened elasticity of wrist tendons from overuse. Physical therapy is very helpful for treating wrist injuries and can help guide patients to full recoveries by increasing wrist strength, stability, and range of motion.
What is Wrist Tendinitis?
Wrist tendinitis is when the tendons of your wrist can become inflamed or irritated from repetitive strain. The tendons of the wrist are actually elongated from muscles of the forearm, and connect to the fingers of the hand so that the muscles can cause different grip and hand movements. The tendons are much like cable, and are easily visible on the backs of your hands. Following are the most common conditions of wrist tendinitis:
- Wrist tendinitis is a term to describe the early stages of tendon inflammation and irritation.
- Tendinopathy is a term when wrist tendinitis has becoming chronic and has persisted for a long time, typically more than 2 months.
- Tenosynovitis describes the irritation that develops in the synovial sheath, where the tendons glide in. The sheath thickens from inflammation and restricts tendon gliding.
- De Quervain’s Tendinitis is a special tendinitis in that it describes the inflammation to the thumb tendons at the radial aspect of the wrist. This is most commonly seen in mothers who pick up young children a lot.
Signs and Symptoms
Following are what a patient may feel if they have wrist tendinitis:
- Pain and aching at the wrist, pain may radiate up the forearm and to the elbow.
- Pain on the radial aspect of the wrist (where the thumb joins the wrist), or on the ulnar side of the wrist (the pinky finger side).
- When the wrist is twisted or put under strain, pain ensues. This wrist pain may get worse if left untreated and activity is not modified.
- Pain with weight-bearing pressure onto the hand, like when performing a push-up or when pushing off a chair to stand up.
- Stiffness in the wrist enabling the patient from fully bending and straightening the wrist joint.
- Swelling in the wrist area.
- Tenderness to pressure and massage in the wrist and forearm muscles.
How Is It Diagnosed?
Your physical therapist will conduct a thorough evaluation of your wrist to properly discern the anatomical structures affected. He/she may have to rule out other conditions such a carpel tunnel syndrome, or more serious orthopedic cases like a large cartilage tear, wrist strain, or even a fractured wrist. Your physical therapist will also ask you relevant questions such as the activity that caused the injury, the manner, and movements in which your symptoms can be aggravated, and most importantly which activities of daily living are affected by your injury. You will undergo an objective exam, whereby your range of motion, amount of swelling, forearm strength and grip strength are recorded to establish a baseline for your progress.
Physical Therapy Treatment for Wrist Injuries
Physical therapy is highly effective for treating tendinitis and wrist injuries. Everyone’s plan of care and length of treatment will differ according to presentation and functional goals, but here is an example of the key focus areas your physical therapist may treat you with:
Pain Management. Your physical therapist will hone on in painful movements of the wrist and help you avoid noxious movements and activities, so you prevent further strain and stress on the wrist structures. Rest may be recommended in the short-term if the wrist pain is acute, as well as ice to treat the inflammation and alleviate pain. Your physical therapist may also recommend a wrist brace to help stop you from performing painful ranges of movement, and to stabilize your joint for better comfort and allowance for tendons to heal.
Manual Therapy. Gentle joint movements when the wrist injury is acute, or more aggressive joint mobilizations when the injury is chronic may be done to help your ease of motion. Soft tissue massage will also help tight and sore muscles relax. Your physical therapist could also prescribe your you stretches to do in the clinic and at home to get your wrist to move better.
Strengthening and Range of Motion Exercises. Your physical therapist will determine the progression of exercises for you to strengthen the stabilize the wrist, along with promoting healthy joint motion. Most times, the entire arm and shoulder can be weakened and be the cause of the wrist injury. This movement dysfunction is apparent in all sorts of movement where weakness from the shoulder can cause the patient to compensate with the wrist and hand. Your physical therapist will design home exercise programs and in-clinic exercises to help you meet your functional goal.
Patient Education. Your physical therapist will likely recommend you keep your wrist in a neutral position while lifting and doing activities to best protect wrist tendons and cartilage. They will show you how to keep this neutral position while simulating different sports maneuvers and activities. This simulation of activities is integrated into the exercise program as because your physical therapist wants to make sure you can return to full activity healthfully and prevent future re-injury.
Can wrist injuries be prevented?
Wrist injuries can indeed be prevented. Here are several tips:
- Avoid repetitive wrist and hand movements, especially those that require a lot of grip power, high arcs of movement, and force. If you have to perform these movements, make sure to take frequent resting breaks for your hands.
- Warm up the wrist and forearm muscles before starting repetitive hand activity (be it a sport or work). Your do this by making wrist circles, or using a hand gripper.
- In addition to resting breaks, perform regular wrist stretches to maintain flexibility.
- Make sure you maintain upper-body conditioning if your are performing an upper-body sport (like tennis, weightlifting, or boxing). Strong shoulders always means less stress to wrist and hand muscles.
- If an activity causes you wrist pain, don’t work through it. The pain signifies something wrong, like tendon irritation and/or damage. Discontinue your activity and rest – at least until the pain subsides.
Seeing a skilled physical therapist is crucial with wrist injuries in order to determine the source of dysfunction, whether that be a weakness, joint hypomobility, or a carpal tunnel issue. Often the most beneficial wrist sprain treatment for tendon injuries will include a training modification and specific strengthening exercises. These are very individualized wrist injury treatments, so it’s important to team up with a Doctor of Physical Therapy such as those at the Portland Area Stride Strong clinics who are willing to put the time into treating your wrist pain ailment.