HAND & WRIST INJURIES

 

The wrist and hand require a great degree of movement and control to provide complex and fine movements we use on a day-to-day basis. The wrist acts to allow positioning of the hand around a wide range of movements, this enables the fine motor control movements of the hand to be adapted to various tasks.

This adaptability is achieved with a combination of multiple small bones that make up the wrist and hand with the absence of bulky muscular support across the joints of the wrist and small muscles at the hand.

Reliance on stability at the wrist is placed on the ligaments and tendons that cross this area. As a result, the wrist is prone to overload from repetitive activities and more vulnerable to direct impact than other joints in the body with greater muscular support.

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Symptoms that occur at the hand and wrist:

 

Pain

Ache

Weakness

Numbness

Restricted Movement

Tingling (Paraesthesias)

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Conditions that a chiropractors can treat and help manage:

 

Sprains- traumatic and repetitive strains

Tendinopathies/ tendinitis

Nerve entrapments e.g. carpal tunnel syndrome

Minor sporting Injuries

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Traumatic injuries:

 

A fall into the hand and wrist can result in a fracture of one or more small bones, present as a ligament sprain  between these bones, and in addition, cause muscles at the forearm and hand to become strained by an excessive stretch placed on the wrist and/or hand when moved into an unnatural position during trauma.

If ligamentous laxity is present from a previous a traumatic injury, pain is more likely to occur during repetitive low intensity tasks due to an overall reduction in stability.

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Specific traumatic injuries include:

 

Fractures & dislocations

Strains and sprains

Cartilage injury
 

Repetitive strain injuries: 

 

Repeated loading such as with computer work, sports and manual labour can result in the gradual build up of small amounts of damage to the various structures at the wrist and hand and usually result in pain during a task, or compression of structures that run through this region.

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Specific repetitive injuries include:

 

De Quervain’s Tenosynovitis: Pain is felt immediately below the thumb at the wrist and is often associated with repetitive use of the thumb. This pain is caused by an irritation of the tissue surrounding the tendons to the thumb.

 

Tendinopathies:

A gradual decrease in the strength of a tendon due to repetitive loading and often insufficient healing time between periods of stressful activity. Felt as pain at the wrist relating to specific activities.
Common in drummers, racquets sports, rowing and golf. It can also occur in patients with rheumatoid arthritis.

 

Tendinitis:

An irritation of a tendon or the fluid surrounding a tendon, commonly resulting from overuse and sometimes from a local blow/ knock. Results in localised pain, tenderness and swelling.

Trigger finger: Results in reduced ability to extend finger into fully stretched position, i.e. finger held in flexion. Caused by an increased friction of the tendon as it slides through its guiding sleeve at the finger. Lock during movement and swelling can occur. Associated with repetitive finger movement, sometimes initiated by a knock or blow (trauma).

 

Peripheral nerve entrapments:

Compression of the nerves that supply the muscles at the hand and results from a variety of causes, common amongst them is the gradual build up of fibrous tissue by repetitive activities and compression by a traumatic fall onto the wrist.

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Specific nerve entrapments include:

 

Median Nerve / Carpal tunnel syndrome:

Felt as pins and needles in the thumb, index and middle finger. Wrist, hand and finger stiffness often occurs, especially after rest. Often worse at night.

Ulnar Nerve / Tunnel of Guyon compression: Felt as weakness and/ or pins and needles into the 5th and 4th fingers.

 

Arthritic Pain:

Aches and pain caused by osteoarthritis can be helped by techniques that improve joint mobility and reduce excess tension in the surrounding musculature.

 

Referred pain:

Problems affecting muscle that originate from the elbow and forearm can be felt as pain at the wrist. Part of diagnostic process is to determine whether your pain is referred or primarily caused by a problem at the site of your pain.

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References:

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Papa, J.A. (2012). Conservative management of De Quervain’s stenosing tenosynovitis: a case report. The Journal of the Canadian Chiropractic Association, [online] 56(2), pp.112–20.