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Wrist/Hand Injuries

Wrist/Hand Injuries

De Quervain’s Syndrome:

This condition involves inflammation of the tendons of the thumb. Pain is very noticeable in the wrist and thumb during general thumb use and during gripping and pinching activities. Conservative management usually consists of splinting the wrist and thumb, along with the use of anti-inflammatories (oral and/or injection). Occupational therapy may also be introduced to restore flexibility to the wrist and thumb, evaluate causative factors, educate on the prevention of symptoms, and strengthen the wrist and thumb to regain function. Therapy may also be prescribed to use thermal or electrical modalities to control inflammation and pain.

Fractures to Hand or Wrist:

A  common mechanism of injury is falling on an outstretched arm with the wrist hyper-extended. Proper alignment of the bone(s) is essential for normal healing and restoration of motion. In addition, because of important vessels and nerves surrounding these structures, it is very important to follow-up with an orthopedic surgeon or a hand specialist. Treatment generally consists of casting or surgery to stabilize the fracture, followed by therapy to regain range of motion of the joints.

Tendonitis:

Tendonitis, simply put, is inflammation of the tendon. A tendon is what connects muscles to bone, and it typically crosses a joint. Overuse of the joint or muscle causes inflammation of the tendon. Tendonitis is very common in the wrist and hand. Tendonitis of specific tendon(s) can have different names (i.e. DeQuervain’s tenosynovitis, Intersection syndrome, finger tendonitis), but treatment is generally the same.

Tendonitis is generally treated with anti-inflammatories to reduce pain and swelling as well as by immobilizing the joints the tendon crosses. Occupational therapy may be prescribed to use thermal or electrical modalities to decrease pain and inflammation, for custom splint fabrication, to learn exercises and stretches to restore muscle and tendon flexibility, and to strengthen the wrist and hand to resume normal use. Your workstation and daily activities may need to be modified to prevent further injury and overuse.

Carpal Tunnel Syndrome:

The carpal tunnel is a narrow passageway in your wrist that allows nine tendons in the fingers and thumb, as well as the median nerve, to travel into the hand. Pressure inside the carpal tunnel may be increased by repetitive wrist motions, gripping, or sustained wrist and finger positions. This increased pressure on the nerve may cause wrist pain, numbness and tingling in the thumb and first two fingers, and eventual hand weakness.

Carpal Tunnel Syndrome may be managed with anti-inflammatories and with splinting to immobilize the wrist and decrease pressure in the carpal canal. A patient may be referred to an occupational therapist for splinting, nerve and tendon exercises, thermal or electrical modalities to decrease inflammation, and education on prevention of symptoms and activity modification. Our professional staff may also visit your worksite to adjust your workstation and fully optimize good technique to avoid future injury or recurrence. If conservative management is unsuccessful, surgery may be required to decompress the nerve.

Arthritis:

There are many forms of arthritis with most forms being categorized as either Osteoarthritis or Rheumatoid arthritis. Osteoarthritis generally occurs from “wear and tear” on the joints, while Rheumatoid arthritis is actually an autoimmune disorder that attacks the lining of the joints. Both forms of arthritis frequently occur in the wrist and hand. In addition to medical management, occupational therapy may be prescribed. Therapy goals are to decrease joint inflammation, improve joint range of motion, and provide education on joint protection techniques as well as to provide equipment to relieve strain on the affected joints during daily activities. Therapists may also fabricate rigid splints to rest and immobilize joints during a “flare-up” and recommend a variety of soft splints that support joints during hand use.

Trigger Finger:

Trigger finger, also known as stenosing tenosynovitis, can occur in any of the fingers or thumb. It is caused by the swelling of one of the tendons that bend the finger or thumb. This tendon inflammation causes the finger to catch in a bent position. Straightening of the finger will then cause it to snap. Trigger finger can be associated with chronic inflammation (i.e. rheumatoid arthritis), overuse of the hand, or from using tools with hard or sharp edges. Conservative management may consist of anti-inflammatories or cortisone injections. Occupational therapy may be prescribed for splinting of the hand in order to rest the tendon and prevent triggering, for use of modalities to decrease inflammation, to provide exercises to maintain joint motion, and to provide ergonomic assessment and education.

Mallet Finger:

Mallet finger is an injury to the fingertip. It commonly occurs when the tip of the finger is hit—usually while playing sports such as baseball and basketball. With this injury, the tendon that straightens the tip of the finger is disrupted, and the finger ends up in a bent position. Mallet finger can also be associated with a fracture of the fingertip. Your finger will be splinted or pinned in a straight position until the tendon heals (usually around 6 weeks). The tip of the finger is NOT allowed to bend during this time. You may need to see a specialist if there is a fracture or if the finger does not heal properly.

Tendon/Ligament Injuries to Fingers:

These types of injuries usually occur with direct contact to the fingers (“jammed finger”) or forceful gripping of an object that is moving. Pain may occur with movement, or in some cases, finger movement may not occur at all if a tendon is ruptured. Proper medical attention is necessary to avoid permanent deformity to the finger involved. Immobilization is usually done as required by the physician to allow proper healing of the damaged tissues. Once the splint is removed, occupational therapy will help restore proper motion to the fingers and facilitate the return to full function.

Guyon Canal Syndrome:

This condition involves the ulnar nerve and artery as they pass into the hand at the wrist (on the small-finger side of the hand). It is also known as “handlebar palsy”—named for pressure on the ulnar nerve in the hand from the handlebars of a bicycle during long-distance cycling. Pressure on this nerve causes numbness and tingling in the ring and small finger, pain on the small-finger side of the hand, and eventual hand weakness.
Treatment generally consists of conservative management with the use of anti-inflammatories and/or therapy. Therapy may include splinting of the wrist until the irritation of the nerve subsides, use of modalities to decrease inflammation, activity and tool modification to reduce pressure on the nerve, and strengthening of weak muscles.

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