Wrist and Hand

Carpal Tunnel Syndrome:
This condition occurs when the median nerve is pinched as it travels through the wrist. There is a 'tunnel' made up of wrist bones and connective tissue that surround the median nerve called the carpal tunnel. If the connective tissue is too tight, the nerve gets pinched, leading to pain, tingling or numbness in the hand, usually the thumb and index finger region.

Other Nerves can be trapped in the wrist, such as the radial and ulnar nerves, leading to pain, tingling, and numbness in other regions of the hand.


Treatment includes:
Education about the condition and how to avoid making it worse, including education on the neutral position of the wrist.

Therapeutic modalities to improve circulation and/or reduce inflammation and pain such as ultrasound, laser, interferential current, electrical muscle stimulation, acupuncture.

Exercises to stretch or strengthen the appropriate muscles or stabilize the joint.

Manual therapy to improve the movement in the area and decrease the tightness of the connective tissue of the carpal tunnel.

Splinting may be appropriate to ensure that the wrist is in a good position.

If surgery is necessary, physiotherapy can be beneficial afterwards to decrease surgical pain and improve wrist range of motion.

Broken Wrist/Hand:
Broken wrists or hands are common when falling on an outstretched hand or through direct trauma. Immobilization and icing is the first line of treatment for this injury. Seek medical attention as soon as possible to prevent further injury.
After a broken bone in the wrist or hand has been immobilized for a period of weeks and the cast is removed, it is common for the client to develop stiffness and weakness.

Treatment includes:
Education about the condition and how to avoid making it worse.

Therapeutic modalities to improve circulation and/or reduce inflammation and pain such as ultrasound, laser, interferential current, electrical muscle stimulation, acupuncture.

Exercises to stretch or strengthen the appropriate muscles or stabilize the joint.

Manual therapy to improve the movement in the area and reduce stiffness.

Mallet Finger Deformity:
This condition results from trauma to the tip of one of the fingers resulting in rupture of one of the tendons. It is common in baseball catchers and football receivers when the ball's force to the tip of the finger causes it to bend quickly. Symptoms include pain and most notably an inability to straighten the tip of the finger actively.

Treatment includes:
Education about the condition and how to avoid making it worse, which may include referral to a surgeon to reconstruct the injured tendon.

Therapeutic modalities to improve circulation and/or reduce inflammation and pain such as ultrasound, laser, interferential current, electrical muscle stimulation, acupuncture.

Exercises to stretch or strengthen the appropriate muscles or stabilize the joint.

Manual therapy to improve the movement in the area.

Splinting of the finger may be appropriate.

Palmar Fasciitis/Dupuytren's Contracture:
This condition affects the fascia (connective tissue surrounding the muscles) of the palm of the hand which commonly leads to decreased range of motion in one or more of the fingers. Thickening of the fascia can be felt as bumps under the skin referred to as nodules. Surgery may be indicated depending on how much loss of finger movement occurs.

Treatment includes:
Education about the condition and how to avoid making it worse.

Therapeutic modalities to improve circulation and/or reduce inflammation and pain such as ultrasound, laser, interferential current, electrical muscle stimulation, acupuncture.

Exercises to stretch or strengthen the appropriate muscles or stabilize the joint.

Manual therapy to improve the movement in the area.

Splinting of the finger may be appropriate.

Thumb Sprain/Skier's Thumb/Gamekeeper's Thumb:
A sprain is a stretch or tear of a ligament. A ligament is a strong band of connective tissue that connects one bone to another. Ligaments restrict excessive movement at a joint. This condition is common when the thumb movement is forced past the normal motion of the thumb leading to a stretching of the ligaments in the area, notably the ulnar collateral ligament. It is common in many sports when the thumb is caught on another's jersey or during skiing when the thumb is caught up in the ski pole during a fall. Symptoms include pain, decreased range of motion, swelling, and decreased strength.

Treatment includes:
Education about the condition and how to avoid making it worse. In severe cases, surgery is required. Proper assessment will determine if the sprain can be healed using physiotherapy or if a consult to a surgeon is warranted.

Therapeutic modalities to improve circulation and/or reduce inflammation and pain such as ultrasound, laser, interferential current, electrical muscle stimulation, acupuncture.

Exercises to stretch or strengthen the appropriate muscles or stabilize the joint.

Immobilization using a splint or tape may be beneficial initially to decrease the stress on the healing ligament.

Wrist Sprains:
A sprain is a stretch or tear of a ligament. A ligament is a strong band of connective tissue that connects one bone to another. Ligaments restrict excessive movement at a joint. This condition is common when the wrist movement is forced past the normal motion of the wrist leading to a stretching of the ligaments in the area. It is common when falling on an outstretched hand and in many sports. Symptoms include pain, decreased range of motion, swelling and decreased strength.

Treatment includes:
Education about the condition and how to avoid making it worse.

Therapeutic modalities to improve circulation and/or reduce inflammation and pain such as ultrasound, laser, interferential current, electrical muscle stimulation, acupuncture.

Exercises to stretch or strengthen the appropriate muscles or stabilize the joint.

Immobilization using a splint or tape may be beneficial initially to decrease the stress on the healing ligament. After immobilization, manual therapy techniques may be helpful to regain full range of motion and function of the hand.