Hand and Wrist Problems Explained

About the Hand and Wrist

The wrist is a joint where the two forearm bones (radius on the thumb side and ulna on the pinky finger side) meet the eight bones of the wrist (carpals). The carpal bones are arranged in two rows, each forming small joints with the bones beside them. The furthest row of carpal bones connects to the bones of the palm (metacarpals), of which there are 5. The fingers are each formed by 3 small bones called phalanges. The thumb is made up of two phalanges. It is connected to the palm by a saddle joint which allows it to move in all directions. Ligaments connect all of the small bones of the arm, wrist and hand together to provide stability to the joints.

Two major groups of muscles start in the arm, cross the wrist, and end in the hand. One of these groups flex, or bend, the fingers and wrist; and the other group extends, or straightens, the fingers and wrist. The tendons of these muscles are covered in slippery sheaths (synovium) that act as pulleys and allow them to glide smoothly with movement. There are also short muscles that start and end in the hand that assist with finger and thumb movements. A major nerve (the median nerve) travels from the neck, down the arm and through a tunnel in the wrist called the carpal tunnel. This tunnel is formed by the wrist bones (carpals) on the floor and walls of the tunnel, and is covered by an inflexible tissue called the flexor retinaculum. The long tendons of the muscles the flex the wrist and fingers also pass through this tunnel.

What Causes Hand and Wrist Pain?

There are many possible causes of hand and wrist pain including:

Wrist Sprain

Wrist Sprains happen when the ligaments of the wrist are either stretched, partially torn or fully torn. This typically occurs because of a fall on an outstretched arm, which commonly happens during sports or recreational activities, but can also happen during activities of daily living.

Wrist sprains are graded (Grades 1-3), depending on the severity of the injury to the ligaments:

  • Grade 1 is when the ligaments are stretched but not torn
  • Grade 2 is when there is a partial tear in the ligaments
  • Grade 3 is when there is a full thickness tear of the ligaments

The symptoms of this injury may include: pain, especially with movements of the wrist, tenderness to touch, swelling, bruising, a feeling of warmth inside the wrist, and a feeling of popping or tearing inside the wrist during the fall.

Depending on the severity of the injury, people experience difficulty with activities of daily living and/or work or sport-related activities.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome can cause pain in the wrist area, as well as tingling and numbness in the thumb, index, middle and half of the ring fingers. The pain is often worse at night and when doing repetitive activities with the wrist or fingers bent, such as typing or tool work.

This injury is caused by compression of the median nerve as it passes through the carpal tunnel at the wrist. Anything that increases the pressure inside the carpal tunnel can cause this injury, but it commonly occurs as a result of activities involving repetitive flexion of the wrist and/or fingers. This type of movement can cause the tendons that flex the wrist / fingers to swell and because they pass through the carpal tunnel, they become compressed and put pressure on the median nerve. Carpal Tunnel Syndrome can also occur in pregnancy because retained fluid increases the pressure inside the carpal tunnel.

De Quervain’s Tenosynovitis (Tendonitis)

De Quervain’s occurs when the tendons at the base of the thumb become inflamed and painful. The synovium, which acts as a pulley for the tendon, also becomes irritated and the tendon cannot glide smoothly through it. The tendon may catch as it moves through the synovium causing a catching or snapping sensation.

There may be swelling or a fluid filled cyst over the thumb side of the wrist. This injury makes it difficult to move the thumb and wrist; and causes pain when making a fist, grasping or gripping objects and when turning the wrist.

Gamekeeper’s/ Skier’s Thumb

Gamekeeper’s Thumb, also known as Skier’s Thumb, is an injury to the ulnar collateral ligament of the thumb. This is the ligament that attaches the bones at the base of the thumb on the side closest to the index finger.

In some cases the ligament can be torn, but in 90% of the cases it becomes avulsed (detached) at the point where it joins to the bone. A common way that this can occur is through a fall on an outstretched arm.

This injury causes the thumb to become unstable, painful and weak when using a pinch grip to grasp objects. There may be swelling or bruising at the base of the thumb.

Arthritis

Arthritis can affect the joints of the wrist and fingers. Two kinds of arthritis affecting the hands are osteoarthritis and, less commonly, rheumatoid arthritis.

Both osteoarthritis and rheumatoid arthritis cause inflammation within the joints of the hand and can cause deformities of the joints of the hand and wrist over time if they are not treated.

What can you do if you have hand or wrist pain?

At Kanata Orthopaedic Physiotherapy Clinic, your Physiotherapist will determine the exact cause of your symptoms and prescribe a course of treatment to address the underlying issues.

Your treatment may include one or more of the following:

  • Modalities for pain relief including electrical currents, acupuncture, heat and ice
  • Manual therapy to improve the movement of the joints in your wrist/hand
  • Massage to promote soft tissue healing and to break up scar tissue
  • Strengthening and stretching exercises
  • Recommendations to wear a brace to protect the injured area
  • A specific plan to improve your daily functioning and to help you to avoid wrist/hand injuries in the future