The Wrist

Wrist pain responds well to physiotherapy treatment and is something we see regularly at Walker and Hall.

We know how disabling it can be, affecting every aspect of your life e.g., dressing – particularly fastening buttons, eating – especially holding a knife or fork, writing, typing, using a key and even drinking.

The most common types of wrist pain we treat are

Colles fracture
Scaphoid fracture
Carpel tunnel syndrome
Tenosynovitis – De Quervain’s syndrome
Referred pain

If your condition is not listed above please contact us

We have extensive experience in treating these conditions and managing your recovery.

To see how Walker and Hall can help you please see below:

Colles Fracture (also known as a Broken Wrist, Wrist Fracture, Fractured Radius, Distal Radius Fracture, Broken Radius)

This is the most common fracture of the wrist we treat at Walker and Hall. We know through experience how disabling it can be, particularly if it involves the wrist of your dominant hand (the hand you write with) as this type of fracture will affect all aspects of your life from washing and dressing, to work related activities to sports and leisure activities.

Anatomy

The forearm consists of 2 long bones known as the radius and ulna which are situated beside each other. The radius bone lies on the thumb side of the forearm and forms joints with the ulna (near the elbow and wrist) and several small bones at the wrist. During certain activities such as a fall on the outstretched hand, stress is placed on the radius bone. When this stress is traumatic and beyond what the bone can withstand a break in the radius may occur. This condition is known as a Colles fracture.

Causes of a Colles fracture

A Colles fracture tends to be more common among the elderly although it can occur in young patients. Often a Colles fracture occurs in combination with fractures to other bones in the area such as the ulna or scaphoid.

• Trauma – in our experience this is the most common cause of a Colles fracture, a fall onto the outstretched hand. This may occur with any fall but most commonly is associated with “slipping” on ice. Other causes may include skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving.

Signs and symptoms of a Colles fracture

  • Pain – sudden onset of sharp, intense wrist or forearm pain at the time of the fall. This often causes you to support / cradle the arm in order to protect the wrist. The pain is usually felt on the thumb side of the wrist and forearm and can occasionally settle quickly leaving you with an ache at the site of injury that is particularly prominent at night or first thing in the morning. The pain may also increase during certain movements – gripping and during weight-bearing activity (such as pushing up from a chair)
  • Swelling over the affected area of the bone
  • Deformity – this is present in severe cases. When looking at your wrist an obvious deformity is present

How Walker and Hall can help you

Depending upon the extent of the fracture, treatment can range from immobilisation in a plaster cast to surgery.

If treatment in a plaster cast is chosen, then the wrist will be immobilised for 4 – 6 weeks and during this time it is important that the shoulder, elbow and hands joints are gently exercised.

Once the cast is removed physiotherapy treatment is very effective and will include

  • Gentle wrist mobilising techniques to increase the range of movement in a controlled manner
  • Pain relieving techniques e.g., electrical therapy – ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Muscle strengthening techniques
  • Home exercise programme to continue with the treatment and in particular to maintain joint range and muscle stability and strength
  • Advice with regards to returning to active sport, usually at the 6 week mark depending upon the improvement achieved during treatment.

If surgery is chosen, once again, following the removal of the plaster cast physiotherapy treatment is very effective and will include the above.

Scaphoid Fracture (also known as a Fracture of the Scaphoid and Fractured Scaphoid)

In our experience this is a relatively common fracture of one of the small bones in the wrist. If it involves the wrist of your dominant hand (the hand you write with) it can be particularly disabling as it can affect all aspects of your life from washing and dressing, to work related activities to sports and leisure activities.

Anatomy

The wrist consists of 8 small bones located between the forearm bones (radius and ulna) and the bones of the hand. The scaphoid bone lies in a space between the radius (outer arm bone) and the base of the thumb. During certain activities, such as a fall on the outstretched hand, stress is placed on the scaphoid bone. When this stress is beyond what the bone can withstand a break in the scaphoid may occur. This is known as a scaphoid fracture.

Causes of a Scaphoid fracture

  • Trauma – a fractured scaphoid most commonly occurs due to a traumatic weight bearing force being placed through the wrist e.g., a fall onto an outstretched hand. This can occur with any fall, but is particularly common in sports such as skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving

Signs and symptoms of a Scaphoid fracture

  • Pain – often sudden and severe and felt at the time of injury. It is usually felt on the thumb side of the wrist and occasionally can settle quickly leaving you with an ache in the wrist that is particularly noticeable during the night and or first thing in the morning. There may also be pain on weight-bearing e.g., when pushing up from a chair
  • Swelling – often over the thumb side of the wrist in an area at the base of the thumb known as the “anatomical snuff box”
  • Reduced grip strength and pain on weight-bearing through the affected wrist (e.g. doing a hand stand or push up)

How Walker and Hall can help you

Depending upon the extent of the fracture, treatment can range from immobilisation in a plaster cast to surgery.

If treatment in a plaster cast is chosen, then the thumb and wrist will be immobilised for 4 – 6 weeks during which time it is important that the shoulder, elbow and hands joints are gently exercised.

Once the cast is removed physiotherapy treatment is very effective and will include

  • Gentle thumb and wrist mobilising techniques to increase the range of movement in a controlled manner
  • Pain relieving techniques e.g., electrical therapy – ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Muscle strengthening techniques
  • Home exercise programme to continue with the treatment and in particular to maintain joint range and muscle stability and strength
  • Advice with regards to returning to active sport, usually at the 6 week mark depending upon the improvement achieved during treatment.

If surgery is chosen, once again, following the removal of the plaster cast physiotherapy treatment is very effective and will include the above.

Carpal Tunnel Syndrome

In our experience Carpal Tunnel Syndrome is a common cause of wrist and hand pain affecting all aspects of your life from washing and dressing, to work related activities to sports and leisure activities. Whilst it can occur at any age, it tends to affect people between the ages of 30 to 60 and whilst it most frequently affects the dominant hand (the hand you write with), it can occasionally affect both.

Anatomy

There are 8 small bones in the wrist which together are known as the Carpal bones. They are all connected to each other by strong ligaments and a piece of thick tissue (connective tissue) on the palm called the flexor retinaculum. The passageway below this tissue is the carpal tunnel. The carpal tunnel contains tendons from the muscles in the forearm (the flexor tendons) and a nerve known as the median nerve (this nerve supplies sensation and movement to the thumb and first three fingers of the hand). When the carpal tunnel narrows the median nerve can become compressed. Compression of the median nerve at the wrist is known as carpal tunnel syndrome.

Causes of carpal tunnel syndrome

Any condition that narrows the carpal tunnel and leads to compression of the median nerve will cause carpal tunnel syndrome e.g.,

  • Damage to the flexor tendons of the forearm – during contraction of the forearm flexors, tension is placed through the tendons within the carpal tunnel. When this tension is excessive due to too much repetition or high force, damage to the tendons may occur and the tendons become inflamed and swollen. This will reduce the space within the carpal tunnel and may cause compression of the median nerve

Examples of activities that place repetitive stress through the flexor tendons are sports such as gymnastics, cycling, golf or racquet sports, manual work such as carpentry, painting, chopping wood, bricklaying, repetitive use of a screwdriver, use of vibrating machinery, social activities such as sewing and knitting or working at a computer

  • Forceful or repetitive gripping of the hand
  • An increase in activities that place stress on the flexor tendons or due to a change in these activities e.g., weight lifting and increasing your training schedule or working and taking longer to finish an activity than anticipated
  • Trauma – a fall onto the outstretched arm, forcing the wrist backwards, can cause a sprain of the wrist and cause the tendons on the front of the wrist to become inflamed and swollen
  • A history of wrist, elbow, shoulder, neck and upper back injury may increase the likelihood of you developing carpal tunnel syndrome

Signs and symptoms of carpal tunnel syndrome

The symptoms associated with carpal tunnel syndrome usually develop gradually over a period of time and may include

  • An ache in the wrist and hand following the aggravating or unaccustomed activity, often felt at night or first thing in the morning
  • Pain or a burning sensation in the wrist and hand. This is often seen as a progression of the condition and the symptoms become present with every day activities involving the wrist and fingers such as carrying shopping, opening a jar, shaking hands or using the computer
  • Pins and needles and or numbness in the fingers (excluding the little finger)
  • Weakness in the thumb and first three fingers of the hand, often first noticed as a difficulty with fine movements such as fastening buttons, reduced grip strength and an increased frequency of dropping objects
  • Wrist and finger stiffness on waking
  • Wasting (a reduction in size) of the muscles of the thumb and hand – often in in longstanding cases
  • Neck and or upper back pain on the same side

How can Walker and Hall help you

Carpal Tunnel Syndrome can be treated either surgically or non-surgically. For non-surgical treatment a thorough musculoskeletal examination is required to determine which structure(s) in the wrist are causing the problem. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for carpal tunnel syndrome include:

  • electrotherapy (e.g. Ultrasound, Interferential Therapy) to reduce swelling, pain and muscle spasm
  • gentle joint mobilization techniques to improve the range of movements
  • soft tissue massage to reduce swelling, pain and muscle spasm
  • a home exercise programme to improve strength and maintain and improve wrist mobility
  • anti-inflammatory advice
  • general advice regarding the best way to arrange your workspace, car / van driving position and other situations where you spend a long time sat in one position.

For surgical treatment we are able to provide the appropriate post-operative physiotherapy management to ensure you return to normal activity in the shortest possible time.

De Quervain’s syndrome (also known as De Quervain’s Tendonitis, De Quervain’s Tenosynovitis, De Quervain’s Syndrome)

In our experience De Quervain’s Tendonitis is one of the most common overuse conditions affecting the wrist and thumb and if it involves the dominant hand (the hand you write with) then it can be particularly disabling as it can affect all aspects of your life from washing and dressing, to work related activities to sports and leisure activities.

Anatomy

The forearm comprises two long bones known as the radius and the ulna. These bones join with the small bones of the wrist which in turn joins to the small bones of the fingers and thumb. There are several muscles that control the movement of the thumb and these originate on the back of the forearm. Two of these muscles are known as extensor pollicis brevis and abductor pollicis longus and connect to the thumb via tendons. These tendons cross the back / outer aspect of the wrist to attach to the back / outer aspect of the thumb and as they do so they pass close to a bony prominence (bump) at the thumb side of the wrist. These two muscles are responsible for moving the thumb away from the other fingers, for gripping activity and the general movement of the thumb. During contraction of these thumb muscles, tension is placed through the tendons and as they move they may rub against the bony prominence situated at the wrist. When the contraction forces are excessive, due to too much repetition or high force, damage to the tendons may occur. This is known as De Quervain’s tendonitis.

Causes of De Quervain’s tendonitis

  • repetitive and or prolonged activities. Any activity that places strain on the tendons at the back / outer aspect of the thumb can cause inflammation and pain. This may include occupations that use computers and/or involve a lot of writing, and other occupations such as joinery, carpentry, painting, bricklaying, the repetitive use of a hammer and/or screw driver and the use of vibrating machinery, sports such as golf, racket sports, bowling and rowing, and social activities such as knitting
  • forceful or repetitive gripping of the hand and thumb
  • a sudden increase in activity or a change in existing activity – this can place stress on the thumb tendons
  • trauma – this may be due to a fall, a direct blow to the back of the thumb and wrist and or a forceful movement involving heavy lifting or a gripping force through the thumb tendons
  • A pre-existing history of thumb, wrist, elbow, shoulder, neck or upper back injury. It is thought that this may increase the likelihood of developing De Quervain’s tendonitis

Signs and symptoms of De Quervain’s tendonitis

The symptoms associated with De Quervain’s tendonitis tend to develop gradually over a period of time and include

Pain – initially felt as an ache or stiffness at the back of the wrist and thumb following the aggravating or unaccustomed activity. In the early stages it may be felt at night, on waking and then settle down as the aggravating activity continues. As the condition progresses it will be felt more frequently i.e., with every day activities involving the wrist and thumb such as carrying shopping, particularly opening a jar, cooking and using the computer.

Swelling – often noticed over the affected tendons on the back / outer aspect of the wrist and thumb

Crepitus (a crunching sensation associated with movement). If you place a finger over the swelling and move the thumb and wrist a crunching sensation may be felt, this is known as crepitus

Weakness in the wrist, hand and thumb – this often presents as a difficulty performing fine movements such as fastening buttons, a reduction in grip strength and occasionally may be associated with dropping objects

Pins, needles and or numbness in the thumb

De Quervain’s tendonitis may also be associated with neck and or upper back pain on the same side.

How Walker and Hall can help you

A thorough musculoskeletal examination is required to determine the extent of the inflammation of the tendons. This is essential if the optimum recovery is to be achieved.

Following the diagnosis a treatment plan is devised and discussed with you.

The types of physiotherapy treatment used at Walker and Hall for De Quervain’s tendonitis are

  • R-I-C-E. For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression bandage and keeping the arm Elevated (providing this is comfortable)

The REST component of the RICE regime is particularly important in the treatment of De Quervain’s tendonitis, as it is only by resting from the aggravating activity that you can ensure that the body can begin the healing process in the absence of further tissue damage.

  • Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
  • Wrist and thumb mobilising techniques e.g., gentle stretching and muscle release techniques.
  • Home exercise programme – a graduated mobilising and strengthening programme to ensure an optimal outcome.
  • Advice with regards to returning to the aggravating activity, be that your occupation, sport or social activity without aggravating the symptoms
  • Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist

Referred Pain

Not all pain experienced around the wrist is necessarily coming from a problem within the wrist area. Occasionally pain felt in this area can be referred or caused by a problem in another area of the body such as the neck or spine. This is called referred pain.

What is Referred Pain?

Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, examples being sciatica, where pain is felt down the leg whilst the problem is in the back, and a heart attack, where the pain is felt in the shoulder, arms and neck.

What structures can refer pain into the wrist?

The following structures have the ability to refer pain into the wrist

The cervical and upper thoracic spines (from the 3rd cervical vertebra to the 4th thoracic vertebra – C3 to T4). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a wrist problem.

  • The shoulder joint (gleno-humeral joint) and the acromioclavicular joint
  • The elbow joint (radio-humeral joint, humero-ulna joint and the superior radio-ulna joint)
  • Joints of the forearm (inferior radio-ulna joint)
  • The muscles of the rotator cuff
  • The muscles of the upper arm i.e., biceps and triceps muscles
  • The muscles of the forearm

How can Walker and Hall help you distinguish between forearm pain and referred pain

At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for the pain in your wrist.

It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.

You will be involved in all stages of your treatment given every opportunity to ask questions.