Hand and Wrist Pain
We use our hands and wrists every day to open jars and doors, type, chop vegetables and golf, climb, or play most any racquet sport. The multitude of bones, ligaments and muscles in the wrist, combined with the many complex movements required makes wrist injuries common.
Some frequent causes of wrist pain are:
De Quervain’s Tenosynovitis – causes pain on the thumb side of the wrist/forearm when you use your thumb to grip something, or when you rotate your wrist. This is usually caused by friction of the Abductor Pollicis Longus and Extensor Pollicis Brevis (APL/EPB) when they are overused.
Intersection Syndrome – a relative of DeQuervain’s but caused from friction of the APL/EPB and the wrist extensors as they intersect on the back of your wrist. The biggest hallmark sign of this condition is localized swelling and a gnarly crepitus (or grinding) sensation on the back of your forearm.
Cervical Radiculopathy – A pinched nerve in your neck can cause pain in the shoulder blade, upper arm, wrist or hand, as well as weakness, tingling, or numbness in the arm.
Arthritis:
Rheumatoid arthritis is an autoimmune disease that can affect many joints in the body, but often involves a breakdown of the cartilage in the wrist and hand joints with associated joint deformities.
Osteoarthritis of the wrists and CMC (at the base of your thumb) is common as we age but does not have to be debilitating with proper physical therapy treatment. OA of the 1st CMC is quite common and responds quite well to mobilization and movement re-education to use the underused thumb muscles and decrease use of the overused ones.
Wrist Fractures – Common from a fall on an outstretched arm in children, elders and extreme sport enthusiasts. The toughest part of regaining wrist function following a period of immobilization is getting back movement. Get a physical therapist to help you kickstart the wrist mobility and start a progressive loading program when you are ready to start strengthening. Timing and progression are critical to a full recovery.
Carpal tunnel syndrome: (CTS) is a common condition of the wrist and hand that affects use of the whole arm. Pressure on the median nerve in the palm causes burning, tingling, or numbness in the fingers (not the palm), especially at night. If the condition worsens, symptoms are noticed during the daytime and are often worse when holding something.
CTS affects 1 in 20 Americans. Surgery performed on the wrist can make room for the median nerve. Fortunately for most people with CTS, PT relieves pain and numbness and restores function without surgery. But even if you have surgery, PT afterwards is vital to restore full motion and function.
TFCC Injuries – The Triangular Fibrocartilage Complex is a meniscoid structure on the little finger’s side of the wrist. It can become damaged with increased torsion through the wrist during periods of repetitive rotational loading (hanging and climbing with straight elbows or weight bearing without good shoulder stability). Often, these faulty movement patterns go unnoticed until the ulnar wrist pain occurs. TFCC injuries improves with a little stabilization and movement correction during activity to allow the TFCC to heal.
Some frequent causes of Finger and Hand Pain are:
Pulley Injuries:
Acute or Traumatic Pulley Injuries: Pulley injuries are almost exclusively seen in climbers. Often accompanied by an audible pop with sudden pain during a period of high finger loading such as latching a crimp dynamically. This injury will take months to heal, but that doesn’t mean you will be out of climbing for that long; there are many ways to continue participating in climbing as the pulley heals.
Flexor Tendon Tenosynovitis: More common than the traumatic pulley injuries, these occur from increased friction between the tendon sheath and the pulley when grabbing something. It’s commonly painful in a crimp position as this will increase the compression between the flexor tendon and pulley (irritating the sheath). Changing grip habits and improving shoulder mechanics when climbing has beneficial effects to keep you participating in climbing.
Lumbrical Strains – Another nearly exclusive injury to climbers. Lumbricals are muscles located in the palm of your hand that help fine tune and stabilize the flexor tendons. They may become damaged in frequently used climbing grip positions where the 4th or 5th finger fall off the hold (3 finger drag, or climbing in pockets). Correcting muscle imbalances, hand shape, and getting the pinky involved will help take pressure off the lumbricals and allow you to keep climbing.
Where you hurt does not tell us why you hurt. Sorting out movement dysfunction and the reason behind it and then giving you the tools to recover quickly is what we aim to do here at ALTA Physical Therapy, in Boulder, CO.
