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Hand

Hand Physiotherapy

Common Conditions at Total Physiotherapy

Hand Physiotherapy Common conditions

Osteoarthritis of the hand

Signs and Symptoms 

  • Most commonly affects the base of the thumb (the carpo-metacarpal joint) particularly in women over the age of 50.
  • Pain within the joint, weakness of pinch grip, loss of range of movement and stability of the joint, reduced function especially if the dominant hand is affected.

 

What is happening with the body? 

Osteoarthritis  is a condition where the articular cartilage (lining of the bone joint surface)  begins to diminish in size and changes to the surface of the joint occur making it irregular instead of smooth. This process can lead to swelling, pain and reduced strength of the surrounding muscles.

 

How can physiotherapy help? 
Massage, gentle mobilization, use of a splint to rest and support the joint as well as assist in function, advice on achieving a balance between rest and exercise to optimize function with minimal pain. Splints may be a neoprene or elastic thumb wrap, or a custom made thermoplastic version which offers more support for painful joints.

Carpal Tunnel Syndrome

Hand 1

 

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) occurs when the medium nerve is compressed as it passes through the tunnel of the wrist. The tunnel is surrounded by bones, ligaments and tendons. The median nerve provides sensation to the skin of the palm, thumb, index, middle fingers, and half the ring finger, as well as supplying the muscles of the thumb.

 

What is happening with the body? 

 Carpal Tunnel Syndrome (CTS) occurs when the medium nerve is compressed as it passes through the tunnel of the wrist. The tunnel is surrounded by bones, ligaments and tendons. The median nerve provides sensation to the skin of the palm, thumb, index, middle fingers, and half the ring finger, as well as supplying the muscles of the thumb.

 

Predisposed Medical Conditions

Certain medical conditions can predispose a person to CTS: 

  • Diabetes 
  • Thyroid dysfunction 
  • High blood pressure 
  • Fluid retention from pregnancy or menopause 
  • Autoimmune disorders e.g. rheumatoid arthritis 
  • Fractures or trauma to the wrist

 

Signs and Symptoms 

Signs and symptoms in the hand (thumb, index, middle, half the ring finger, and palm): 

  • Pins and needles 
  • Tingling 
  • Numbness 
  • Pain 
  • Weakness or clumsiness of the hand 
  • Pain can sometimes be referred into the arm or shoulder 
  • Symptoms are often worse at night 

 

How can physiotherapy help?  

Physiotherapy management can include:

  • Provision of a night splint in a neutral wrist position to improve the posture of the wrist 
  • Tendon gliding exercises to mobilise the tendons in the tunnel
  • Massage and mobilisation of the wrist bones and soft tissues 
  • Advice on pacing activities and modifying if necessary
  • Advice on ergonomics, posture and sleeping positions 
  • Nerve gliding exercises of the arm 

Cortisone injection into the wrist may be helpful if physiotherapy has not relieved symptoms.

Surgical decompression of the tunnel by a hand surgeon may be necessary if physiotherapy does not help.

Click here to access a printable flyer on Carpal Tunnel Syndrome.

De Quervains Syndrome

 

Signs and Symptoms 

Pain and tenderness over the two affected tendons on the thumb side of the wrist, often accompanied by palpable swelling and difficulty gripping. Common in new mothers (or grandmothers!) when nursing the baby or changing nappies.

 

What is happening with the body? 

De Quervains Syndrome is the name for a range of conditions that cause irritation or “tendinopathy” of two of the thumb tendons. It is essentially an overload of these tendons – the load placed on the tendons is greater than the ability of the muscle and tendon to cope with that load. The types of activities that overload the tendon are those that involve pinching, grasping, pushing or pulling play a part, and intensive use of a computer mouse. There may also be a hormonal impact as it is a common problem in breastfeeding and postmenopausal women.

 

How can physiotherapy help?  

Splinting the thumb and wrist to rest the tendons, massage, therapeutic ultrasound, ice or heat to reduce pain and swelling, and specific exercises.