Tag Archives: Wrist pain

Carpal Tunnel Syndrome, Hand Pain Treatment

Carpal Tunnel Syndrome: Physio 101

Leave a comment

Hand wrist pain from carpal tunnel syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is a common neurological disorder. It  occurs when the median nerve, which runs from your forearm into the palm of the hand, becomes compressed or squeezed at the wrist.

Importantly, the median nerve provides feeling to the thumb, index, and middle finger, and part of the ring finger (but not the little finger). Also, it controls some small muscles at the base of the thumb. Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and compresses the median nerve. For example, a common sign is that you might wake up and feel you need to “shake out” your hand or wrist.

What are the symptoms of carpal tunnel syndrome?

Usually, carpal tunnel syndrome symptoms start gradually and includes:

  • Tingling or numbness – You may notice tingling and numbness in the fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not the little finger. You might feel a
    sensation like an electric shock in these fingers. The sensation may travel from the wrist up the arm. The numb feeling may become constant over time.
  • Symptoms often occur while holding a steering wheel, phone or newspaper, or may wake you from sleep.
  • Feeling the need to “shake out” their hands to try to relieve their symptoms.
  • Weakness – You may experience weakness in the hand and are more likely to drop objects.

What is the cause of carpal tunnel syndrome?

Anterior view of wrist comparing a healthy carpal tunnel with a compressed median nerve in the carpal tunnel
SOURCE: ortho_carp-tun-rel-endo_anat.ai

As a reminder, carpal tunnel syndrome is caused by pressure on the median nerve.  Firstly, the median nerve runs from the forearm through a passageway in the wrist (carpal tunnel) up to the hand. Consequently, anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. For example, a wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation caused by conditions like rheumatoid arthritis.

What are the risk factors?

  1. Trauma or injury to the wrist that causes swelling, such as a sprain or fracture
  2. Imbalance of either the pituitary gland or the thyroid gland
  3. Rheumatoid arthritis or other arthritic diseases
  4. Mechanical problems in the wrist joint
  5. Repetitive use of tools or wrist movements
  6. Fluid retention during pregnancy or menopause
  7. Development of a cyst or tumor in the canal
  8. Sex—women are three times more likely than men to develop CTS
  9. Diabetes or other metabolic disorders – can directly affect the nerves and make them more susceptible to compression
  10. Sleeping positions  ex. with a bent wrist
  11. Increasing age—CTS usually occurs only in adults.

How is it diagnosed?

This condition can be diagnosed by:

  • Physical exam
  • Routine laboratory tests
  • X-rays
  • Specific wrist tests may produce the symptoms of CTS ex. Phalen’s test
  • Electrodiagnostic tests such as nerve conduction study and
    electromyography
  • Diagnostic imaging such as ultrasound imaging and magnetic resonance imaging (MRI).
Phalen's Test for carpal tunnel syndrome

Phalen’s Test for carpal tunnel syndrome

How is carpal tunnel syndrome treated?

  • Splinting – Initial treatment is usually a splint worn at night
Splint for carpal tunnel syndrome

An example of a night time splint for carpal tunnel syndrome, from https://www.orthomed.ca/

  • Activity modification – Avoiding daytime activities that may provoke symptoms, take frequent breaks from tasks to rest the hand
  • Medication – In special circumstances, various medications can ease the pain and swelling associated with carpal tunnel syndrome. For example, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may provide some short-term relief from discomfort. However, they haven’t been shown to fully treat CTS
  • Exercise – Ask a physiotherapist at PhysioNow about hand exercises that might help with pain and improve grip strength among those with CTS. Alternatively, therapies such as acupuncture and chiropractic care have benefited some people with CTS. However, their overall effectiveness remains controversial in the research
  • Vocational or occupational therapy – You may need to learn new ways to perform certain tasks or job skills so as not to aggravate or worsen your CTS

Our team of qualified physiotherapists at PhysioNow will help and guide you through the treatment and exercises that will help you reduce pain and improve your quality of life. Book your first appointment with PhysioNow today!

General Category, Hand Pain, Wrist pain

Triangular Fibrocartilage Complex (TFCC) Injury

Leave a comment

Triangular Fibrocartilage Complex (TFCC) Injury

The TFCC is a combination of ligament, tendon and cartilage and therefore name as Triangular Fibrocartilage complex. This ligament has a major function of stabilizing and supporting the wrist. It is an important structure connecting the forearm bones to the small bones in wrist, thereby giving you the mobility when you grip object tightly or rotate the wrist. The TFCC provides these movement more support and range while behaving as cushion in the area.

What causes TFCC strain or tear?

There are two ways your TFCC can give up – either due to injury or any degeneration of these ligament.

  1. Injury – most often when you fall on outstretched hand is a common precursor of the TFCC injury or tear. The mechanism could be a sudden impact or a twisting injury. Older adults are more vulnerable as there can be thinning of these ligaments with age and making it easy to injure. If there has been a fracture of forearm or wrist, this can directly impact the TFCC. Overuse activities or repetitive movement can cause the area to injure.
  2. Degeneration – as any structure in your body, this too can get thinner with wear and tear of aging. There can be a chronic tear which is gradually occurring over time.

Symptoms

Injury to TFCC can cause following symptoms

  • Pain and tenderness on wrist area mainly outside of wrist
  • Difficulty in rotating wrist or forearm with clicks or pops sometimes
  • Reduced strength in wrist with weak grip strength

Diagnosis and Tests

Early intervention is important, before the weakness takes over and causes atrophy. Upon your first meet with Physiotherapist, they will ask for the pain and medical history to know how it started. The next step is physical exam with few tests of the ligament and muscles to confirm the involvement of the TFCC. Followed by this, upon pressing different areas in wrist there will be determination of amount and intensity of the issue. The range of motion is tested again to see how far the involved area is affected.

TFCC tests can be diagnosed with fovea test where the provider applies pressure to outside o wrist for tenderness. This is often compared to other side for confirmation.

Your provider may also recommend imaging tests — such as X-rays or MRI — to look for fractures or tears.

Treatment for TFCC

After a TFCC injury you may find difficulties in doing daily activities. In such scenario your provider may recommend one or more from below-

  1. The doctor may prescribe some anti-inflammatory to help reduce swelling as well as may reduce some pain.
  2. Bracing of wrist to prevent from further damage so it can be protected can be important during acute/initial phase. The 3pp carpal lift brace are generally prescribed in initial acute phase to support the wrist small bones. It has cushion on base to stabilize the wrist.
Wrist Brace TFCC

Wrist Brace

  1. Physiotherapist may also with it do manual therapy and exercises to strengthen the muscles around wrist joint.
  2. Remember to ice everyday 10 minutes at a time in initial week and move on to heat as per your physiotherapist’s advice. The therapist can use Taping.
  3. Surgery: If more conservative treatments don’t provide relief, your provider may recommend surgery. In most cases, minimally invasive arthroscopic surgery can repair TFCC tears. Following a surgery, few step to be mindful of are, make sure you keep your wound dry.  Follow up with surgeon as suggested – after 2 weeks and then after 2 months. Physiotherapy sessions 2-3 times a week for 8 weeks and follow the home exercise programme as prescribed by the physiotherapist.

Preventing TFCC

There are few ways to prevent it from getting injured, as mentioned below,

  • Avoid repetitive, high-impact activities using the hands
  • Do warmup exercises before a sport or activity that involves twisting your arm or wrist (like playing tennis or baseball).
  • Strengthen your wrist and forearm muscles
  • Gradually increase any athletic activity, rather than suddenly increasing the activity amount or intensity.

Prognosis

Most of the injuries and tears can take up to 12 weeks due to the sensitive location and the nature of the structure. But be mindful to call the doctor, if there is any swelling, discoloration or loud pops heard.

In most of scenarios, during initial phase it is advised not to do any training, lifting or gymnastics. It is known to heal faster when wrist is rested in neutral position. Furthermore, you can return to these activities in 3-4 months based on the extent of injury. It is always advised to review with your physiotherapist before returning to any heavy weight exercise or work.

Need Some Help?

If you think you have Triangular Fibrocartilage Complex or have been diagnosed with it rest assured that there is help book. We have many experienced Registered Physiotherapists at PhysioNow who would love to help you out. Book with us at PhysioNow today for your initial assessment and treatment.

General Category, Wrist pain

Osteoarthritis, Learn About It Here!

Leave a comment

Osteoarthritis is a degenerative disease of the joint affecting the articular cartilage and bony structures and tissues involved.

It starts with changes to the surrounding tissues of the joint and in advanced stages it affects the articular cartilage thereby reducing and narrowing the joint space causing structural bony changes.

Osteoarthritis

Signs and symptoms of Osteoarthritis in hand and wrist:

  • Swelling of the joints or knuckles.
  • Morning stiffness in fingers and wrist.
  • Pain with movements.
  • Difficulty with gripping and handling objects.
  • Decreased strength.
  • Enlarged joints or deformed joints in more than one or more area.
  • Heberden’s nodes, and Bouchard’s nodes/ hard or bony lumps on the fingers in more than 3 to 4 joints or knuckles.

Risk Factors:

  • Commonly seen in females.
  • Age over 40.
  • Menopause
  • Family history.
  • Previous injury to the hand and wrist.
  • Work or occupation related repetitive usage of the joints.

Diagnostic imaging:

X ray, MRI, CT scan would show the changes in the joint and the articular cartilage.

Management of Osteoarthritis:

Pharmaceutical:
  • Analgesics
  • Non steroidal anti inflammatory drugs.
  • Intra articular steroid injection.
Surgical:
  • Arthrodesis, fusion of the joint.
  • Arthroplasty, Joint replacement.

Physiotherapy:

Evidences and studies show that physiotherapy does decrease the impact of OA on joints and thereby improving the strength and function of the joint. Physiotherapy management includes:

osteoarthritis

Joint Protection

osteoarthritis

Hand Exercises

osteoarthritis

Laser and Ultrasound Machine

  • Joint protection and advices on splints and braces, and suggestion on adaptive equipment to make function easier.
  • Heat wraps/ paraffin wax for pain relief and joint function.
  • Laser and ultra sound for reducing swelling and for soft tissue healing.
  • Hand exercises involving strengthening and stretching to improve joint function and reduction of pain.
  • Joint mobilization and soft tissue techniques to reduce pain and to improve mobility and flexibility of the joint.

Need some help?

Your concerns are best managed by a health care professional. Here at PhysioNow, we have many highly knowledgeable physiotherapists that can assist you with your issue. If you think you may have osteoarthritis or are diagnosed with it, book with PhysioNow today for your first assessment and treatment!

Applewood Physionow, Applewood Sports & Physiotherapy Ltd, Erin Mills Physionow, Erin Mills Physiotherapy Ltd., Exercise, General Category, Health and Wellness, Lorne Park PhysioNow, Lorne Park Sports & Physiotherapy Ltd., Manual Therapy, Massage Therapy, Massage Therapy at Erin Mills Physiotherapy Ltd., Massage Therapy Services Mississauga, PhysioNow, Physiotherapy, Registered Massage therapist Mississauga, Registered Massage Therapy Lorne Park PhysioNow, Registered Massage therapy Mississauga, Registered Physiotherapist Mississauga, Registered Physiotherapy Mississauga, Seniors, Wrist pain

Carpal tunnel syndrome

Leave a comment

Carpal tunnel syndrome

Carpal tunnel is the entrapment of median nerve at the wrist. Carpal tunnel syndrome leads to pain, numbness and tingling in first three fingers of the hand sparing the palm, weakness of thumb, loss of grip strength and dexterity.

Symptoms are usually worse at night and are eased by shaking the hand. Anything that irritates the median nerve at the wrist can lead to carpal tunnel syndrome. This can include a fracture around the wrist, swelling due to inflammatory conditions such as Rheumatoid arthritis, changes in the balance of body fluids as in pregnancy and menopause. It can also include workplace factors such as vibrating tools, poor position of the hand, obesity, diabetes mellitus or double crush syndrome.

Carpal Tunnel Syndrome needs to be differentiated from wrist tendonitis, cervical radiculopathy, cervical derangement and thoracic outlet syndrome leading to similar types of symptoms. If not treated at the right time, it can lead to varying degrees of functional loss.

Treatment for Carpal Tunnel Syndrome

There are two general approaches for treatment for carpal tunnel syndrome – conservative treatment and surgical treatment.
Your Registered Physiotherapist will address the following strategies to help you with your symptom management and treatment:

• Education: It is important to maintain healthy weight, exercise and manage any health problem such as diabetes.
• Proper body mechanics: Keeping your wrist neutral,
avoiding repetitive wrist flexion movements, tight pinching and gripping
An Ergonomic assessment of your workplace can help to prevent recurrence.
• Decompressing the nerve: Mobilisation of certain carpal bones such as the capitate helps to create more space for the median nerve and hence decompress the nerve.
Stretching the retinaculum and improving the flexibility of the muscles around the wrist will also help. Nerve and tendon gliding exercises will ensure the unrestricted motion of the nerve.
• Grip strengthening exercises, fine motor and hand dexterity exercises and postural correction.
• Treat the spine if your symptoms are related to double crush syndrome.
• Taping the wrist or using a Wrist splint.
Check out this link for more information.

The earlier the carpal tunnel syndrome is treated, the less likely are the chances for symptoms to return.Carpal tunnel syndrome Resolution of the symptoms after surgery can be more temporary if the symptoms originate from elsewhere. Our experienced Registered Physiotherapists at PhysioNow will assess you to find out the actual cause of your symptoms and will help you to get rid of your symptoms. Call today!

acupuncture, Exercise, General Category, Health and Wellness, Sports Injuries, Sports Physiotherapy, Wrist pain

Carpal Tunnel Syndrome

Leave a comment

CARPAL TUNNEL SYNDROME:

Carpal Tunnel Syndrome

Carpal tunnel syndrome is compression of the median nerve as it passes into the hand. The median nerve is located on the palm side of the hand (also called the carpal tunnel). It provides sensation (ability to feel) to your thumb, index finger, long finger, and part of the ring finger. Compression of the nerve produces numbness, tingling and, eventually, hand weakness. Proper Physiotherapy treatment can relieve the tingling and numbness and restore wrist and hand function.

Causes of Carpal Tunnel Syndrome:

• Carpal tunnel syndrome can be made worse if the wrist is overextended repeatedly
• Repeated motions of your wrist contribute to swelling and compression of the median nerve
• Poor positioning of your wrists while using a keyboard or mouse
• Prolonged exposure to vibrations from using hand tools or power tools
• Any repeated movement that overextends your wrist, such as playing the piano or typing
• Gripping frequently, even an iPad or book for long periods of time
• Lifting free weights
• Gripping weight machines at the gym or home
• Resting your head on your hand with your wrist in a bent position

Symptoms of Carpal Tunnel Syndrome include:

• Numbness, tingling, and pain in the thumb and first three fingers of the hand
• Pain and burning that can travel up the forearm
• Wrist pain at night that interferes with sleep
• Weakness in the muscles of the hand

Physiotherapy Treatment for Carpal Tunnel Syndrome:

• Wrist splints that hold your hand in a neutral position, especially at night
• Avoiding activities that put your wrist into extreme positions up or down
• Ultrasound and Interferential current can help to reduce the swelling in the Carpal Tunnel
• Proper posture for work and home while reading, working on the computer, etc.
• Exercises done in physical therapy may also be helpful
• Acupuncture may help to stimulate the median nerve and relieve pain

Overall, Carpal Tunnel Syndrome is a very uncomfortable condition. It can interrupt your life and your sleep. Getting the proper Physiotherapy Treatment Program is very helpful! PhysioNow has fully trained Registered Physiotherapists standing ready to help you Now! Please call today to get started on relieving your pain!