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Arthritis, Hand Pain Treatment, Health and Wellness, Hip Pain, Physiotherapy, Shoulder pain, Wrist pain

Rheumatoid Arthritis and What You Should Know

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Rheumatoid arthritis (RA) is an inflammatory disorder that can affect multiple joints, usually on both sides simultaneously. In other words, if it affects your wrists, it would likely be both, not just one. RA is an autoimmune disorder. Essentially, a flare up is when your immune system starts to attack your own body’s tissues. Ultimately, it has systemic (body-wide) effects and can damage your skin, lungs, heart and blood vessels in some cases.  RA mainly damages the lining of your joints causing large amounts of pain and swelling that can eventually result in joint line erosion and deformities. In most cases, the damage is permanent and leads to a decreased quality of life and increased disability.

What increases the risk of developing Rheumatoid Arthritis?

The ultimate cause of rheumatoid arthritis is unknown, but what we do know is certain things increase the risk of development. This includes:

  • Family history
  • Smoking
  • Obesity
  • Environmental or external factors (exposure to pollutants, stress, infection etc)
  • Sex: Women develop RA more often than men

What are the signs and symptoms of Rheumatoid Arthritis?

The symptoms depend on the current stage the condition is in, and it cycles between two stages:

  1. Relapsing: Also known as a flare up, symptoms appear and are more intense
  2. Remitting: Symptoms including pain will decrease or are absent, but structural deformities will persist  

During a relapse/flare up, symptoms include:

  • Pain in the joints, usually 4 or more joints at a time
  • Warmth and redness around the affected joints
  • Swelling 
  • Tender to the touch 
  • Morning stiffness
  • Fever
  • Fatigue

In the early stage of RA, the small joints of the body like the fingers or toes are more affected. As the disease progresses, the larger joints become involved like the wrists, knees, ankles, elbows and hips.

How is rheumatoid arthritis diagnosed?

Primarily, RA is identified through a combination of a physical exam, analysis of your health history, x-rays and other imaging tests, and blood work looking for markers that may indicate the presence of the disease.

Physiotherapy Management of Rheumatoid Arthritis

  1. Education about the condition and the key role of interprofessional and collaborative care in the management of RA:
    Managing your Rheumatoid Arthritis requires coordination of care from a variety of health care professionals.

    Your Physiotherapist can help you understand the condition, identify early signs and advise you on how to proceed or where to seek help. For example, they may help connect you to a medical doctor and a rheumatologist (professional that specializes in the care of inflammatory conditions) for specific management of RA. Additionally, these specialty clinics may provide additional resources for the management of the condition. 

    2. Activity modification

    During a flare up, strenuous activity should be avoided and rest becomes the priority. This may include things like lifting, climbing stairs, and even walking can put excessive pressure on the joints. To help, your Physiotherapist may give you strategies to help you manage fatigue, conserve your energy, and prescribe you with a gait aid or other adaptive devices. For example, using a walker or cane to offload the lower body, or installing railings or raised toilet seats.

    3. Therapeutic exercise

    During periods of remission, therapeutic exercises will be used to maintain normal muscle strength and prevent deterioration. The duration, severity, and types of exercise will be determined after a thorough assessment. Your Physiotherapist will uniquely adapt the exercises to an appropriate level for your condition. Overall, these exercises could include range of motion and stretching, aerobic conditioning, and strengthening.

    4. Manual therapy

    Manual therapies like soft tissue release, gentle joint mobilizations, and other massage techniques are useful for relieving pain and swelling and improving flexibility. It is also beneficial for promoting a general feeling of well being and increasing mood, which is often affected in this condition. Thus, it is an important part of the management of RA.

    Where can I find help?

    If you are experiencing difficulties with RA or any kind of joint pain, look for PhysioNow! We have many expert Registered Massage Therapists and Physiotherapists that can help you with your recovery today. With 10 clinics across the GTA from Burlington, Oakville, Mississauga, and Etobicoke, our highly accessible locations are ready to serve you! Book with PhysioNow today for your first assessment and treatment!

    Hand Pain, Physiotherapy, Sports Injuries, Wrist pain

    TFCC Injury and Wrist Pain

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    What is a TFCC (Triangular Fibrocartilage Complex) injury?

    First, the Triangular Fibrocartilage Complex (TFCC) is a critical structure located in the wrist,
    specifically on the side of the pinky finger. It plays a role in stabilizing the wrist joint, particularly during activities that involve gripping or weight-bearing through the hands. It is comprised of a triangular fibrocartilage disc, ligaments, and associated structures. Importantly, the TFCC provides cushioning and stability between the 2 bones at the end of the forearm/beginning of the wrist (the radius and the ulna)

    A closer look at the TFCC

    The TFCC consists of several components, including the triangular fibrocartilage, the ulnar collateral ligament, and the dorsal and palmar radioulnar ligaments. These components work together to stabilize the wrist, absorb shock, and facilitate smooth movement between the radius and ulna. Especially, the complex is important for athletes and individuals who engage in activities requiring repetitive wrist motion or heavy lifting. Namely, it helps to prevent injuries in these high-stress situations.

    How does the TFCC get injured?

    TFCC injuries can occur due to various factors, primarily categorized into traumatic and degenerative causes. Traumatic injuries often result from a fall onto an outstretched hand, direct impact to the wrist, or sudden twisting motions. These injuries are common in sports such as gymnastics, football, and skiing. On the other hand, degenerative injuries, develop over time, often due to repetitive wrist motions or age related wear and tear. Medical conditions such as rheumatoid arthritis can also contribute to the deterioration of the TFCC.

    Symptoms of a TFCC Injury

    Individuals with a TFCC injury typically experience a range of symptoms. This can include but is not limited to:

    • Pain, localized to the ulnar/pinky side of the wrist
    • Worsened by gripping, twisting, or weight-bearing activities on the hand/wrist
    • Swelling around the wrist
    • Decreased range of motion in the wrist
    • A feeling of instability in the wrist joint
    • Clicking or popping sounds when moving the wrist

    How is a TFCC Injury treated?

    Wrist bracing can help reduce pain from a TFCC injury and increase the function in your wrist while it heals

    The treatment for TFCC injuries varies based on the severity and how it was injured. Primarily, conservative options are the first line of defense and often include rest, immobilization in a splint or brace, and physical therapy. Physical therapy goals include improving range of motion, strength, coordination, and a return to sport/activity plan. Pain management may involve the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. In cases where conservative treatments are ineffective, surgical intervention may be necessary. Surgical options can include debridement, repair, or, in severe cases, reconstruction of the TFCC itself.

    Where can I find help?

    In conclusion, a TFCC injury can significantly impact wrist function and quality of life. Early
    intervention with appropriate treatment are the best options. The longer you leave the injury untreated, the trickier it becomes to return to your normal function and activities. Thus, if you are experiencing wrist pain, look for PhysioNow! We have 10 convenient locations across the GTA and many Registered Physical Therapists highly experienced at treating sports injuries. Book with PhysioNow today for your first assessment and treatment!

    Hand Pain, Hand Pain Treatment

    DeQuervain’s Tenosynovitis: Why does my thumb hurt?

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    What is DeQuervain’s Tenosynovitis?

    Diagram showing the 2 inflamed tendons (extensor pollicis brevis and extensor pollicis longus)

    DeQuervain’s tenosynovitis is inflammation involving 2 of the tendons in the thumb and along the side of the wrist. The names of these 2 muscles are the extensor pollicis brevis and the extensor pollicis longus, as depicted above. First, to break down the naming, the Latin name of the thumb is pollex, hence pollicis, while the “extensor” refers to the movement that the muscles create at the thumb, extension! Lastly, brevis and longus refers to how short (or brief!) or long the muscle is with brevis being the shorter and longus the longer. In tenosynovitis, these 2 muscles thicken and swell above their normal side. As a result, the tendons don’t slide as easily and normal mobility of the hand, wrist and thumb become painful.

    Who gets DeQuervain’s Tenosynovitis?

    Usually, this is a repetitive sprain injury so individuals that use their hand and wrists a lot in their daily life or workplace are more susceptible to developing DeQuervain’s. Oftentimes, it is developed in middle aged individuals around 30-50 years old. For example:

    • Women during or after a pregnancy
    • Parents with small children or baby care
    • Job or hobbies that include repetitive grasping or holding

    What are the signs and symptoms?

    Symptoms will vary based on the severity of the injury and may feel different for each individual. Most commonly, people with DeQuervain’s report:

    • Pain at the wrist and thumb
    • Swelling at the thumb and over the wrist
    • Locking, catching, or sticky sensation when moving the thumb
    • Difficulty and pain with thumb and wrist movements, especially twisting, grabbing, and lifting
    • If more severe, pain may go up the forearm as well

    How is it diagnosed?

    A health care professional should examine your hand to determine whether there is DeQuervain’s. First, they will look at your thumb and wrist on the affected side and check for pain, swelling, and impairments in your mobility. Next, a specific test, named the Finkelstein’s test may be used to check for the possibility of DeQuervain’s. Your health care professional will put your thumb into your palm and have you make a fist around it, then bend your wrist towards the pinky side of your hand. Then, a test is considered positive if it recreates your pain at the thumb/wrist and indicates that you may have DeQuervain’s. Additionally, medical imaging like an Ultrasound can show DeQuervain’s.

    How is DeQuervain’s Tenosynovitis treated?

    Physiotherapy Treatment is an effective way to manage and resolve your thumb pain. In the early stages, DeQuervain’s management involves relative rest, bracing or splinting, in order to let the tendon heal and inflammation resolve. A lot of this will involve proper education on when to wear the brace, activities you should avoid or modify, and how to manage your symptoms effectively.

    Once you attend Physiotherapy, they may use treatments such as

    • Manual therapy and massage techniques to help with pain and stiffness
    • Laser and Ultrasound to help with pain and inflammation
    • Electrotherapy for pain relief
    • Custom exercise programs to improve your mobility, strength, and prevent a reoccurring issue
    • Grip retraining
    An example of a thumb mobility exercise called thumb opposition

    Most cases of DeQuervain’s resolve conservatively with Physiotherapy Treatment. Unfortunately, in some cases, the pain becomes chronic and a referral to surgery may be indicated. Next, in this surgery, the tendon sheath is cut to make more room for the irritated tendons, which effectively resolves the symptoms. Additionally, recovery from this surgery is fairly simple and few encounter post-surgical complications.

    Where can I find treatment?

    If you are experiencing DeQuervain’s or any other kind of hand pain, look for PhysioNow! We are a Physiotherapist owned and operated clinic with locations across the GTA. Specifically from Burlington, Oakville, Mississauga, and Etobicoke we have 10 locations to offer our patient’s convenience. Book with us today for your first assessment and treatment with a Physiotherapist!

    Hand Pain, Physiotherapy

    Trigger Finger: Why is my finger locking up?

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    What is trigger finger?

    Trigger finger is a hand condition where the finger can get stuck in a bent position. Afterwards, it may straighten suddenly with a snap. Usually, the fingers most often affected are the ring finger and the thumb, but the condition can affect any finger. Depending on the severity, the locking and popping open of the finger may be quite painful.

    Why does it happen?

    The tendon sheathe becomes swollen and blocks movement.

    Trigger finger happens when the tendon that controls that finger can’t glide smoothly in the sheath that surrounds it. This may occur if part of the tendon sheath becomes swollen or if a small lump forms on the tendon. In many cases, repetitive and prolonged work with the hands such as typing, lifting, and grabbing can increase the risk of developing a trigger finger. The condition is most common in women over the age of 50. Additionally, you may be at higher risk of trigger finger if you have diabetes, low thyroid function or rheumatoid arthritis.

    Symptoms of trigger finger

    Symptoms of trigger finger may progress from mild to severe and include:

    • Finger stiffness, particularly in the morning.
    • A popping or clicking sensation as the finger moves.
    • Tenderness or a bump in the palm at the base of the affected finger.
    • Finger catching in a bent position and suddenly popping straight.
    • Finger completely locked in a bent position and unable to straighten.

    Unfortunately, trigger finger can affect any finger, including the thumb. Not only that, but more than one finger may be affected at a time, and both hands might be involved. Triggering (getting stuck) is usually worse in the morning.

    Treating a trigger finger

    Treatment of trigger finger can include:

    An example of a trigger finger splint by Vive.

    • Splinting

      • Trigger finger splints are designed to keep your finger in a straight position and minimize the amount of movement. This allows the finger to rest and can make the morning stiffness or locking more manageable.

    • Rest

      • Avoid or modify activities that require repetitive gripping, repeated grasping or the prolonged use of vibrating hand-held machinery until your symptoms improve.

    • Physical Therapy

      • Conservative treatment is always the first step. Your physical therapist will give you exercises to help keep the area mobile and strong, perform manual therapy, and use modalities like ultrasound or laser therapy to help your trigger finger.

    • Steroid injections

      • In some cases, an injection can provide an immediate relief in pain and locking. However, the improvements may be temporary so physical therapy should still be done at the same time to ensure a full recovery.

    • Surgery

      • As a last resort and in severe cases, trigger finger surgery can be done to restore the full range of motion in the finger. This is done by increasing the amount of space there is for the tendon to move in by performing a cut in the area. Afterwards, it is important to undergo physical therapy to ensure a full post-surgical recovery.

    Need help?

    If you are experiencing a trigger finger or any other kind of injury, look for PhysioNow! With locations across the GTA from Burlington, Oakville, Mississauga and Etobicoke, our expert physiotherapists are at your service. Book with PhysioNow today for your first assessment and treatment.

    Hand Pain, Hand Pain Treatment

    Thumb Arthritis: Physio 101

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    Anatomy of the 1st CMC Joint

    The 1st Carpo-meta-carpal (CMC) joint is more commonly referred to as the thumb joint. It is located at the base of the thumb between the carpal bones and the metacarpal bones. It is classified as a saddle joint, meaning it allows the thumb to move freely in many directions. As a result of this mobility, you can perform a wide variety of complicated tasks such as opening a jar, pinching an object, writing, and holding differently shape objects.

    What is Thumb Arthritis?

    Arthritis is a general condition that can affect any joint in the body. 1st CMC arthritis is specific to the thumb joint but as seen in the picture above, it may affect the other fingers in a similar presentation.

    The bones that make up the CMC joint are covered in cartilage (tough but flexible tissue) which allows for smooth gliding in a healthy joint. With overuse and age, there eventual wear and tear on the cartilage which can result in the joint space narrowing and pain. Consequently, this increases friction within the space and can damage the joint tissues further. Osteoarthritis is the result of this overuse as the joint space narrows and more inflammation occurs as a result.

    Symptoms of Thumb Arthritis

    • Pain and tenderness at the base of the thumb
    • Inflammation and redness around the base of thumb.
    • Deformity in the shape of joint (dependent on severity)
    • Pain with use
    • Enlarged appearance of the CMC joint
    • Reduction in strength of the joint
    • Increase in pain while grasping (such as opening a jar) or pinching (turning a key)

    Muscles of the Thumb

    There are the group of muscles who covers the CMC joint and helps in different movements of the thumb.

    Flexors group: writing and Pinching grip

    Extensor + abductor group: wider grip like opening a jar

    Role of Physiotherapy in Relieving Thumb Arthritis Pain

    Treatment may include supporting the joint through the use of aids like a soft brace or taping as seen above.

    Physiotherapy plays a vital role in managing CMC arthritis by reducing pain and improving joint function and overall hand strength. Here are some key components of physiotherapy treatment for CMC arthritis:

    1. Pain Management:


      o Therapeutic Modalities: Physiotherapists use various modalities such as ice, heat, ultrasound, and electrical stimulation to reduce pain and inflammation.
      o Manual Therapy: Gentle joint mobilizations and soft tissue techniques can help alleviate pain and improve joint mobility.

    2. Exercises to Improve Function:

      o Range of Motion Exercises: Gentle stretching exercises help maintain and improve the range of motion in the thumb and hand.
      o Strengthening Exercises: Targeted exercises to strengthen the muscles around the thumb and wrist can enhance stability and function. Examples include thumb abduction and opposition exercises using resistance bands or putty.

    3. Splinting and Support:


      o Thumb Splints: Custom-made or prefabricated splints can provide support, reduce pain, and prevent further joint damage. Splints are often worn during activities that worsen symptoms.

    4. Activity Modification:


      o Ergonomic Advice: Physiotherapists provide guidance on modifying daily activities to reduce stress on the CMC joint. This may include using adaptive devices or altering grip techniques.
      o Joint Protection Strategies: Educating patients on techniques to protect the joint, such as avoiding repetitive gripping or pinching, can help manage symptoms and prevent further damage.

    5. Education and Self-Management:


      o Patient Education: Understanding the condition and its management is crucial. Physiotherapists educate patients about self-care, treatment options, and the expected outcomes.
      o Home Exercise Programs: Tailored home exercise programs empower patients to take an active role in their treatment, promoting long-term management and symptom relief.

    Preventing Arthritis

    While it may not be possible to completely prevent CMC arthritis, certain strategies can reduce the risk and delay its onset:

    • Ergonomic Adjustments: Use tools and devices designed to reduce stress on the thumb joint during activities.
    • Strengthening and Stretching: Regular exercises to maintain thumb and hand strength and flexibility.
    • Activity Modification: Avoid repetitive stress on the thumb joint by varying activities and using proper techniques.

    Need more help?

    CMC arthritis can significantly impact hand function, but physiotherapy offers a range of effective treatments to manage symptoms and improve your quality of life. If you are experiencing symptoms of CMC arthritis or any other type, look for PhysioNow! We have many expert Physiotherapists that can support your recovery. Book with PhysioNow today for your first assessment and treatment.