Wrist and Hand
The wrist and hand are incredibly sophisticated joints. Our bi-pedalism means we do not need these structures for support and we are freed up for the intricate activities which so often contribute to our high-level of creativity. Whether we are painting, cooking or playing a musical instrument it is our hands that allow us to participate in these past times. However our high dependence on our hands makes it a challenge to prevent the over-use of these joints and to maintain healthy, pain free functioning.
The wrist is comprised of three bones. The lower end of the radius (bone in line with the thumb) and the ulna (in line with the 5th finger) form the curve that fits a series of 4 bones called the first row of the carpus. This design allows for a high degree of movement however it is not very stable. The wrist’s lack of bony stability means it is at a higher risk for arthritis however sprains to the ligaments and over-stressing muscles and tendons are also common causes of pain.
The bones of the wrist can be fractured when you fall. As we fall it is natural to reach out to brace ourself, causing this injury to be one of the most common on an icy winter day.
Although there is not much actual muscle support around the wrist joint there are quite a few tendons on both the front and back of the joint and these tendons can be strained from over-use. The ligaments extending from the lower aspect of the forearm to the upper carpal bones can also be a source of pain if over-strained.
The hand is comprised of 8 bones in the two rows of the carpus as well as 14 bones in the fingers. There are ligaments spanning between each bone and muscles that may traverse only a short distance or begin above the elbow and extend to the end of our fingertips.
The stability of the hand is highly dependent on its shape. Anatomists borrow the architectural term “keystone” to describe the shape and to help to explain its stability. This shape is considered one of the most stable in architectural design.
Injuries can occur to any structure however some of the most common conditions are over-stressing the thumb joint to cause arthritis or injuring a tendon to cause De Quervain’s tendonitis. Pain can be caused by a strain to the muscles in the hand or to any of the ligaments between each of the bones.
At The Orthopaedic Therapy Clinic your therapist will partner with you to determine the best course of treatment for your injury. When you are having symptoms the most important first step is to understand what you have. Your therapist will provide a thorough assessment to determine whether your symptoms are caused by the joint, ligament, muscles or are referred from other structures such as the neck.
Once the injury is diagnosed the next step is to determine where you are in the recovery sequence. Treatment is predominately determined by your stage of healing as more acute injuries usually require a plan to reduce pain and inflammation. Sometimes braces are needed to let the area rest at night or for support while at work. When required we will help you to determine the best type of support to protect the injury as you recover.
As you continue to heal then focus of your therapy shifts to the restoration of flexibility, rebuilding strength and re-establishing normal, coordinated movement patterns. The final stage is to determine a strategy to help you return to full activity and sport. An analysis of your ergonomic set-up can be an important part of your long-term prevention strategy.
Our therapists are experienced in the treatment of both acute and chronic wrist and hand condition. We have extensive experience in the treatment and prevention of repetitive strain injuries. We work with clients after surgical repair of fractures i.e. Colles fracture. We provide therapy after tendon repairs and joint dislocations both in non-operative and post-operative conditions.