Can Physical Therapy Help My Wrist?

ACUTE AND CHRONIC WRIST INJURIES NEED A LITTLE HELP TOO

Most humans are born with hands that we use constantly throughout the day. While the fingers may be the star of the dexterity show, the wrist is the supporting actor that helps to position the hands precisely where you need them to do their jobs. Because of its important role in hand function, you can imagine the muscles, tendons, ligaments, and bones of the wrist take on a lot of stress. Sometimes that stress can become too much for tissues to adapt to, leading to symptoms of pain, numbness, tingling and discomfort. 

Whether you are a new parent holding an infant, a graduate student burning the midnight oil at your keyboard or a gymnast handstand walking across the gym, chronic wrist conditions can put a real damper on performance. While the wait and see approach might lead to resolution in some instances, there is no reason to live with chronic wrist pain or discomfort. Just as knees, backs and necks sometimes need physical therapy, the wrist responds very well to physical therapy treatment. 

We now know that PTs can help improve chronic wrist symptoms, but what about an acute injury? In physical therapy school they teach us a term called FOOSH. You may have no idea what it stands for but I have no doubt you have done it before. In fact you’ve probably done it almost every time you’ve fallen. FOOSH stands for fall on an outstretched hand--the automatic protective reflex we all have to extend our arms out in front of us to break a fall. While this action often protects our heads, chests and other body parts from the trauma of a fall, the quick transfer of force through the hand and forearm can cause sprains and fractures of the wrist. Trauma to the wrist can occur from a fall, from a workplace or sports injury. In severe cases surgery may be needed but in all cases physical therapy can help to support the healing tissues and facilitate the return of normal strength, stability and mobility of the wrist. 

A CLOSER LOOK AT WRIST SPRAINS AND FRACTURES

The wrist includes the two bones of the forearm called the radius and ulna which allow for supination and pronation--movements that translate the hand from a palm up to a palm down position and back. It also includes two rows of four small carpal bones at the base of the hand. The position of these joints allow for flexion and extension of the wrist up and down and what is called radial and ulnar deviation that bend the wrist to the left and right. At the base of the thumb is a special joint called a saddle joint where the long metacarpal bone of the hand meets the carpal bones of the wrist and it allows for multiplanar movement of the thumb. 

A fall or sudden impact can cause a fracture to the bone or a sprain of the ligaments supporting the bones. When a fracture occurs, if the alignment of the bones remains intact, splinting or casting may be enough to allow the bones to heal. If the bone fragments are out of place then surgical fixation may be necessary to ensure proper healing. 

During the initial phases of healing the wrist itself will likely be immobilized. If it is a sprain, the duration of immobilization will depend on the severity of the sprain and how many fibers are torn (Grade I, II or III sprain).  Once the bone or ligaments have healed sufficiently the cast or splint will be removed. Joint stiffness, muscle weakness and atrophy are common after immobilization but restoring full function of the wrist is essential to resuming normal activities and preventing the development of chronic injuries that may result from persisting strength or flexibility impairments. 

Your physical therapist will assess the strength of wrist muscles including grip strength. They will measure your wrist range of motion and assess for residual pain and swelling. Modalities such as ultrasound, electrical stimulation, dry needling or ice may be used initially to manage pain and swelling and to promote tissue healing. Manual therapy techniques such as joint or soft tissue mobilization may be applied by your therapist with his or her hands to gently improve the flexibility and movement of joint and soft tissue structures. 

You will also be given a series of graded exercises such as stretches to restore flexibility of the wrist. Progressive resistance exercises with bands, putty or dumbbells, for example, will help increase the strength of the wrist muscles. Later in your rehabilitation you will perform functional exercises specific to the tasks you do in your daily life such as weight bearing through the hands, manipulating tools or performing certain sports drills to prepare you for return to full activity.

WHAT ABOUT THOSE CHRONIC CONDITIONS?

Repetitive use injuries are fairly common in the wrist. Poor biomechanics or lack of sufficient strength and flexibility are often major contributing factors. While the mechanism of injury may be different, the treatment for chronic wrist conditions contains many of the same elements outlined above. Manual therapy techniques and modalities may be used to manage pain and inflammation in early stages. Special care will be taken to address strength and flexibility issues at the wrist but also in the hand, elbow and shoulder and you will learn about how to optimize your movement patterns to lessen the stress and strain on the wrist structures. 

Below you will find a list of some common wrist conditions that physical therapists often treat:

Carpal Tunnel: caused by compression of the median nerve at the wrist. Symptoms include pain, numbness and weakness in the wrist and hand. Surgical intervention may be needed in addition to PT in severe cases. Jobs that require repetitive movements of the wrist or fingers, awkward positioning of the hands or mechanical stress on the palm of the hand put you at risk for Carpal Tunnel Syndrome. 

DeQuervain’s Tenosynovitis: pain and inflammation in the tendons that run from the wrist to the thumb. This condition is caused by repeated wrist or hand movements. Sometimes called “mother’s thumb” because it is common in parents who are holding infants for long periods of time. 

Tendinopathies/tendonitis: any repetitive wrist motion can cause irritation and inflammation of one of the many tendons that cross the wrist. Often biomechanical or movement errors, muscle strength and length asymmetries or insufficiencies are an underlying cause. Pain is usually described as a dull ache that can interfere with your activities. Tenderness, mild swelling and general weakness may also be present.

LET US HELP YOU GET ON THE ROAD TO HEALING 

Physical therapy is an excellent treatment option for acute and chronic wrist pain and injuries. Through a thorough assessment and evaluation, a physical therapist at Evolve can get to the root of your problem and develop a plan of care that will not only treat your symptoms but help prevent future injuries. 

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About EvolveNY-

Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!

First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.

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