Do you have pain in your hands typing on the keyboard at work?
Do you have pain in your hand or wrist when opening and closing jars?
Do you feel you have less strength in your hands when performing everyday manual tasks?
Hand and wrist arthritis may be the cause of your problem.
What is arthritis?? I hear you ask…
Arthritis is a very common degenerative condition that can form in the joints of your body as you get older.
It causes wearing away of the cartilage in the joint, which is the shock absorbing material between the bones. This can result in inflammation of the synovial lining in the joint. This is significant as this lining is responsible for producing synovial fluid, which helps protect and lubricate the joint.
What are the common signs and symptoms of hand and wrist arthritis?
If you have arthritis in the wrist and hands you may experience some of the following signs and symptoms:
- Loss of movement in the joints of the wrist and hand.
- You might notice grinding or cracking noises with joint movement.
- Pain in the joint may come and go. It can become worse with gripping objects or repetitive wrist and finger movement. As the arthritis progresses it may develop into a constant ache, even at rest.
- The joints may swell and can become tender to touch.
- The joints may appear to be misshaped or deformed.
How can we solve the problem?
Mild symptoms associated with arthritis can be treated effectively by oral anti-inflammatories and physiotherapy. Physiotherapy would involve soft tissue massage to relieve muscle tightness around arthritic joints. Specific exercises can be prescribed for the joints to help improve and maintain range of motion and strength. Additionally, a physiotherapist could provide a splint or support to help protect the joints whilst performing everyday tasks.
In more severe cases of wrist and hand cortisone injections or surgery may be indicated. Surgery is considered when conservative management, no longer eases the pain, or when deformity prevents normal use of the hand. Surgery is also recommended in some patients with inflammatory arthritis. In these patients, the surgery stabilizes joints and prevents tendon damage. Deformity, loss of motion and pain that is not adequately controlled are the main reasons for surgery.
The small bones in our wrist form one side of a tunnel and a ligament (or retinaculum to more specific) forms the other side. In this tunnel, called the Carpel Tunnel sit many tendons which are used for gripping and bending the wrist into flexion. The median nerve also sits in this tunnel. There is only a certain amount of space in the tunnel. If the tendons get irritated by overuse they will naturally swell and increase the pressure within the tunnel and compress the median nerve. Other reasons why pressure within the tunnel can increase can be the effects of pregnancy.
Symptoms include burning wrist pain on the palm side with numbness and pins and needles in the distribution of the Median Nerve. That is the thumb, index finger, middle finger and thumb side of the ring finger. Nocturnal pins and needles is common. Pain can radiate to the forearm, elbow and shoulder. Diagnosis is achieved through history taking and holding the wrist in prolonged flexion to reproduce symptoms. Tinsel’s sign can also help reach a diagnosis. This test comprises of repetitively tapping over the wrist on the palm side where the Median Nerve passes to reproduce symptoms.
Mild cases can be treated effectively with anti-inflammatories and physiotherapy. A Physiotherapist will release the tension from the muscles and tendons that flex the wrist and fingers and provide stretches for a patient to do. Additionally a physiotherapist will provide a splint which keeps the wrist in a neutral position for the irritated Median Nerve to settle. For more severe cases simple surgery to create more space in the tunnel can be done.
According to recent survey’s, 81% of Australians use a smartphone. This jumps to 96% in 18-34 year olds, with 79% of them checking their phone as soon as they wake up. In fact, 23% of people spend more time on their smartphone or tablet than talking to their partner or friends. The average person will spend between 2-4hrs a day on their mobile device, checking it over 200 times a day and adding up to almost 1000hrs of smartphone usage in a year.
With smartphones playing such a large role in our lives, it is unsurprising that many people can experience episodes of pain following their use. One of the most common injuries is texting thumb, or De Quervain syndrome as discussed in one of the earlier blogs. This is caused by the repetitive strain placed on the tendons around your thumb while texting, leading to areas of irritation and inflammation.
Common symptoms can include:
- pain at the thumb or wrist
- reduced grip strength
- reduced movement
So how can you manage your pain? Regular stretches and icing the thumb and wrist can help reduce post-texting pain. You can also try using other fingers to text, scroll or email. If this fails, a review by your physio may be necessary as in severe cases a splint or taping to support the joint may be necessary.
However, the most effective treatment is to spend less time on your smartphone and talking to your friends or partner. Even checking your phone only 100 times a day can reduce the time spent on your device by 500hrs over the course of the year. Imagine what you could do with all that free time!
The wrist is a complex joint involving the articulation between 8 small carpal bones, the 2 bones of the forearm (ulna and radius) and your 5 key hand bones (metacarpals). The wrist has multiple ligaments to aid stability around each of these boney articulations. The complex nature of these articulations is what enables us to have such flexibility and combined movement options of the wrist, but of course this also means that this complex is prone to injury.
There are multiple tendons around this region involved in moving our wrist, fingers and thumb at differing joint levels. These tendons can become inflamed and painful with overuse use injuries or repetitive tasks – one example being DeQuirvain’s syndrome at the base of the thumb.
Our three main upper limb nerves (median, ulna and radial) run through the wrist complex under a thick ligamentous type structure called our retinaculum. As a result these can also be a source of wrist pain or tingling symptoms in the fingers/hand. The most common being carpal tunnel syndrome – compression/irritation of the median nerve.
In addition we have a wedge of triangular cartilage on the outside of the wrist, under the ulna (forearm bone) to aid our load bearing and wrist stability. This is called our TFCC (triangular fibrocartillage complex) – this too can become a source of pain or dysfunction in the wrist, leading to nonspecific pain around the outside of the wrist and hand and/or clicking. This can occur as a result of a traumatic incident or just gradual overuse.
Pain & Management: Wrist pain can occur as a result of direct trauma, sudden overuse or gradual wear. Treatment varies depending upon diagnosis but may include relative rest with use of a splint or taping, massage of any overused muscles and specific rehabilitative exercises.
If unsure regarding the cause of your wrist pain book an appointment with your physiotherapist to fully assess these structures and guide you regarding the correct management.