Acute injuries to the hand and wrist are common with up to 25% of sporting injuries involving the hand and wrist. In sport, these injuries can result in a long time away from training or playing. In addition to sport, we use our hands for a huge number of activities of daily living, hobbies and work duties. Therefore this is an extremely important area of the body and injuries should be managed appropriately. When injuries do not heal properly, then they can become a long term problem – leading to deformity, persistent pain and poorer outcomes. Ongoing pain and disability can take a large toll on quality of life, sporting participation and work. Management of acute hand and wrist injuries by a qualified physiotherapist can help you to improve your recovery, making a quicker return to function.
COMMON ACUTE INJURIES TO FINGER, HANDS AND WRISTS INCLUDE:
- Finger and wrist ligament injuries
- Skier’s thumb
- Volar plate injuries
- Finger, hand and wrist fracture
- Tendon rupture
- Mallet finger
- Swan neck or Boutonniere deformities
Jessica was a young woman who presented to Southside Physio with wrist pain and difficulty gripping objects after a fall onto her outstretched hand. Through careful assessment of her wrist, she was thought to have a low-grade sprain of a ligament in her wrist. Using a brace and by modifying her activities at work, her pain quickly settled. We then worked together towards restoring full range of motion and strength and gradually increasing her workload. After just a few weeks, she had made a full recovery as was discharged from physiotherapy.
TREATMENT OF ACUTE CONDITIONS
Physiotherapists can offer a range of treatment options to help your recovery from acute finger, hand or wrist injuries. Treatments we offer include:
- Thermoplastic splinting and immobilisation
- Swelling management
- Scar management
- Range of motion exercises
- Strength exercises
- Return to work/sport programs
After hand or wrist injury, often a period of relative rest and immobilisation is indicated, like in Jessica’s case. Relative rest is different from absolute rest in that we aim to preserve joint movement and muscle strength in surrounding joints or tissues. Management of swelling can be very important in the early days after injury as excess swelling can cause the joints of your fingers and wrist to become stiff. The early stages of recovery can be difficult as we normally use our hands for many different tasks both at home and at work. It is important to discuss all these activities with your physiotherapist to decide on alternatives to avoid further harm. For more information on how to manage acute injuries, please see our PEACE and LOVE Blog Here.
When sufficient healing has occurred following your injury, the next stage of recovery is to regain function. We aim to restore range of motion, muscle strength and neuromuscular control through targeted and progressive exercises. There are numerous treatments available including the use of specialised equipment such as putty, rice and hammers.
It is important to consider returning to activities such as work, sport, hobbies or household tasks as part of your rehabilitation. Often a graded return to these is needed to ensure that your body can handle the increased load. In Jessica’s case, her symptoms may have been easily aggravated again if she had undertaken too much activity too soon.
It is important to complete a thorough rehabilitation program as research shows that one of the greatest risks of injury is previous injury. Like in other areas of the body, we commonly see people who have neglected aspects of their rehabilitation and subsequently re-injured their hand or wrist. Other risk factors should be identified and managed as best as possible. This may include arrangements at work or addressing technique errors in your sport. Finally, maintaining function and injury prevention are key elements of a successful recovery.
The other category of hand and wrist injuries is chronic injuries. Unlike acute injuries, these can develop slowly over time and take longer to improve, which will need a different physiotherapy treatment approach. Often chronic hand conditions develop after an increased change in load. Some examples of this could be spending a whole weekend pruning in the garden, starting a new DIY project involving hammering, or even repetitive lifting and carrying of a newborn many times a day. Chronic hand conditions can also develop after an acute injury, where the strength, mobility or control hasn’t returned back to normal. An example of this is when a footballer dislocates their thumb during a tackle, and the thumb remains stiff and doesn’t regain proper strength. Consequently, the tendons or other structures are forced to compensate for a weakened or stiff thumb joint. Chronic hand conditions can also develop over a long period of time. Someone who has spent their whole life doing a very manual job or hobby may develop pain slowly and cause problems after a long time of repetitive use.
There is a very wide range of chronic hand conditions that physiotherapists can treat. Some commonly seen conditions are as follows:
· TENDINOPATHY AND TENOSYNOVITIS
Change in loading or repetitive activity can stress the tendons in the hand, and as a response they start to undergo changes in an attempt to adapt. Occasionally this can cause inflammation in the tendon and surrounding structures. Most commonly, it causes a degeneration of the collagen protein in the tendon, resulting in a gradual increase in pain during and after activity. This commonly occurs in the base of the thumb and the wrist.
· FINGER/THUMB/WRIST ARTHRITIS
Like other joints in the body, Osteoarthritis can develop in joints of the hand. It is quite common with a prevalence of 41.4% of those >50 years of age3. Cartilage within a joint normally assists in the smooth movement of the joint. When there has been a lot of pressure put through the joint, it can start to break down the amount of cartilage and start to cause stiffness, swelling and pain. This commonly affects the base of the thumb and the wrist. Rheumatoid Arthritis also affects the hand, where a break down in cartilage is caused by an autoimmune inflammatory response, which results in inflammation in various joints such as the fingers.
· CARPAL TUNNEL SYNDROME
A very well known condition that affects the wrist is Carpal Tunnel Syndrome. The term can be used to describe a range of different symptoms affecting the front of the wrist where the carpal tunnel is located. Tendons, nerves and blood vessels pass through the carpal tunnel to supply the hand, and if there is inflammation or something else taking up space, it can cause pain, pins and needles or numbness in the hand and wrist. This is commonly due to repetitive flexion of the wrist and fingers.
TREATMENT OF CHRONIC CONDITIONS
Physiotherapists can offer a range of treatment options to help decrease pain and dysfunction from Chronic hand conditions. Treatments we offer include:
- Activity modification education
- Pain management education
- Strength and control exercises
- Manual therapy
- Assistive devices prescription
The aims of physiotherapy treatment are to decrease pain, improve function and prevent the reoccurrence of these injuries. Treatment will almost always include education on self- management techniques to manage your symptoms such as using heat, wearing compression garments or using taping. Treatment also includes modifying or ceasing certain activities to prevent the specific structures affected being aggravated. This can also include providing assistive devices such as braces or splints when activity modification isn’t possible or effective. We can also provide gentle mobilisation and soft tissue therapy to the structures effected to provide short-term relief. You will also be provided with exercises to strengthen or mobilise specific joints if indicated to improve movement and technique.
Each acute and chronic condition presents differently and will need a unique approach. Our physiotherapists can perform an assessment to tailor treatment to your specific injury, lifestyle and goals. If you have sustained a finger, hand or wrist injury or you’ve been experiencing pain or dysfunction, please call our clinic or book online to arrange an appointment with either Marlo or Lizzy at Southside Physiotherapy Woden.
Phone: (02) 6282 5010
Book Online with Lizzy or Marlo at our Woden Clinic
 Rosenbaum, Y. and Awan, H., 2017. Acute hand injuries in athletes. The Physician and Sportsmedicine, pp.1-8.
 Bahr, R. and Holme, I., 2003. Risk factors for sports injuries- a methodological approach. British Journal of Sports Medicine, pp. 384-392.
3 Eaton, C. B., Schaefer, L. F., Duryea, J., Driban, J. B., Lo, G. H., Roberts, M. B., … & McAlindon, T. (2022). Prevalence, Incidence, and Progression of Radiographic and Symptomatic Hand Osteoarthritis: The Osteoarthritis Initiative. Arthritis & Rheumatology, 74(6), 992-1000.