Physiotherapy and rehabilitation
We will present the most common wrist injuries in detail. Every pathology or wrist injury comes with a description of general facts, causes that led to the development of the injury, characteristics of the symptoms, diagnosis, and the course of treatment.
Carpal tunnel syndrome of the wrist is the most common entrapment neuropathy and at the same time the most common overuse injury of the wrist. The carpal tunnel is a narrow passageway in the wrist, limited by eight wrist bones on the upper side and a transverse carpal ligament on the bottom side. Flexor muscle tendons of the wrist (9 tendons) and the median nerve that innervates the first three fingers and half of the ring finger, run through it. When the tendons of flexor muscles in the wrist become inflamed, they start pressing on the median nerve in the wrist passageway. The carpal tunnel is most often injured due to the overuse of flexor muscle.
Carpal tunnel syndrome appears most often among middle-aged women and generally among office workers since frequent typing and the use of the computer mouse overburden flexor muscles of the wrist. The reason for the development of carpal tunnel syndrome are most often unvaried repetitive movements of the wrist, hormonal changes among women during pregnancy and after it, traumatic wrist injuries, changes among women during menopause, and various diseases (rheumatoid arthritis, diabetes, thyroid disease, etc.).
The initial symptoms of carpal tunnel syndrome include tingling, prickling, and a change of sensation in all the fingers of the hand except for the little finger. The tingling and the prickling sensation of the hand or the fingers occur most often at night, which can disrupt sleep.
Towards the morning, it is common to observe numbness of the fingers and the feeling of a swollen palm. Carpal tunnel syndrome is also typically accompanied by decreasing muscle strength and occasional dropping of items. Gradually, difficulties in carrying out various daily tasks may appear, for example, house chores, using a screwdriver, lifting heavy objects, cycling, the use of a computer mouse, etc.
The diagnosis of carpal tunnel syndrome is confirmed by a neurophysiological test EMG that measures the conduction of the median nerve or the degree of wrist passageway narrowing. In the initial phases of carpal tunnel syndrome, conservative treatment is suggested with physical therapy and special exercises that aim to improve the mobility of the wrist tunnel and eliminate asymmetry in strength and the activation of muscles of the forearm and wrist.
It is recommended to wear a brace and avoid repetitive movements of the wrist during conservative treatment. We also recommend you use an ergonomic mouse for the office. If nonsurgical treatment of carpal tunnel using physical therapy is not effective or the pathology is already at an advanced stage, then surgical treatment is the best choice for the patient.
Surgical treatment of carpal tunnel is a routine procedure with a good prognosis on the effects of treatment. After the surgical procedure, the arm is secured in a brace that is usually removed after three days. Soon after surgery, the fingers are carefully therapeutically stretched until pain is felt. After three days, the patient begins with more intense exercises to strengthen the muscles of the fingers and stretching. Three weeks after the surgical procedure, the arm should be prepared for easier everyday tasks. For more difficult physical activities and sports, the arm should be prepared after a month of an adequate rehabilitation exercise programme. Symptoms such as decreased strength of the fingers, occasional tingling, and a painful scar can be present even for multiple months after the procedure and should gradually go away in a period of up to one year.
Wear a brace and avoid repetitive movements of the wrist for a long period of time. We also recommend you use an ergonomic mouse for the office.
In the initial phases of carpal tunnel syndrome, conservative treatment is suggested with physical therapy and special exercises that aim to improve the mobility of the wrist tunnel and eliminate asymmetry in strength and the activation of muscles of the forearm and wrist.
Wrist instability is a pathological condition characterised by the loss of normal wrist function due to the incorrect position of wrist bones and/or radioulnar joint. Over a longer period, limitations of movement and mobility are typical of unstable wrists. Unless the condition is treated with adequate exercise rehabilitation, the patient bears the risk of developing radiocarpal or intercarpal degenerative arthritis, chronic pain, and permanent dysfunction of the hand.
The cause of wrist instability is oftentimes a former traumatic injury that causes changes in the ligament structure of the wrist and associated micro-injuries of the connective tissue. Chronic ligament weakness of the wrist leads to issues with joint stability. A common cause of wrist instability are also degenerative lesions of wrist joints that mostly appear amongst the older population, such are usually rheumatoid arthritis or osteoarthritis. The instability of the wrist joint is more common among the young and the middle-aged age groups, because it is most often a consequence of overexercising, falling, hitting the arm, and suffering fractures, all of which are generally more typical of active individuals.
25% of all wrist injuries remain undiagnosed or are diagnosed too late when the symptoms of instability or degeneration have already developed, which significantly reduces the chances of successful conservative management. The wrist is the most complex joint of the human body, the instability can therefore cause damage to many ligaments and the symptoms are consequently nonspecific.
The most common symptoms of wrist instability are a sense of weakness inside the wrist when putting a strain on it, limited movement of the joint and severe pain during final amplitudes of movement, pain deep in the wrist, clicking and popping sounds when moving the wrist and limited ability to rotate the wrist. There are 4 types of wrist instability: dorsal intercalated segment instability (DISI), volar intercalated segment instability (VISI), ulnar translocation (UT), and dorsal translocation (DT).
If we notice functional anomalies in the wrist joint, it is important to have magnetic resonance imaging (MRI) performed promptly, as it provides the exact parameters about injuries inside the joint tissues. Most wrist injuries are treated conservatively with physical therapy and exercises for the correction of asymmetrical and atrophied groups of muscles. The mobility of the joint is improved using special exercises from the field of kinesiotherapy. During the initial phase of conservative treatment of wrist joint instability, immobilisation is applied. It is possible to use anti-inflammatory medication along with therapeutic techniques to promote healing.
There is no one specific surgical treatment for the instability of the wrist joint, instead, it mostly depends on the type of wrist instability and the severity of ligament or wrist bone damage. The type of surgical procedure is suggested according to the functional limitations of the wrist, the risk of developing arthrosis, and the self-healing potential of wrist ligaments.
If 80% of mobility and strength of the wrist joint is preserved, then surgical intervention is rare. When ligaments are torn and cause greater limitations, surgical fixation of the affected segment is carried out. Post-surgical rehabilitation aims to regain the former extent of movement and strength of the wrist. In the initial phase, the exercises are predominantly of the isometric type as the patient begins to improve the performance of complex wrist movements. The timeline of post-surgical rehabilitation varies according to the injury specifics.
