Physiotherapy and rehabilitation
Here we present the most common wrist injuries. Every wrist pathology or injury has a description of general features, the cause of the injury, the characteristics of the symptoms, diagnostics, and the course of treatment.
Carpal tunnel syndrome is the most common entrapment neuropathy and also the most common overuse injury of the wrist. The carpal tunnel is a narrow passage in the wrist, bounded on the upper side by eight carpal bones and on the lower side by the transverse carpal ligament; the tendons of the wrist flexor muscles (nine tendons) and the median nerve, which innervates the first three fingers and half of the ring finger, pass through the carpal tunnel. Inflammation of the tendons of the wrist flexor muscles leads to compression of the median nerve in the carpal tunnel area. The carpal tunnel is most often injured due to overuse of the flexor muscle.
Carpal tunnel syndrome most often occurs in middle-aged women and generally in office workers, as frequent typing and computer mouse use cause overuse of the wrist flexor muscles. The most common causes of carpal tunnel syndrome are repetitive, monotonous wrist movements, hormonal changes during and after pregnancy in women, traumatic wrist injuries, changes during menopause in women, and various diseases (rheumatoid arthritis, diabetes, thyroid disease, etc.).
The initial symptoms of carpal tunnel syndrome are tingling, numbness, and altered sensation in all fingers on the hand except in the little finger. Tingling and numbness in the palm or fingers are more common at night, which can disrupt sleep patterns. Towards morning, numbness of the fingers and a feeling of a swollen palm are typical. Carpal tunnel syndrome is also typically accompanied by a decrease in muscle strength and occasional dropping of objects from the hands. Gradually, difficulties may arise during various everyday activities, such as housework, screwing, lifting heavy objects, cycling, using a computer mouse, etc.
The diagnosis of carpal tunnel syndrome is made neurophysiological EMG test, which assesses the conductivity of the median nerve or the degree of narrowing of the carpal tunnel. In early stages of carpal tunnel syndrome, conservative treatment with physical therapy and specialised exercises is recommended to improve mobility of the carpal tunnel and eliminate asymmetries in the strength and activation of forearm and wrist muscles.
During conservative treatment, it is recommended to wear a splint and avoid repetitive wrist movements over a long period of time, and we also advise the use of an ergonomic office mouse. If non-surgical treatment of carpal tunnel with physical therapy is not effective or the pathology is already in an advanced stage, surgical treatment is the best choice for the patient.
of the is a routine procedure with a good prognosis for treatment results. After surgery, the arm is placed in a splint, which is usually removed after three days. Shortly after the procedure, the patient starts finger mobility exercises until pain is felt; after three days, the patient begins more intensive exercises to strengthen the finger muscles and improve mobility. Three weeks after surgery, the hand should be ready for lighter everyday chores; with an appropriate rehabilitation training programme, the hand is ready for more difficult physical activities and sports after a month. Reduced strength in fingers, occasional tingling, and a painful scar may be present for several months after the procedure and gradually resolve over a period of up to one year.
– Wear a splint and avoid repetitive wrist movements over a long period of time, and we also advise the use of an ergonomic office mouse.
– In early stages of carpal tunnel syndrome, conservative treatment with physical therapy and specialised exercises is recommended to improve mobility of the carpal tunnel and eliminate asymmetries in the strength and activation of forearm and wrist muscles.
Wrist instability is a pathological condition characterised by the loss of normal wrist function due to an incorrect position of the carpal bones and/or the radioulnar joint. Wrist instability is characterised over a longer period of time by limitations in range of motion and mobility; if the condition is not treated with appropriate training rehabilitation, the patient is at risk for degenerative radiocarpal or intercarpal arthritis, chronic pain, and permanent palm dysfunction.
The cause of a wrist instability is often a previous traumatic injury, which causes changes in the ligamentous structure of the wrist and associated microinjuries to the connective tissue. Chronically weakened wrist ligaments lead to problems with joint stability. Degenerative lesions of the wrist joints are a common cause of wrist instability, occurring primarily in the older age group; specifically, these are usually rheumatoid arthritis or osteoarthritis. Wrist instability is more common in younger and middle-aged populations, as it is most often the result of excessive sports activity, falls, impacts, and fractures, which are generally more typical of active individuals.
As many as 25% of all wrist injuries remain undiagnosed or are diagnosed too late, when symptoms of instability or degeneration have already developed, which significantly reduces the chances of successful conservative treatment. The wrist is the most complex joint in the human body, and instability can be caused by damage to numerous ligaments, resulting in non-specific symptoms.
The most common symptoms of wrist instability are a feeling of weakness in the wrist when under load, limited mobility of the joint and severe pain in the final amplitudes of movements, pain deep in the wrist, popping and clicking sounds when moving the wrist, and limited ability to perform wrist rotations. There are four types of wrist instability, specifically: dorsiflexed intercalated segment instability (DISI), volarflexed intercalated segment instability (VISI), ulnar translocation (UT), and dorsal translocation (DT).
When experiencing functional anomalies in the wrist joint, it is important to promptly perform diagnostics with magnetic resonance imaging (MRI), which provides us with precise parameters of damage within the joint tissues. Most wrist injuries are treated conservatively with physical therapy and exercises to correct asymmetrical and atrophied muscle groups. Joint mobility is improved with specialised kinesiotherapy exercises. In the initial phase of conservative treatment of wrist instability, immobilisation is applied, and anti-inflammatory medications may be used with therapeutic techniques to promote healing.
There is no one specific surgical treatment for wrist instability; it depends primarily on the type of wrist instability and the degree of damage to the ligaments or wrist bones. The type of surgical procedure is suggested based on the functional limitations of the wrist, the risk of arthrosis, and the self-healing potential of wrist ligaments. If 80% of the mobility and strength of the wrist joint is preserved, surgical treatment is rarely performed; in cases of ligament rupture that causes greater limitations, surgical fixation of the damaged segment is performed. Postoperative rehabilitation is aimed at gaining range of motion and strength in the wrist; in the initial phase, exercises are mainly isometric, and the patient progressively begins performing complex wrist movements. The timeline for postoperative rehabilitation varies depending on the specifics of the injury.
– It is important to promptly perform diagnostics with magnetic resonance imaging (MRI), which provides us with precise parameters of damage within the joint tissues.
– In the initial phase of conservative treatment of wrist instability, immobilisation is applied, and anti-inflammatory medications may be used with therapeutic techniques to promote healing.
– If 80% of the mobility and strength of the wrist joint is preserved, surgical treatment is rarely performed; in cases of ligament rupture that causes greater limitations, surgical fixation of the damaged segment is performed.
