Elbow/Wrist/Hand

Physical Therapy for Elbow Wrist and Hand

Your arms and hands play a vital role in your daily living activities. Think of your morning routine as an example; brushing your teeth, combing your hair, eating breakfast, dressing up, driving a car, and so on. It is easier to neglect how useful your arms are until you're in pain and unable to carry out these menial tasks without discomfort or impairment.

Let's discuss some common causes of dysfunction in your elbows, wrists, and hands, following up with rehabilitation and prevention strategies provided by Truwell Physical Therapy, to improve your physical and social well-being.

But first, here's a brief description of the above-mentioned joints.
By size, your elbow and wrist joints are considered intermediate while the hand consists of several small joints. The elbow moves in one plane, much similar to the knee. Two bones in the forearm move over each other, allowing for the "turning over" movement of your hand (i.e., palm up and palm down). The wrist joint connects forearm to hand. It is highly functional and allows your hands to perform precise movements. The palm and fingers collectively form your hand. There are 27 joints in your hand, that are reinforced by over 100 ligaments and tendons, and 34 muscles. Due to its complex structure, surgical intervention for the hand is avoided as much as possible (i.e., conservative treatment is highly preferred).

What to expect in Physical Therapy Rehabilitation for the Elbow Wrist or Hand
The need for physical therapy may arise from musculoskeletal injuries, chronic conditions, or post-surgical rehab. A common underlying cause of pain is inflammation, which is settled with rest and cryotherapy. You may have to wear a splint for a while, to avoid worsening the condition. Joint splinting is accompanied by manual physical therapy, therapeutic exercises, and electrotherapy to preserve joint function and prevent it from freezing into place.

Conditions affecting Elbow, Wrist, or Hand that require Physiotherapeutic Rehab:

Arthritis

It is an inflammatory condition resulting from injury, old age, or auto-immune disorders, leading to the degeneration of joint structures including cartilage and bone ends. It causes pain, stiffness, and crepitus (crackling noise). The condition worsens with time, as the cartilage has a minute blood supply. The condition is managed via lifestyle modifications, rehabilitation, symptomatic treatment, and in severe cases, joint replacement or fusion.

Fracture

Forearm and wrist fractures commonly result from falls, accidents, or blunt trauma. Simple, closed fractures are managed with a cast worn until the fracture is healed. Complex fractures may need surgical fixation before splinting. The areas proximal and distal to the splinted area are subjected to therapeutic exercises to enhance the healing process. Nonetheless, after severe weeks of immobilization, the affected limb is bound to lose strength, flexibility, and muscle mass. To regain strength and full function, an elaborate therapeutic regime is followed. It consists of stretching, mobilization, strengthening, and task-specific retraining.

Sprains/Strains

Sprain refers to an injury to the ligament, while strain refers to an injury to a muscle or tendon. These are overstretching injuries that cause a tear in the structure leading to pain in movement in a specific direction. Sprains and strains can be differentiated through a simple test. If the pain is only aggravated by active movement, it is a strain. But if it is present in passive movement as well, it is a sprain (i.e., ligament injury).

Sprains may often take longer time to heal than strains and even fractures. In such conditions, it is important to take precautions with the injured area when participating in heavy activities. The use of supportive garments is recommended.

Nerve Injuries

Symptoms of numbness, tingling, and paresthesia (pins and needles-like sensation) indicate nerve injury, either at the level of the spine or some other area in the arm. It can cause muscle weakness and a loss in temperature sensation. Electrical nerve stimulation can help improve nerve function.

Tendinitis

Overuse or straining of a muscle leads to the inflammation of the adjoining tendon, leading to localized pain. Tendinitis in the forearm region may be caused by activities such as racquet sports, golf, skiing, painting, gardening, or scrubbing. It can be treated with a cold compress, activity cessation, OTC pain medication, soft tissue mobilization, and mild stretching exercises. Tendinitis can be avoided by adequate warm-up, improved technique and posture, and taking breaks often.

Now, I'd like to discuss some location-specific musculoskeletal conditions affecting the forearm region.

Carpal Tunnel Syndrome

Carpal tunnel is an area over the wrist, from where the median nerve passes through, along with some tendons that attach to the fingers and are responsible for bending them. Its roof is made of a fibrous band to protect the structures underneath. Yet, it is possible for the nerve to get irritated or compressed as a result of injury or inflammation in the nearby structures. This leads to carpel tunnel syndrome which is characterized by nerve injury symptoms arising in the thumb and first two fingers. It may also cause grip weakness. Carpal Tunnel Syndrome is a common condition that affects nearly 5% of Americans. It is especially common in individuals with diabetes, and those who are pregnant. Early intervention ensures a quicker recovery.

Cubital Tunnel Syndrome

The cubital tunnel is yet another nerve passageway that is located behind your elbow on the inner side (i.e., under the funny bone). It encompasses the ulnar nerve, whose irritation can lead to nerve injury symptoms in the ring and pinky fingers that may spread in the forearm. It occurs in individuals who repetitively lean on their bent elbow or perform activities that include pulling or lifting. It may also be caused by bone spurs or arthritis changes in the elbow.

Nerve compression syndromes are initially managed through conservative treatment but if all else fails, it comes down to surgical decompression to relieve the symptoms and prevent paralysis. Early treatment reduces the risk of severity.

Tennis Elbow

Repeated use of muscles whose tendons attach to the outer side of the elbow leads to lateral epicondylitis a.k.a tennis elbow. But playing tennis is not the only cause of this condition. It may also be caused by hammering, painting, or similar activities performed with an outstretched arm.

Golfer's Elbow

It is also called medial epicondylitis, as it involves the muscles attached to the inner side of the elbow. Common causes of the Golfer's Elbow include activities that involve repetitive flexion of the wrist, leading to the inflammation of the medial epicondyle.

Injuries due to repetitive action can be prevented by taking necessary breaks, improving flexibility and strength, warming up, and enhancing your movement technique.

In your rehabilitative phase, your PT with provide the treatment as well as teach you the precautionary measures to avoid reinjury in the future.

De Quervain's Tenosynovitis

It is the inflammation of the tendon sheath due to overuse of the wrist and thumb that causes pain and swelling at the base of the thumb (near the wrist joint), leading to dysfunctional grip and hold. It can be confirmed by closing your fist with the thumb held under your fingers and moving the wrist away from it. Aggravation of pain is a positive sign. Do it gently to avoid triggering severe pain. Splinting is significant in the management of De Quervain's Tenosynovitis.

Trigger Finger

Trauma to your finger or repetitive gripping activity can lead to a trigger finger, a condition in which your finger gets stuck in a bent position, or straightens with a snapping sound. The tendon of the affected finger seems to be swollen but the exact underlying cause is unknown. This is yet another condition where overnight splints can be significant. You can further discuss the treatment options with your PT.

Elbow Bursitis

Olecranon bursitis, otherwise known as popeye's elbow, is characterized by the appearance of a lump on the tip of your elbow, similar to that of Popeye-The Sailorman, a famous cartoon character. It may be caused by a direct injury or repeated strain on the elbow, possibly from leaning on it, or an infection. The treatment starts by preventing any further stress with the use of elbow pads or protective wrapping around it, which helps reduce the pain and swelling.

Physical Therapy interventions help you regain your normal function without any adverse effects of treatments, a risk possessed by pharmacological and surgical interventions. Those options have their own significance, but a safer option employed early on during an illness can save you from the high costs of surgery, and a long post-surgical recovery period. If you are suffering from pain, swelling, and restriction in your elbow, wrist, or hand, book an appointment with Truwell Physical Therapy for an expert opinion and appropriate treatment.

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