Wrist
Injuries and overuse syndromes are managed with the goal of full functional recovery.
Carpal tunnel syndrome
Carpal tunnel syndrome is one of the most common hand conditions. It occurs when the median nerve is compressed within the carpal tunnel — a narrow passageway at the base of the wrist, surrounded by bones and ligaments. Pressure on this nerve can cause numbness, tingling, and weakness in the thumb and fingers.
Various factors may contribute to the syndrome, such as wrist anatomy, health problems, and repetitive hand movements. With proper physical therapy and therapeutic exercise, symptoms often subside and hand function is restored.
Symptoms
Symptoms of carpal tunnel syndrome usually appear gradually and include:
Numbness and tingling: These sensations usually affect the thumb, index, middle, and ring fingers — but not the little finger. There may be an “electrical” feeling that occurs when holding the steering wheel, the telephone, or a newspaper, or even during sleep. This feeling can extend from the wrist to the arm. Many people move their hands to relieve the pain. Over time, the numbness can become constant.
Weakness: There may be weakness in the hand and objects may fall. This may be due to either numbness or weakness of the muscles at the base of the thumb, which are also controlled by the median nerve.
Causes
Carpal tunnel syndrome is caused by pressure on the median nerve.
The median nerve starts in the forearm and passes through the carpal tunnel at the wrist, ending in the hand. It provides sensation to the palm of the thumb and the remaining fingers, except the little finger. It also controls the movement (motor function) of the muscles at the base of the thumb.
De Quervain's Syndrome/ de Quervain's Syndrome
De Quervain's syndrome is a painful condition that affects the tendons on the thumb side of the wrist. The patient feels pain when twisting the wrist, gripping something, or making a fist.
Although the exact cause of de Quervain's syndrome is not fully understood, activities that involve repetitive hand or wrist movements — such as gardening, golf, racquet sports, or lifting a baby — may worsen the condition.
Symptoms
Symptoms of the syndrome include:
• Pain near the base of the thumb
• Swelling near the base of the thumb
• Difficulty moving the thumb and wrist when performing movements that involve grasping or gripping
• A feeling of "stuck" or "stop and go" in the thumb when moving it
If the condition remains untreated for too long, the pain may extend to the thumb or forearm or both, and movement of the thumb and wrist may worsen the pain.
De Quervain's syndrome affects the two tendons on the thumb side of the wrist. Tendons are fibrous structures that connect muscles to bones.
Chronic overuse, such as repetitive hand movement every day, can irritate the sheath around the tendons. If the sheath becomes irritated, the tendons can thicken and swell, restricting their movement through the narrow tube that connects them to the base of the thumb.
Other factors that contribute to the exacerbation of the syndrome include:
• Inflammatory arthritis, such as rheumatoid arthritis
• Direct injury to the wrist or tendon, which can cause scarring that limits tendon movement
• Fluid retention, which can occur due to hormonal changes during pregnancy