Wrist pain and conditions
Identify and treat tendinitis, carpal tunnel syndrome, and other wrist conditions.
Distal radius fracture
What is a distal radius fracture?
The radius is one of the forearm bones connecting the elbow to the wrist. A distal radius fracture refers to a break in this bone just before the wrist joint. It is the most commonly fractured bone in the arm.
- A simple fracture means the bone is broken in only one place.
- A complex fracture occurs when the bone breaks into several pieces, another bone is fractured, or the bone is displaced.
What are the symptoms?
A distal radius fracture can cause:
- Pain, swelling, and bruising
- Tenderness to the touch
- Visible deformity of the wrist
- Numbness or tingling in the fingers
- Difficulty bending or straightening the fingers or thumb
What are the causes?
The main causes of a distal radius fracture are:
- A fall onto an outstretched hand (FOOSH - Fall On an Outstretched Hand)
- Contact sports or intense physical activities
- Low bone density or osteoporosis, increasing the risk of fracture
What are the treatments?
The treatment depends on the severity of the fracture:
- An X-ray will be taken to confirm the fracture.
- A simple fracture can be treated with immobilization using a cast or a brace.
- A complex fracture may require surgical intervention to realign the bone.
What is the role of the hand therapist in recovery?
A physiotherapist or occupational therapist specialized in hand therapy works in collaboration with the physician to ensure proper recovery. Their intervention includes:
- Reducing swelling and pain
- Designing a custom-made splint to protect the wrist
- Teaching strategies to facilitate daily activities
- Restoring mobility and strength of the wrist, forearm, and fingers
The goal is to regain optimal function of the wrist and arm to safely resume daily activities.
Scaphoid fracture
What is a scaphoid fracture?
The scaphoid is a small wrist bone that is part of the carpal bones, located beneath the thumb. It is the most commonly fractured carpal bone. Due to its limited blood supply, some scaphoid fractures may have difficulty healing and require appropriate medical management.
What are the symptoms?
- Pain in the wrist or thumb, worsened by movement
- Increased tenderness on the thumb side of the wrist
- Difficulty pinching or gripping objects
- Swelling and bruising at the base of the thumb and wrist
- In some cases, moderate pain that can be mistaken for a wrist sprain
What are the causes and risk factors?
- Fall onto the hand with the wrist extended
- Direct trauma to the wrist (e.g., car accident, contact sports)
- Increased frequency in active young adults
What are the treatments?
Diagnosis and immobilization
- An X-ray is performed to confirm the fracture, but it may not be immediately visible.
- In case of doubt, temporary immobilization with a splint or cast is recommended before follow-up imaging (X-ray or MRI) after two to three weeks.
- Some fractures require prolonged immobilization ranging from 8 weeks to 6 months.
Conservative (non-surgical) treatment
- Immobilization with a cast or splint covering the base of the thumb, the wrist, and sometimes the elbow to stabilize the fracture
- Regular monitoring of bone healing through medical imaging
Surgical treatment
- Indicated in the case of displaced or complex fractures
- Placement of screws or fixation devices to stabilize the bone and promote healing
What is the role of the hand therapist in recovery?
An occupational therapist or physiotherapist specialized in hand treatment can intervene at different stages:
- Fabrication of a custom splint to protect the wrist and promote healing
- Patient education on pain and edema management
- Rehabilitation after removal of the immobilization to regain mobility and strength in the wrist and hand
- Assistance in resuming daily and professional activities
Proper management allows for optimal recovery and reduces the risk of long-term complications.
Synovial cyst
What is a synovial cyst?
A synovial cyst is a fluid-filled mass that develops from the membrane surrounding a joint or tendon. It commonly appears on the back or palm side of the wrist, as well as at the base of the fingers. Its size can vary, ranging from a small nodule to a larger mass. The cyst may change in size depending on the use of the affected joint.
What are the symptoms of a synovial cyst?
The main symptom is the presence of a lump under the skin, whose size may fluctuate. A small cyst may be painless, while a larger cyst can put pressure on nearby structures, causing discomfort or pain, especially during movements that stress the joint. In some cases, it may limit the range of motion.
What are the causes of a synovial cyst?
The exact origin of synovial cysts remains uncertain, but they may be related to repeated microtrauma or joint irritation that promotes the accumulation of synovial fluid. Activities that involve frequent wrist or finger movements may contribute to their formation.
What are the treatments for a synovial cyst?
Some cysts disappear spontaneously without the need for treatment. In cases of pain or functional discomfort, temporary immobilization with a splint may be recommended to limit joint irritation. If the cyst persists, fluid aspiration with a needle or a cortisone injection may be performed. In more complex or recurrent cases, surgical intervention may be considered.
What is the role of the hand therapist in recovery?
A hand therapist helps identify and adjust daily movements that may worsen symptoms. They can design a splint to limit painful movements and suggest exercises to maintain mobility and muscle strength. After surgery, they support rehabilitation to restore hand functionality and prevent recurrences.
Triangular fibrocartilage complex (TFCC) injury
What is a TFCC injury?
The wrist is made up of two main forearm bones (the radius and ulna) as well as eight small carpal bones. The triangular fibrocartilage complex (TFCC) is a crucial structure connecting the ulna to the carpal bones, providing stability and support to the joint. A TFCC injury can affect the fibrocartilage disc, ligaments, or tendons that make up this structure, leading to pain and a reduction in wrist mobility.
What are the symptoms of a TFCC injury?
Common symptoms include pain on the side of the wrist near the little finger, which may worsen with movements such as forearm rotation (turning a key, opening a door) or gripping objects tightly. Loss of wrist mobility, weakness in grip, swelling, or a clicking sensation may also be observed.
What are the causes of TFCC injuries?
These injuries are usually caused by a fall onto the hand or repetitive movements involving force and wrist rotation, such as using a screwdriver. They can also develop gradually due to joint changes related to osteoarthritis or previous wrist fractures.
What are the treatments for TFCC injuries?
In the case of suspected TFCC injury, an MRI may be performed to assess the affected tissues. Depending on the severity of the injury, treatment may include temporary wrist immobilization and therapy sessions to promote healing. In more severe cases, surgical intervention may be necessary.
What is the role of the hand therapist in recovery?
A hand physiotherapist or occupational therapist works with the physician to optimize care. They can design a custom splint to stabilize the wrist, teach strategies to reduce pain and inflammation, and guide the patient through an exercise program aimed at restoring mobility, strength, and function of the wrist. Proper rehabilitation is essential to regain optimal hand use and prevent long-term complications.
Scapholunate ligament injury
What is a scapholunate ligament injury?
The wrist is made up of eight small bones called the carpal bones. Among them, the scaphoid (near the thumb) and the lunate (in the center of the wrist) are connected by the scapholunate ligament. This ligament plays a crucial role in wrist stability, especially during gripping and pushing movements. A partial tear of the ligament is called a sprain, while a complete rupture leads to significant wrist instability.
What are the symptoms?
The main symptoms include pain on the side of the thumb or at the back of the wrist, often accompanied by swelling. Initially, the pain may be mild, but it can gradually worsen with use. Some patients also experience cracking or a feeling of locking during wrist movements.
What are the causes?
The most common cause is a fall onto the palm of the hand, leading to hyperextension of the wrist. In some cases, these injuries can also occur during activities that involve significant pressure on the wrist, such as gymnastics or the use of vibrating tools.
What are the treatments?
Treatment depends on the severity of the injury. For a sprain, wrist immobilization for a certain period and avoiding activities that strain the area are typically recommended. In the case of a complete ligament rupture, surgery may be necessary to restore wrist stability.
What is the role of the hand therapist in recovery?
A hand therapist can design a custom splint to immobilize the wrist and guide the patient through a progressive rehabilitation program. The goal is to regain optimal range of motion and strengthen the wrist muscles. Collaboration between the therapist and the surgeon is crucial to ensure optimal recovery and reduce the risk of long-term complications.
SLAC wrist (Scapholunate Advanced Collapse)
What is a SLAC wrist?
The SLAC wrist (scapholunate advanced collapse) is a form of wrist arthritis that results from damage to the scapholunate ligament. This ligament plays a key role in maintaining the alignment of the carpal bones, particularly the scaphoid and lunate. When this ligament is damaged, the bones gradually shift, leading to instability and joint wear, which can progress to painful degeneration.
What are the symptoms of a SLAC wrist?
People with this condition typically experience pain, weakness, and stiffness in the wrist. These symptoms often arise during activities that strain the wrist, such as lifting, carrying, pushing, or pulling objects. It also becomes difficult to apply pressure to the palm, such as when lifting a chair or performing a push-up exercise.
What are the causes of SLAC wrist?
This condition does not occur immediately after trauma but develops gradually following an injury to the scapholunate ligament. A fall onto the palm or repetitive wrist movements can damage this ligament. The progressive weakening of this ligament structure leads to misalignment of the wrist bones, thus promoting joint degeneration.
What are the treatments for SLAC wrist?
The choice of treatment depends on several factors, including age, overall health, and the level of daily discomfort. In moderate cases, a conservative approach involving hand therapy sessions may be recommended. When pain and weakness become too debilitating, surgery may be considered to stabilize the wrist and restore joint function.
What is the role of the hand therapist in recovery?
A hand therapist plays a central role in managing SLAC wrist. They provide exercises to improve mobility and strengthen the wrist muscles. A custom-made splint may be prescribed to relieve pain by providing additional joint support. The therapist also guides the patient in adapting daily movements to reduce strain on the wrist and preserve its function.
Carpal tunnel syndrome
What is carpal tunnel syndrome?
Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs through the wrist, becomes compressed or irritated, leading to progressive pain. The carpal tunnel is a narrow passageway connecting the forearm to the hand, through which the median nerve and nine tendons pass. It is surrounded by a rigid structure made up of the carpal bones and the transverse carpal ligament.
What are the causes of carpal tunnel syndrome?
CTS is usually caused by a combination of factors. Some people naturally have a narrower carpal tunnel, making them more susceptible to nerve compression. A wrist injury, such as a sprain or fracture, can cause swelling that puts pressure on the median nerve. Other conditions such as arthritis, thyroid disorders, diabetes, pregnancy, repeated use of vibrating tools (like drills or jackhammers), or prolonged wrist positioning in extreme angles can also contribute to the development of the syndrome.
What are the symptoms of carpal tunnel syndrome?
People with CTS often experience numbness and tingling in the thumb, index finger, middle finger, and part of the ring finger, mainly on the palm side of the hand. Some describe sharp or throbbing pain in the hand, wrist, and forearm. The syndrome can also lead to clumsiness, reduced grip strength, difficulty grasping small objects, or trouble performing precise tasks such as buttoning a shirt or picking up a coin.
The contribution of the hand therapist
A hand therapist plays a key role in the management and recovery of CTS. After a thorough evaluation to identify the underlying cause of the issue, they may recommend wearing a splint, particularly at night, to keep the wrist in a neutral position. During the day, a splint may be suggested for activities that could exacerbate symptoms. The therapist also provides personalized advice to adapt daily movements and reduce pressure on the median nerve. Finally, they may propose specific exercises to relieve symptoms and prevent recurrences.
De Quervain's tenosynovitis
What is De Quervain's tenosynovitis?
De Quervain’s tenosynovitis is an inflammatory condition affecting the tendons located on the side of the thumb at the wrist. These tendons play a crucial role in the thumb’s spreading and extension movements. They pass through a tunnel called the first dorsal compartment. When inflammation occurs, the tendons struggle to glide freely, resulting in pain and discomfort.
What are the symptoms?
- Pain on the side of the wrist, near the base of the thumb
- Radiating pain toward the thumb or forearm
- Difficulty performing actions such as pinching, grabbing objects, or twisting movements (e.g., wringing out a cloth)
- A sensation of swelling or crepitus in the affected area
What are the causes and risk factors?
De Quervain’s tenosynovitis can be caused by:
- Repeated overuse of the thumb tendons
- Inflammation or degeneration of the tendons in the first dorsal compartment
- Hormonal changes (common in young mothers after childbirth)
- No identifiable triggering factor in some cases
What are the treatment options?
Conservative (non-surgical) approach
- Repos et modification des activités: éviter les mouvements aggravant les symptômes
- Custom-made splint: immobilization of the wrist and thumb to allow healing.
- Medication: anti-inflammatory drugs or corticosteroid injections to reduce inflammation.
- Physiotherapy and occupational therapy: exercises and techniques to restore mobility and reduce pain.
Surgical approach (as a last resort)
- Recommended in cases of persistent symptoms lasting more than six months despite conservative treatments.
- An intervention involving opening the first dorsal compartment to release the passage of the tendons.
What is the role of the hand therapist in recovery?
A specialized therapist can help with:
- Identifying movements that worsen the pain
- Suggesting ergonomic adjustments to reduce strain on the tendons
- Designing or recommending a suitable splint to limit painful movements
- Recommending targeted exercises based on the stage of the injury
- Guiding rehabilitation after a possible surgical intervention
With appropriate care, most patients regain optimal function without the need for surgery. Personalized follow-up is essential to prevent recurrences and ensure effective recovery.
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