Often due to overuse injury, these are a group of conditions that are highly treatable if caught early. Physiotherapy helps by restoring strength, and movement range, reducing pain and restoring functions.

1) Carpal tunnel

Carpal tunnel syndrome is a compression of the median nerve within the carpal tunnel. There is pain, tingling, and in severe cases, numbness in the thumb, index middle and half of the ring finger. It is typically caused by repetitive tasks involving the hand and wrist. Typing with the wrists resting on hard surfaces can result in this problem. It is often worse at night or while driving and can lead to loss of grip strength and coordination. As the problem progresses, atrophy (muscle wasting) of the thumb muscles may occur. Treatment typically consists of splinting the wrist in a neutral position (no bend in the wrist in either direction), anti-inflammatory medication, and, most importantly, activity modification, such as wearing a padded glove during cycling. Surgical release of the transverse carpal ligament is often performed before muscle wasting occurs. Physical therapy follows to help restore range of motion and strength as well as to educate the patient on factors that can lead to a recurrence of the problem.

2) De Quervain tenosynovitis

This is a common condition in which the tendons that extend or straighten the thumb and their surrounding sheaths (Extensor pollicis brevis and Abductor pollicis longus) become inflamed. Pain is located at the base of the thumb and wrist. De Quarvain’s tenosynovitis is common with repetitive work activities such as wringing and scissoring tasks. Treatment includes rest, splinting, and rehabilitation to restore flexibility, reduce inflammation and modify tasks and activities. Surgery is rarely indicated, but a steroid injection is occasionally necessary.

3) Wrist drop (Nerve injury)

Wrist drop is a medical condition in which the wrist and the fingers cannot extend or lift at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of the flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralysed. Bracing and physiotherapy are usually the first lines of treatment, failing which surgery is indicated.

4) Trauma/ fractures

Fractures of the wrist and hands are commonly named for their anatomical location, how they occurred, or a doctor that discovered or studied the given type of fracture.

The fingers are susceptible to fracture in household mishaps, recreational injuries and work-related trauma.

Most hand fractures are stable and do not require surgery. However, occasionally, fractures will not heal without appropriate surgical intervention. Internal support or “hardware” is necessary to stabilise fractures. The therapist may apply a form-fitting, custom thermoplastic splint to protect the fracture during healing. These splints may be removed for exercise and hygiene.

Most therapy programs commence days to 3 or 4 weeks post-op to regain motion, decrease pain, and reduce swelling. Rehabilitation may continue for weeks or months to restore range of motion (ROM) and strength.

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