Role of Physiotherapy in Wrist Pain

Introduction

Hands and wrists are used to perform daily activities and daily tasks. The wrist is one of the intricate parts of the body. It is a joint that helps in connecting the hand to the forearm. It is not a single joint but a complex structure with various joints, muscles, tendons, and ligaments. From typing and writing to holding heavy objects, the wrists are used. Discomfort or pain in the wrist can be frustrating and annoying since it can disturb our daily activities. It can be caused by sprains or fractures or by any long-term problems. Physical therapists can help relieve wrist pain and prevent it from progressing. This article will discuss in detail the possible causes of wrist pain and the role of physiotherapy in treating wrist pain in detail.

What Are the Possible Causes of Wrist Pain?

There are various possible causes of wrist pain. Some of them are:

• Wrist Sprain: Any traumatic injury to the ligaments of the wrist when it is overstretched or twisted or any lacerations in the ligaments of the wrist can lead to wrist sprains. The symptoms range from numbness, tingling sensation, presence of bruising, and severe pain during hand movements.

• Wrist Tendonitis: Tendon is a connective tissue that connects the muscle to a bone. Various tendons cross over the wrist region to connect the forearm muscles to the hand. When there is any inflammation or irritation in these tendons, it results in wrist tendonitis. Symptoms of wrist tendinitis include swelling in and around the wrist joints, stiffness during hand movements, and popping sensations that can be felt during hand movements. Pain caused by this condition can be dull pain.

• Wrist Tenosynovitis: This condition is very similar to that of tendonitis. Here there is inflammation of the synovial membrane(fluid-filled sheath that protects the tendons) surrounding the wrist tendon. Symptoms are similar to wrist tendonitis.

• Wrist Joint Fracture: This condition occurs when there is a break in the continuity of one or more wrist joint bones. Wrist joint fractures occur commonly during falls while trying to catch their weight. People with osteoporosis are at higher risk of wrist fractures. Symptoms include severe pain while trying to hold something or any hand movement and swelling of the injured area.

• Carpal Tunnel Syndrome: This condition occurs due to the compressive pressure over the median nerve that crosses through the wrist, often resulting in pain and tingling in the hands. The pain usually worsens during the night time. This condition occurs commonly in people with daily activities or jobs involving excessive use of fingers.

• Arthritis: Wrist pain occurs in various arthritic (joint disorder) conditions, such as rheumatoid arthritis, osteoarthritis, and gout.

• Other less common causes of wrist pain include ulnar neuropathy, benign cysts, and synovial sarcoma.

How Is It Diagnosed?

Diagnosing the cause of wrist pain can be challenging. The healthcare provider will make an initial detailed history taking by asking questions on the onset of the pain, the recent history of trauma and the intensity of the pain, etc.; later, the doctor will do a thorough physical examination of the wrist, looking for tenderness, bruises, swelling or hand deformity. They may also perform various tests to rule out other differential diagnoses. Radiographic investigations are performed, especially an x-ray of the wrist, which can reveal the presence of fractures and arthritis.

How to Manage Wrist Pain?

• Firstly, The patients are asked to stop doing activities that might trigger the pain in the wrist.

• Applying ice to the wrist region for 20 minutes every three hours can help with inflammation and swelling.

• Non-steroidal anti-inflammatory drugs or corticosteroid injections are advised for relieving pain, especially if the pain is due to tendinitis, sprain, or arthritis.

• Compression of the wrist with an elastic bandage can help reduce swelling.

• Elevation of the wrist above the heart level.

What Is the Role of Physiotherapy in Managing Wrist Pain?

Once the primary interventions are given to the patients, they are recommended to physical therapists to help relieve the wrist pain and prevent it from progressing.

• Patient education: The physical therapists will guide the patient in performing daily activities while protecting the hand and the wrist joint to prevent stress on the joint.

• Manual therapy: The physical therapist will perform various manual therapies, such as mobilization of the soft tissues and the carpal bones to improve the range of motion and facilitate wrist movement.

• Functional training: Once the pain is reduced, the physical therapist will perform functional training on the patient to guide them on the proper wrist mechanics.

• Range of motion exercises: The physical therapist will teach various stretching techniques to reduce joint stiffness in the wrist, such as

  • Wrist extension stretch: With the arm straight and the wrist bent, the opposite hand applies gentle pressure over the palm and is pulled. The stretch is felt over the forearm. This position is held for five seconds and repeated on the alternate hands five times. The elbow should not be locked while performing this exercise.

  • Wrist flexion stretch: Begin by keeping the arm straight with the palm facing down and bend the wrist down. The opposite hand is used in applying gentle pressure towards the body until a stretch is felt at the forearm. This position is held for five seconds and repeated five times on alternate hands.

  • Ball squeeze.

  • Finger extension with a rubber band.

  • Prayer stretch.

  • Steeple stretch.

• Strengthening exercises: The physical therapists will program an individualized strengthening exercise program depending on the patient's ability to perform. The strengthening exercises for the wrist include:

  • Wrist curls: This exercise can be done with a clenched fist or with weight. Begin with the arm resting over the knees, the palms facing down, and the wrist over the knee. The hand is moved up as far as possible with a steady and controlled motion. Repeated ten times. The exercise is repeated with palms facing upwards.

  • Resistance band exercises.

  • Wrist walking.

  • Grip strengthening exercises.

  • Rubber band strengthening exercises.

• Other physiotherapy modalities, such as ultrasound therapy and Transcutaneous Electrical Nerve Stimulation, effectively treat pain.

Conclusion:

The wrist joint is one of the complex structures in the body. Pain in this joint can occur for various reasons, such as injury or long-term problems. Wrist pain can occur with various other symptoms like swelling and bruising; early diagnosis of the cause is important in managing wrist pain. Physiotherapy interventions can help relieve wrist pain by performing various exercises, manual therapy, and other modalities depending on the type of pain and the cause. The physical therapist will also develop an individualized home exercise program for the patients.