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Wrist/Hand/Forearm Conditions

Gamekeeper’s Thumb is caused by a traumatic force that causes the thumb to go outward.  This is a common injury with skiing and football.  The person will experience pain and swelling over the knuckle of the thumb.  Bracing or splinting may be appropriate as well as physical therapy treatment for ROM, strengthening, and fine motor skills.

Carpal Tunnel Syndrome is compression of the median nerve as it passes through the carpal tunnel at the wrist joint.  Symptoms can be pain, numbness, tingling in the thumb, index finger, middle finger, and the inner half of the ring finger.  Pain is typically worse at night or while driving.  If symptoms persist, a person can experience loss of grip strength, loss of coordination during fine motor activities, and muscle wasting.  Treatments include splinting, anti-inflammatories, activity modifications, and physical therapy to relieve pain and restore ROM and strength.  Surgery can be indicated in severe cases of nerve involvement.

Guyon’s Canal Syndrome (Handlebar Palsy) is very similar to carpal tunnel syndrome except that this condition affects the ulnar nerve as it passes through its canal at the inner aspect of the wrist.  This condition often affects cyclists because of the way they place their hands on the handlebar.  Treatment is basically the same as that of carpal tunnel syndrome.

DeQuervain’s Tenosynovitis is a common condition causing pain at the base of the thumb due to the tendons that straighten the thumb becoming inflamed most often due to overuse and repetitive activities.  Rest, splinting, activity modification, and physical therapy are all helpful treatment options.  Sometimes a steroid injection may be indicated as well.

Fractures of the Forearm/Wrist/Hand, whether they require surgery or not, will benefit from physical therapy treatment during the rehabilitation process.  The therapist need to apply a form-fitting brace to protect the fracture during the healing process.  The recovery time for these types of injuries can sometimes be lengthy where physical therapy is vital for decreasing swelling and maintaining ROM, strength, and fine motor skills until complete healing occurs.

A Colles Fracture is a fracture at the end of the radius toward the wrist.  The radius is the arm bone that is on the thumb side.  This type of fracture generally occurs from a fall on an outstretched hand, or it can also occur from a direct force to the area.  Splinting greatly helps protect and support the injured area while the fracture is healing.  Physical therapy goals include pain/swelling management, increasing movement, and improving grip strength to restore function.

A Scaphoid fracture is a common fracture that occurs in the wrist, usually from a fall on an outstretched hand or with a high-velocity wrist injury.  There will be pain and tenderness where the thumb meets the wrist.  The patient will be splinted or have a surgical fixation in severe cases.  Physical therapy is prescribed for pain management, swelling reduction, ROM/strength improvements, and fine motor skills.

A fracture of the hook of the hamate is over a small region of the palm close to the little finger.  There will be tenderness over the palm of the hand.  Surgery is usually not required for this kind of injury.  Physical therapy may be indicated for pain relief and ROM improvements.

An extensor tendon avulsion, more commonly called mallet finger, occurs with trauma to the tip of the finger that forces it to bend rapidly.  This is a common sports injury which presents with pain, swelling, and the inability to fully straighten the end of the involved finger.  Treatment for this injury is splinting the affected finger in a straight position for 6-8 weeks.  Sometimes surgical pinning can be required.  Physical therapy treatment is generally for pain management, swelling reduction, and ROM improvement.

Skier’s thumb is caused by a traumatic force to or a fall on the thumb that forces it away from the hand.  This a common injury with skiing and football.  Symptoms include pain at the knuckle of the thumb where it meets the rest of the hand, swelling, and instability when using the thumb.  An avulsion fracture where a ligament pulls off part of the bone can also occur with this injury.  With minor tears, bracing or splinting is usually sufficient treatment with surgery indicated for complete tearing of a ligament.  Physical therapy will be indicated for pain management, swelling reduction, ROM improvement and fine motor skills.

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