Wrist and Hand Pain Physiotherapy in Bristol

The Hand and Wrist

The human hand and wrist is a complex mechanism to perform functional activities which are integral for daily tasks.

The hand and wrist have a total of 29 bones arranged to roll, spin and slide allowing the hand to explore and control the environment and objects. The wrist joint is where the forearm bones (radius and ulna) meet the carpal bones of the hand. Both the wrist and hand are supported by a large number of ligaments, tendons and muscles to enable very fine and complex movements of the hand.

What are the common causes of hand and wrist pain?

Common causes of musculoskeletal related pains tend to originate from bones, ligaments, tendons and muscles. These symptoms tend to settle with time and good self-management.

Common conditions of the hands and wrists

Swelling, tenderness on the base of thumb
Stiffness and loss of motion while trying to move thumb
Weaknesses while trying to grip, pinch or grasp.
Bony bump on base of thumb

Osteoarthritis of the thumb

What is it?

Osteoarthritis is a wear and repair process and a commonly affected joint is the thumb. It can cause joint pain with limitation of movement, which may affect daily activities. Osteoarthritis is the most common type of arthritis, affecting approximately 9 million people in the UK.

In osteoarthritis we see changes to the cartilage of the joint as well as other secondary changes such as inflammation. Cartilage helps our joints move freely. Changes to the cartilage can lead to pain, stiffness, and loss of movement. This can in time lead to weakness around the muscles of the joint.

It most commonly affects people older than 45 and is more common if you are overweight, have a family history of it, or have previously injured the joint in question. Osteoarthritis has varying degrees on functional limitation and effect on quality of life. Contrary to popular belief it does not affect everyone as you get older and does not necessarily get worse with age.

Causes of thumb osteoarthritis

Osteoarthritis in the carpometacarpal joint (CMC joint) at the base of the thumb is the most common cause of pain in this area. The CMC joint is formed where the metacarpal bone of the thumb meets the trapezium bone of the wrist.

Due to the movement required at the base of the thumb, you rely on your ligaments and bony structures to maintain stability. Injury or overuse can place high loads through the base of the thumb and lead to joint changes. A good point to remember is that any pressures placed through the tip of the thumb during pinching activities are multiplied by around twelve times through the CMC joint.

Symptoms of thumb osteoarthritis

Pain is the primary symptom associated with thumb osteoarthritis. Initially, pain is present with movement or activity (e.g. turning a key, opening a door, lifting a cup). In some cases of osteoarthritis pain may be present even during inactivity or rest. Other symptoms of thumb arthritis include:

Difficulty gripping objects

Swelling, stiffness, or tenderness at the base of the thumb

Enlarged appearance and altered posture of the CMC joint

Limited range of motion

Osteoarthritis of the hand

Pain felt on the affected joint
Pain increases with movement
Joint stiffness early morning and after activity
Swelling around the affected joint
Grating, popping, cracking felt during movement
Hard lumps or bony bumps felt in the affected joints

Causes of hand osteoarthritis

Osteoarthritis of the hand is a common joint problem. OA in the carpometacarpal joint (CMC joint) at the base of the thumb and in the small joints of the fingers are the most common causes of pain in this area.

OA in the hand can be related to repetitive precision loading (pinch-type activities) and strong grip, as well as other factors such as obesity and hormone changes.

Symptoms of hand osteoarthritis

Pain is the primary symptom associated with hand osteoarthritis. Initially, pain is present with movement or activity (e.g. turning a key, opening a door, lifting a cup). In some cases of osteoarthritis pain may be present even during inactivity or rest. Other symptoms of hand osteoarthritis include:

Difficulty gripping objects
Swelling, stiffness, or tenderness of the small joints of the hand
Enlarged appearance and altered posture of the CMC joint
Nodular (bumpy) formations on the joints of the fingers
Limited range of motion

Carpal Tunnel Syndrome (CTS)

Tingling and numbness in the hand, usually thumb, index, middle and ringer

fingers are affected

Pain may travel to arm from wrist
Weakness on hand grip and pinch
At early stages shaking out the hand or stretching the wrist

will ease the symptoms

What is it?

The carpal tunnel is a canal formed between the small bones of the wrist (carpal bones) and a ligament that lies across the front of the wrist. The median nerve is one of the structures that pass through this canal.
In Carpal Tunnel Syndrome (CTS) the median nerve becomes compressed within the canal.
What are the common symptoms?
Symptoms include pins and needles, pain, aching and/or numbness commonly in the thumb, index, middle and half the ring finger, but you may feel that the whole hand is affected. You may feel weakness of the hand which can cause poor grip, leading you to drop objects. Your skin may feel more dry than usual.
In most cases, there isn’t an obvious cause for CTS. It is more common in manual workers, especially with jobs involving a lot of wrist movement, so overuse of the hand may be a factor.
The following are all associated with CTS: pregnancy, obesity, an underactive thyroid, diabetes, any arthritis affecting the wrist and the menopause.

How to self manage Carpal Tunnel Syndrome

Night-time pain can be relieved by gently shaking your hand and wrist or hanging your hand over the side of the bed.
You may benefit from wearing wrist splint during the night. You can purchase a splint from a number of places online. The aim of the splint is keep the wrist straight. See the instructions at the end of this section to learn how to bend the bar to ensure your wrist is flat, i.e. not bent back or downwards. Remove it in the day unless you are doing aggravating activities e.g.: holding a phone.
Watch out for red marks on your skin due to rubbing or pressure points or a rash due to heat or allergy to the material.
Elastic or Neoprene splints may be hand-washed or machine-washed in an ‘easy care’ load (40°). Make sure the Velcro straps are fastened before putting the splint in a washing machine or place it in a pillow case.

De Quervain’s Tenosynovitis

Pain on base of thumb
Swelling near base thumb
Sharp sticking sensation on base of thumb felt during

thumb movements

Pain and difficulty while gripping or pinching

What is it? 

De Quervain’s tenosynovitis is caused by irritation between the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) tendons of the thumb. This creates a thickening and narrowing of the area in which they are housed over the bony area of the thumb on the side of your wrist. This causes inflammation and pain which becomes worse on moving the thumb or wrist and you may feel an associated ‘creaking’ around the tendons.

The symptoms can start following prolonged or unusual activity such as gardening, DIY, or use of a gaming console.

It is also common in new mums although whether this is due to hormonal changes or repetitive lifting of the baby is unclear.

Trigger finger or thumb

Catching or locking of the finger or thumb
Difficulty fully bending the finger
Pain common in the palm of the hand
Palpable lump at the base of the digit
It can affect any finger or thumb

What is it? 

Trigger finger or thumb is a common disorder characterized by snapping, catching or locking of the finger flexor tendon leading into the palm of the hand. Sometimes there is also a reduced ability to bend the finger. It is commonly associated with pain in the palm; a tender, palpable bump at the base of the affected digit, and a reduction in hand use.

It is often caused by overuse of the finger tendons involved in repetitive or forceful gripping but can be more common with some other conditions such as diabetes, gout, or rheumatoid arthritis

It is usual to be more aware of it first thing in the morning, and then again through the day on gripping or straightening the finger or thumb involved.

Treatment from Physiotherapy: Wrist and hand pain

Along with advice, manipulation, massage, strapping, muscle stimulation and home exercises, The Storm Clinic can also offer you:

Acupuncture. Such sessions could potentially improve joint mobility and reduce stiffness, allowing individuals to move more freely.
Shockwave therapy: Bony spurs, or osteophytes often develop in osteoarthritis. Shockwave therapy is proven to help by breaking down calcifications or small bony growths, potentially reducing their size or impact on nearby tissues. Shockwave therapy has been shown to stimulate the production of collagen, which is important for repairing and strengthening the damaged tendon tissue.
Laser therapy: While the exact mechanisms are not fully understood, laser therapy is thought to work at the cellular level to promote tissue repair and reduce inflammation.

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