Curezone Physiotherapy, Mississauga collaborates with a team of providers providing treatments in various orthopedic conditions. 

     The wrist is formed by the two bones in the forearm known as the radius which is the bone on the thumb side and the ulna which is the smaller bone of the two and it is the bone on the pinky side.  They form a joint and meet at the carpus.  The wrist is made up of multiple joints where bones of the forearm and hand meet to create wrist movement.  The carpus are eight bones referred to as the carpal bones.  There is an easy abbreviation to remember the 8 bones.  SO, LO TO PINKIE HERE COMES THE THUMB.  If you take each of the beginning letters of this abbreviation, they represent the start of the bones name. Scaphoid (So), Lunate (Lo) Triquetrum (To), Pisiform (Pinkie) those bones are on the upper end of the wrist and are counted with the palm facing up starting from the thumb making your way to the pinkie.  Hamate (Here), Capitate (Comes), Trapezoid (The) and Trapezium (Thumb) which are on the lower side of the hand starting at the pinkie moving to the thumb on the lower row. 

     The other bones in the hand include the metacarpals which are the bones the make up the middle part of the hand and the Phalanges which are the 14 narrow bones that make up the fingers.  There are The Distal, Intermediate and Proximal Phalanges, the thumb only has two.  The joints of the fingers include metacarpophalangeal joint (MCP), proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP).  There are many tendons in the hand too like extensor tendons and flexor tendons as well as extensor pollicis brevis and abductor pollicis longus which are the muscles that move the thumb.  

Injuries of the Wrist and Hand

Scaphoid Fracture

     Signs and Symptoms are swelling in the anatomical snuff box pain when extending and abducting the thumb and pain with wrist extension and radial deviation.  Treatment like a fracture of any other kind an x ray will detect if there is a fracture of the scaphoid 2 x rays will need to be completed the hand must be immobilized.  It is also important to note that if this bone breaks there is no blood supply that can travel to this bone so surgery to replace the bone is a very important option. 

     Boxers Fracture

     Signs and Symptoms include a depression where the knuckle should be and swelling over the knuckle that masks the fracture.  Treatment includes PIER, checking for distal circulation or capillary refill, a splint and immobilization.

Carpal Tunnel Syndrome

     Compression of the median nerve passing through the carpal tunnel, the roof of the carpal tunnel is formed by the flexor retinaculum and the nerve is surrounded by the flexor tendons of the wrist.  The main causes of this syndrome is fluid retention, overuse and secondary to any trauma. 

     – Signs and Symptoms tingling and numbness in the first three fingers, progressive paralysis and atrophy of the thenar muscles, may result in a thicker flexor retinaculum, flexor tendon and synovial sheath, can be due to the position your hands are in and if you undergo surgery scar tissue will form and can contribute to ongoing symptoms.    

     – Treatment includes altering your mechanics, stretching the muscles in the area, eliminating inflammation and immobilizing the wrist.

Manual therapy techniques include mobilisation of

• Soft tissue
• Carpal bone
• Median nerve flossing
• Other modalities include ultrasound, Laser therapy, splinting and exercises.

    De Quervain Tenosynovitis

     Irritation and swelling of the sheath which surrounds the thumb tendon as they pass from wrist to thumb.  Pain when grasping or pinching and a thick lump can be felt in the area.  Completing a Finklestein’s test can determine if there is this syndrome by tucking your thumb all the way to the pinkie and making a fist and pointing towards the ground can determine if you have the symptoms of this syndrome. De Quervain’s tendinosis is one of the most common types of tendon lining inflammation (swelling). This condition affects women eight to 10 times more often than men.

Physiotherapy consists of Strengthening and stretching exercises of the thumb and wrist specific to De quervain syndrome. Modalities such a s Laser and Ultrasound Therapy also help in healing the tendons faster.    

   Skiers Thumb

     This is the sprain of the UCL of the MCP joint of the thumb improper healing can lead to permanent instability resulting in weak grasp and osteoarthritis. 

     – Signs and Symptoms pain in the webbed space with movement, area is tender, swelling, bruising and instability when you abduct your thumb

     – Treatment includes surgery, PIER 6 weeks in a cast, Post cast treatment for the ligament  

Ganglion Cyst

     Mass or lump in the hand, noncancerous fluid filled cyst around a ligament, joint lining or sheaths when they become irritated or inflamed it does not require treatment however if the cyst is painful or it begins interfering with your functionality you can get a referral to a orthopaedic surgeon to remove the fluid get an injection of a steroid or surgery.

How can a physiotherapist at Curezone Physiotherapy help?

The first thing a physiotherapist will do is complete a thorough assessment to determine where the source of the tingling, numbness or pain in your hand comes from. Although carpal tunnel syndrome is a common cause of these symptoms, other sources of nerve impingement can be found in your neck, shoulder or elbow. Once a physiotherapist has determined the source of the problem is pressure on the nerve at the wrist, he/she will then identify what activities or positions aggravate your symptoms and help you develop strategies to minimize the affect of these factors to decrease or eliminate the symptoms. Finally, the physiotherapist may provide a few sessions of hands-on therapy as part of the initial treatment plan. This therapy may include manual mobilization of the wrist bones, the tendons, and the nerve itself. These exercises are designed to increase movement and mobility of the nerve and tendons through the carpal tunnel. Exercises to strengthen the muscles around the wrist joint and forearm may also be added to your program.