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Physiotherapists see many patients with wrist pain. Given that it is such a prevalent problem, let’s review some common causes and more importantly, talk about what treatment options are available.

When it comes to diagnosing the cause of pain in the wrist, the first step is to determine whether it’s a true wrist problem or whether the pain is ‘masquerading’, i.e. being referred to the wrist from another part of the body. The most common areas which can refer pain to the wrist are the neck, shoulder and elbow. To understand how this can happen we will use the neck as an example. Imagine that you have a bulging disc in your neck. This disc can put pressure on the nerves which supply the wrist and consequently, you will feel pain in the wrist. Treating the wrist, however, will not result in an improvement as the problem is in the neck, not the wrist. Thus, in this example, it will be necessary to treat the neck, not the wrist, to abolish the symptoms.

The most common causes of true wrist pain are:

• Wrist fracture
• Arthritis
• RSI (repetitive strain injury)
• Carpal tunnel
• Tendinitis

There are also other, more serious, causes of wrist pain. It is important to see your doctor first to be cleared of these. Once you have been cleared, treatment by a physiotherapist should be your next point of call.

So, what treatment is available for wrist pain sufferers? In physiotherapy practice there is a wide range of treatment options which includes electrotherapy, ultrasound, drug phoresies and exercises. To decide which treatment will be most beneficial for each patient, it is important to carry out a detailed assessment first. This assessment will include an analysis of wrist range of motion and strength, as well as some specific tests which help to diagnose the cause of the symptoms. Specific investigations, such as diagnostic ultrasound and X-Rays, can also be helpful in certain cases, particularly if there is a suspected fracture.

We will now review some of the abovementioned causes of wrist pain and specifically discuss which treatments can be helpful for these. In this month’s article, we will discuss carpal tunnel syndrome. In the following March issue of GHG^TM, our article will focus on osteoarthritis and RSI.

Carpal Tunnel Syndrome

This disorder of the hand arises because of pressure on the median nerve as it runs through the carpal tunnel of the wrist. It typically occurs when there is swelling inside the wrist. Swelling can occur because of repetitive tasks performed with the hand, arthritis and pregnancy. Traumatic injury can also be a cause of carpal tunnel syndrome.

Common symptoms include numbness, pins and needles and pain. Weakness may also be felt in the hands and cramping of muscles is not uncommon. This is due to a compromised nerve supply to the affected muscles.

Physiotherapy treatment will involve several components:

• Education: regarding which activities and positions may be most provocative and best to avoid.
• Hands on therapy: where indicated, wrist mobilization and passive stretching may be useful, while massage can help ease the surrounding muscle tension.
• Exercises: nerve and tendon gliding, as well as muscle stretching may be prescribed, with strengthening and fine motor skills being a focus in the later stages of rehabilitation.
• Ultrasound: this has been shown to reduce inflammation and assist with easing of symptoms.