Hand and Wrist Injuries

The hand and wrist provide us with the ability to grasp and preform fine movement patterns. Our hands are filled with a high-density sensory nerve fibers providing feedback to our brain. Because of the this the hands and fingers represent the largest area of brain real estate compared to all other body parts.

If you have experienced pain in your hands and wrist you know getting simple daily tasks complete can be challenging or impossible. There are many types of injuries that can happen, a traumatic injury like a wrist fracture or aches that develop into more sharp and debilitating pain for no apparent reason like a tendinopathy. In all cases, it is important that you have your pain assessed by a physiotherapist and/or chiropractor. The earlier you seek treatment from a professional the faster you will have pain relief and it is less likely stubborn compensations take over creating further problems.

What Makes the Hand and Wrist Unique?

The hand and wrist are made up of multiple joints that function independently but also need to work and coordinate together to achieve proper movement.

The wrist is divided up into different regions defined by the joint articulations:

  • The Inferior Radial Ulnar Joint: This is the joint of the wrist where the two bones of the forearm come together. This joint is unique as between it lies the Triangular Fibrocartilage Complex (TFCC). The TFCC is an important complex structure made of soft tissue that includes a disk, meniscus and ligaments. It acts to protect, cushion and stabilize the wrist when weight bearing through the hands.
  • The Radiocarpal/Ulnomeniscocarpal Joint: The carpals of the wrist are a series of eight small bones that make up the wrist. The eight bones are aligned in two rows one being closer to the wrist and the other row closer to the hand. The radial side of the wrist (thumb side) articulates with the bones called the scaphoid and lunate. The ulna side of the wrist (little finger side) does not articulate directly, it has the TFCC between the joint hence having meniscus in its name
  • The Mid Carpal Region and Intercarpal Region: This is where the eight small bones of the wrist articulate with each other and then longer bones of the palm of our hand
  • The Metacarpals and Phalanges: These are the long bones of the palm and finger bones. They have many tendons from the forearm attaching to them and also multiple pully systems for ensure ideal movement patterns.

It is safe the say the wrist and hand is a complex region with many anatomical articulations, ligaments, muscles, tendons, vasculature and sensory nerves all interacting to functionally provide us with the ability to grasp, feel and preform small motor movements such as writing.

What are the Causes of Hand and Wrist Pain?

Dupuytren’s Contracture

In this condition your finger becomes stuck in a bent position with an inability to straighten, this is called a contracture. The cause of this condition is an abnormally tight band on connective tissue in the palm of the hand. The exact reason why this occurs is unclear. Please click here to learn more about Dupuytren’s Contracture.

Carpal Tunnel Syndrome

This is a common condition found in office workers and manual laborers who use their hands repetitively and throughout the day. Carpal Tunnel Syndrome (CTS) is caused by compression of the median nerve that runs on the front aspect of the wrist into the hand and innervates the thumb and adjacent two and half fingers and nail beds. It also provides the motor input “wiring” to important muscles of the thumb. On its path through the wrist is travels through the “carpal tunnel” which is an anatomically small space and prone to compression due to the multiple tendons that run through it while having carpals and a thick band of connective tissue minimizing the space. Symptoms of CTS will appear as nerve pain in the hand, tingling, numbness, and weakness and will be more apparent at night. Please click here to learn more about Carpal Tunnel Syndrome.

De Quervians Tenosynovitis

This is the most common tendon issue in the wrist. It is created when there is irritation of the tendons coming from the forearm down to insert on your thumb. It is caused by overuse or forceful wrist and thumb movements. If you are suffering from this condition you will have pain located at the base of your thumb and wrist, pain with thumb/wrist movements and gripping. It can be common in office workers who type and mouse daily. Please click here to learn more about De Quervians Tenosynovitis.

Scaphoid Fracture

The scaphoid is one of the eight carpal bones located in the row closest to the wrist on the thumb side. The bone can be damaged with a fall onto your hand. A fracture to this bone is more clinically significant as it is harder to catch on initial X-rays and it has a more vulnerable blood supply that can lead to complications with healing. It is important that this type of fracture is diagnosed and treated correctly and you are seeing a health care professional that can help determine this for you.

Wrist fracture

There are many different types of fractures that can occur at the wrist, the most common being a Collies fracture. This type of fracture is when the bone of your forearm, specifically the radius is disrupted just before it articulates with the carpals to become the wrist joint. This type of fracture can vary in severity and may need to be reset manually at a fracture clinic or with a surgical intervention. Typically, a patient is casted for six weeks to allow the bone to heal and following this will need manual therapy and rehabilitation to regain range and strength.

Triangular Fibrocartilage Complex (TFCC) Sprain

This is when the TFCC has been damaged, either by a tear or irritation of its structures. It can occur with repetitive heavy loading of the wrist when pushing off a surface or post wrist fracture. It will result with pain along the outside of the wrist, decreased in the range of motion, possible clicking with movement and pain specially when loading to push.

Skiers Thumb

This is a sprain of tear to the ligament on the inside of the thumb joint. It is called Skier’s thumb as it can occur when you fall on an outstretched hand with a ski pole under your thumb creating the right leverage to sprain this ligament. It can vary in severity with the worst form also causing a small bony chip to break off at the ligament’s insertion to the bone. Most likely this will not occur and you will have a sprain that presents as pain, swelling and discomfort of the inside of your thumb. It may become stiff as it heals and then feel more unstable with wide thumb grip. It is important that you get proper treatment with a physiotherapist or chiropractor to ensure proper healing.

Ganglion Cyst

This is a small bump that feels firm or spongy and vary in size. It forms over joints or muscle tendons that are experiencing excessive friction from repetitive use or an underlying movement dysfunction. It is common in the hand and wrist but can occur in other areas of the body as well. It is a protective response from your body but over time can interfere with movement and become inflamed and painful. Please click here to learn more about Ganglion Cysts.

Trigger Finger

This condition presents when your finger catches or clicks when you open your hand. It also does not close easily and when forced to fully bend has difficulty straightening back out. It is caused when there is irritation of the anchor’s “pulleys” of the tendons of the fingers. This causes them to not glide well and results in thickening of tissue interfering with proper movement.

Osteoarthritis (OA) of the Hands

The thumb and fingers are more susceptible to OA throughout a lifetime due the repetitive use of these joints throughout the day. Particularly, the thumb joint is common to have OA changes. OA of the hand can lead to deformity or increase size of the joints (knuckles) and can make daily tasks more painful or impossible to complete. Please click here to learn more about Osteoarthritis.

How can Physiotherapy, Chiropractic, and Massage Therapy help your hand and wrist pain?

A team of healthcare professionals can personalize and direct your treatments to address your specific injury, your goals and help recover from faster. The hand and wrist are a complex area and here at Sunup Physiotherapy we have a few therapists with special interest on their treatment and recovery. Treatment with a Physiotherapist or Chiropractor can include controlling pain with therapeutic modalities, acupuncture or dry needling, improve range of motion of a joint with hands on manual therapy or manipulation, strength and motor control with exercises. The need for a brace or finger splinting can also be indicated and prescribed by our practitioners. Soft tissue release is also important and may require massage therapy treatment to reduce muscles tone and relax the nervous system. If your hand and or wrist injury is severe or appears to not be improving your physiotherapist or chiropractor will suggest you get assessed by a physician who can refer out for imaging if deemed necessary.

How Long Does it Take to Recover from Hand and Wrist Pain?

Depending on the cause, severity and what tissue is damaged recovery can take a few weeks up to months. It is important to understand what is happening and to seek guidance and treatment from a qualified health practitioner as soon as possible. Remember to be patient and consistent with your exercise program and follow their advice. Keep in mind that your physiotherapist and/or chiropractor treats these types of conditions regularly and will help you recover as quickly as possible.

What are the Best Exercises to Help with your Hand and Wrist Pain?

A well-rounded program should include range of motion, strengthening, and flexibility of the hand and wrist. These exercises should be individualized to your particular needs and goals. If you are returning to a particular activity the final exercise program will be catered to movements and forces required.

Some of the most commonly prescribed exercises are below, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after their performance.

For motor retraining please preform the exercises below slow and controlled paying close attention to good form, try as many reps until fatigue then repeat for 2 more sets.

  • “Wrist Curls” Strengthening Exercises: To perform these two exercises take a light weight and do repetitive slow controlled curls in both directions (palm up and down). The amount of weight depends on what you can tolerate without pain, we suggest using a soup can or a slightly heavier 2-5 lb dumbbell.
  • Lumbrical and Grip Strength: This can be done using a stress ball, putty or by just creating tension in your mid palm by opening and closing your hand like a talking puppet. Keep your fingers straight and hollow out the mid palm with your movement.
  • Forearm and Finger/Hand Stretching: Perform these exercises with your wrist and hand in two positions. In both, straighten your elbow with your arm out in front. To stretch the back of your forearm, palm faces the ground, make a closed fist and bend your wrist downwards. For the front of the forearm, palm faces the ceiling, splay your hand open, straighten your fingers and bend your wrist and hand down to the ground. In both positions use your other hand to apply over pressure as tolerated. Make sure the stretch does not feel painful, just like a gentle pulling sensation. Hold 30 seconds and repeat 2-3x.
  • Hand Tendon Gliding: Make a straight fist, table top fist, claw grip, straight fist and composite fist. Repeat 5 times per grip, every 2-3 hours.

How to Treat Hand and Wrist Pain at Home?

  • If you have recent injury of your wrist and hand, you may first want to try a contrast bath. This will help to control the swelling and bruising. To prepare you will need two buckets, one with ice cold water and the other with warm. Place your hand in one bucket for 2 min then then other. Always end with cold. This will help you control swelling. If there is minimal swelling but the tissue is warm and painful ice might be the best choice. Apply ice with some compression to the tissue for up to 10min then remove for 10min and repeat up to 3x or as needed. This can be done every two hours or as needed.
  • Protect your hand and wrist and avoid aggravation. There is tissue that has been damaged and you do not want to continue to add strain on this area, it needs the right amount of rest to be able to heal, especially early on. There are numerous bracing options that you can try.
  • Try the above-mentioned contrast bath as tolerated.
  • If the pain continues and does not respond to the aforementioned strategies, consultation with our practitioners is highly recommended.

If you are experiencing hand and wrist pain an assessment and treatment for Physiotherapy, Chiropractic and/or Massage Therapist is highly encouraged. Contact us today!

Dupuytren’s Contracture

Do you have a finger that’s stuck in a bent position, and no matter what you try to do, it won’t straighten out? It could be that you have a condition called Dupuytren’s Contracture. Dupuytren’s can be very frustrating to live with as it makes usually simple tasks in life like putting on a glove very challenging. As such, people often find their hobbies like gardening, carpentry, or gymnastics very unenjoyable.

What is a Dupuytren’s Contracture?

A hallmark sign of Dupuytren’s is a finger that is stuck in a bent (or flexed position) (Figure 1). The inability to straighten your finger no matter what you try is called a contracture. People may also feel a lump or thick band in the palm of their hand as well, which is a sign of local overgrowth of a certain kind of tissue in the palm called collagen in a structure called the palmar fascia (Figure 1).

Figure 1. Thickening of the palmar fascia resulting in nodules or taught bands felt in the palm often leads to a bent finger that is unable to extend fully.

What Causes Dupuytren Contracture?

The etiology of Dupuytren’s is not clearly understood. The most common risk factors include diabetes mellitus, family history, alcohol, and smoking.

How can Physiotherapy and/or Chiropractic Help with Dupuytren’s Contracture?

Treatment for Dupuytren’s often includes surgery/injections, which will break apart the collagen overgrowth to improve extension (or finger straightening) range of motion . After surgery, a custom splint should be worn during the day to preserve your new finger range of motion. In addition to wearing a splint, certain exercises will need to be done to restore hand function. There are numerous secondary issues that arise with having your finger stuck in a bent position. For example, ligaments, tendons, and nerves surrounding the bent finger may become shortened, which further affect range of motion . Your physiotherapist, and/or chiropractor  will know what range of motion exercises to prescribe to you, what modalities such as heat or ice should be used to manage your pain, and what strengthening exercises are appropriate to help improve your hand function.

What Should be Avoided with Dupuytren Contractures?

Generally speaking, you should limit activities that cause excessive pain as it has little therapeutic value.

How Long Does it Take to Recover from Dupuytren’s Contractures?

The whole process of rehabilitation for Dupuytren’s Contracture will take at least 3 months where you have intermittent follow-ups with your therapist and surgeon. Treatment can often extend beyond 3 months so that further hand function and strength can be optimized so that you can return to all your hobbies.

What are Safe Home Exercises I can do for Dupuytren’s Contracture?

Without surgery and rehabilitation, the chances of fixing your Dupuytren’s Contracture at home is very low as exercises aimed at improving your range of motion will at best likely only help you to maintain your current range of motion. Things you can do at home to maintain your range of motion include (Figure 2):

A. Making a straight hand.

B. Making a table top fist.

C. Making a claw fist

D. Making a straight fist

E. Making a full fist

Figure 2. A. Straight hand, B. Table top fist, C. Claw fist, D. Straight fist, E. Full fist. To manage pain, ice or heat can be applied to your hand for 15 min at a time.

If you suspect that you have a Dupuytren’s Contracture, consider booking a Physiotherapy or Chiropractic  assessment to have your range of motion, strength and functional abilities assessed. As you might get a referral to see specialist and wait for your appointment, your Physiotherapist or Chiropractor  will likely be able to help you with managing pain, and also in optimizing existing hand function so that you can continue to enjoy your hobbies. Contact us today!

Carpal Tunnel Syndrome

Have you experienced tingling or numbness in your first three fingers or a sudden sharp pain that shoots from your wrist into your fingers? Are these symptoms more severe when you are using your hands for tasks such as gripping, fine dexterity or even while you are typing or using the mouse on your computer? You might be suffering from carpal tunnel syndrome, which is a painful condition caused by compression of your nerve at your wrist. Carpal tunnel syndrome is a condition that occurs when the median nerve, which travels from your neck, down your arm into your wrist becomes entrapped or compressed by the carpal tunnel (a tunnel formed by connective tissue at the wrist). It is very common to be misdiagnosed with carpal tunnel syndrome if the median nerve is compressed in another region that it travels through such as in the muscles of the neck, upper arm or forearm. The symptoms of median nerve compression in another region will be very similar to carpal tunnel syndrome but will usually be associated with symptoms in other areas such as the neck, upper arm or forearm as well. Your physiotherapist or chiropractor will conduct a thorough assessment of your upper extremity to determine where the nerve is entrapped and if it is indeed coming from compression via the carpal tunnel. The carpal tunnel is a narrow passageway at the base of the palmar side of the hand where the median nerve travels through along with tendons of the forearm. If the connective tissue that forms the carpal tunnel becomes thickened or the contents travelling through the carpal tunnel become swollen or irritated then there is risk of compression to the median nerve. When the median nerve is compressed, it can disrupt the conductivity of the nerve and result in pain, loss of strength, tingling in the regions that the nerve controls.

What symptoms will you experience with Carpal Tunnel Syndrome?

Typically symptoms will develop gradually and worsen with further repetitive use of the wrist, forearms and fingers. You will notice that symptoms worsen when your wrist is in positions of extreme flexion, extension or with tasks that require gripping. You might experience burning, tingling, numbness, and or an aching sensation in the palm of your hand, your thumb, index and middle fingers. Also, you may note that your fingers feel swollen. Sufferers may also notice a decrease in grip strength, decreased coordination or issues with other fine motor tasks required by your hands and fingers.

Treatment for Carpal Tunnel Syndrome

If your physiotherapist or chiropractor determines that your symptoms are due to carpal tunnel syndrome then there are many treatment options that you will benefit from. Your therapist will use a combination of soft tissue release techniques, joint mobilizations, nerve flossing strategies (to improve nerve mobility in the soft tissues), as well as acupuncture, ultrasound and laser therapy to facilitate healing. Your therapist will also determine which muscle imbalances exist in your upper extremity and provide you with an individualized exercise program that will prevent this issue from recurring. You will learn a variety of self-management strategies in addition to learning about ideal posture and ergonomics so that you may achieve the best long-term outcomes. If you have many tight muscles that are contributing to your condition, then your physiotherapist may recommend registered massage therapy to speed up healing and help relieve your symptoms quickly. There are many braces and splints that may benefit you as well in the short term while your nerve is healing. If you are not responding to conservative management then your physiotherapist or chiropractor will refer you to a sports medicine physician who may recommend more invasive treatment options that may include surgery or injections. For more information or to speak with our physiotherapists or chiropractors, contact us today!

DeQuervain’s Tenosynovitis

What is DeQuervain’s Tenosynovitis?

DeQuervains tenosynovitis is a painful condition caused by an irritation of the tendons that are on the thumb side of your wrist. A tendon is the thin, ropey part of the muscle that connects the muscle to the bone. When a muscle contracts it tugs on the tendon and that pulls the bone so that our joints can move. DeQuervains is a condition where the tendons that move your thumb becomes inflamed. It is usually caused by repetitive overuse and stress of these tendons. Some activities that can lead to this injury include caring for your baby, typing on your smartphone, improper ergonomics with your mouse, video gaming, gardening and sports such as golf, tennis, badminton and even weight lifting.

What are the Symptoms of DeQuervain’s Tenosynovitis?

Most individuals with DeQuervain’s Tenosynovitis will report pain that is localized at the base of the thumb. It is not uncommon for the pain to be felt over the boney bump close to your wrist. If the condition has progressed or is persistent, you may notice swelling and redness as well. You might notice a locking or resistance when you are trying to move your thumb and any thumb or wrist movements may aggravate your symptoms. You will particularly notice pain when you are grasping or pinching with your thumb or lifting objects with your wrist in awkward positions.

How can Physiotherapy or Chiropractic Treatment Help?

Your physiotherapist or chiropractor will conduct an initial assessment to determine if you in fact have DeQuervain’s Tenosynovitis and if so what contributing factors are associated with your condition. They will then create an individualized treatment plan that targets your specific contributing issues. The physiotherapist or chiropractor will use a combination of manual therapy, soft tissue release techniques, acupuncture, laser, ultrasound and taping to help relieve your symptoms and regenerate your tendons. They will also educate you on proper wrist positioning when performing recreational activities as well as day-to-day activities. Further, they may advise you to use a brace temporarily to allow for adequate rest of injured tissues in order to allow for optimal recovery. Once your symptoms are managed, they will teach you how to build up strength in this area in order to prevent future recurrences.

What are the Best Exercises for DeQuervain’s Tenosynovitis?

  1. Controlled Active Range of Motion of the Thumb: For this exercise you are going to hold your hand out in front of you with your palm facing the floor. First you will move your thumb up and down the vertical direct 10x, then you will repeat that in the horizontal direction 10x. Be sure to stay in a pain free range of movement.
  2. Wrist Radial Deviation Strengthening: Clasp your hand gently, with your thumb up towards the ceiling, hold onto a light weight (1-2lbs) in the palm of your hand. From here deviate your wrist up and down like you are bringing a cup towards your mouth. Perform 10-15 reps 3x/day.
  3. Grip and Finger Strengthening: Use a stress ball to strengthen the palm and finger flexors. Then use an elastic wrapped around the outside of your lower fingers and splay your fingers open. Repeat this for 1 min or until fatigued in both directions a few times a day.
  4. Forearm Stretching: Put your hands into a prayer pose, palms facing one another and your elbows pointing out to the side. Maintain this position while moving your hands side to side along the horizontal. Also, while keeping your elbows wide, try to rotate/swivel your wrists and fingers around so that the fingers are pointing ahead of you, and rotate backward so that your fingers and wrist are pointing towards your breast bone. You can also try this maneuver with the backs of your hands touching instead of your palms.

Warning– DO NOT push through pain when doing exercises or if you find the exercises aggravate your symptoms modify or stop doing them.

How to Treat DeQuervain’s Tenosynovitis at Home?

Start with applying ice over the area of soreness. 10 min ON/OFF with compression 3x/day.

You can purchase a brace that immobilizes the thumb. This can be worn when you are doing aggravating activities such as carrying groceries or typing.

Perform the active range of motion, stretching and strengthening exercises as described above.

If you are experiencing symptoms of DeQuervain’s and they are not improving within a two-week timeline. It is important that you get it assessed and treated by your trusted physiotherapist or chiropractor.

What is the Expected Recovery Time for DeQuervain’s Tenosynovitis?

If you don’t seek help quickly, your condition may worsen and take longer to recover.

When you seek treatment from an experienced physiotherapist or chiropractor in a timely manner, you will see improvement in your condition within a few sessions and will likely make a full recovery within 4 to 6 weeks. In more severe cases it could take a few months especially if it is hard for you to modify your lifestyle.

If symptoms are not improving the physical therapist or chiropractor will recommend you visit a sports medicine doctor for further investigation.

At Sunup Physiotherapy, our physiotherapists have a great deal of experience dealing with DeQuervain’s Tenosynovitis in addition to many other tendinopathies. Our evidenced based, individualized multimodal approach to rehabilitation has proven to be extremely successful. Contact us Today!

Wrist Fractures

The two most common types of wrist fractures are Colles’ fractures and Smith’s fractures. A Colles’ fracture is a fracture of the distal radius in the forearm just above the wrist and it usually results in a posterior displacement of the bone. A Smith’s fracture is also a fracture of the distal radius in the forearm just above the wrist, it usually results with a volar/anterior displacement of the bone.

What Causes Wrist Fractures?

A Colles’ fracture usually occurs with a fall onto an outstretched hand with the wrist in extension. A Smith’s fracture usually occurs with a fall onto a flexed wrist.

How Can Physiotherapy, Chiropractic and/or Massage Therapy Help Treat Wrist Fractures?

Patients with wrist fractures are usually casted for 6-8 weeks and then sent for physiotherapy, chiropractic and/or massage therapy treatment after. When a joint is immobilized in a cast, there will be bone healing but there will be associated joint hypomobility/stiffness and muscle atrophy, tightness and weakness. Physiotherapy, chiropractic and massage can help with mobilizations to increase joint range-of-motion, soft tissue release work to loosen tight muscles and teaching a patient strengthening exercises to restore strength and function. They may also use acupuncture and modalities for pain control.

The practitioner will also look at the other joints of the upper extremity quadrant as the patient will usually not be using the affected wrist/limb in a normal way and there may be other issues to address.

What Should be Avoided with a Wrist Injury?

There is nothing specifically that a patient should avoid when they have a wrist fractures. One word of advice would be to not over protect the arm and hold the arm in the cast close to the body at all times. Make sure that you are moving the elbow, shoulder and fingers (if able) through full range-of-motion 10 times 4-5 times per day.

Decreasing the risk of falling again would be something to be concerned about.

How Long Does it Take to Recover from Wrist Injuries?

Bone healing takes about 6-8 weeks and usually occurs during the time that the patient is casted. It usually takes another 2-3 months to restore full range-of-motion, strength and function in the wrist. Like with any other injuries, the earlier a patient gets in for rehabilitation, the better.

What are Some Safe Home Exercises for Wrist Injuries?

Range-of-motion (circles, drawing letters of the alphabet) of the wrist, thumb (circles) and fingers (opening/closing) are easy exercises to do at home. Rolling and stretching of the wrist flexor/extensor muscles will help to reduce the tightness/soreness in these muscles. Lastly, wrist flexion and extension curls with no/light weight to start will help to strengthen the muscles.

To book an assessment with our physiotherapist or chiropractor following wrist fracture(s). Contact us today!

Skiers Thumb

Skiers thumb is a term used to describe an injury that often happens to skiers during a fall, which results in an injury to the ulnar collateral ligament (UCL) of the thumb metacarpophalangeal joint.

Pain is usually localized at the base of the thumb along the web space between the first (thumb) and second (index) finger. Swelling may accompany the injury especially in cases where a fracture is present. Since the UCL ligament provides passive stability to the thumb during pinching and gripping activities, people affected by this injury may report additional weakness with gripping activities, which can often limit participation in day-to-day activities, work, and sports.

Injuries to the UCL can range from a partial or full tear of the ligament (ie. sprained ligament) to distal avulsion fracture of the UCL at the base of the thumb proximal phalanx or metacarpal head. Some research articles suggest that in some instances, an associated Sterner lesion may occur, which describes the displacement of the avulsed UCL outside of the adductor aponeurosis. If this occurs, surgery is often indicated to reattach the avulsed fragment.

Causes of Skiers Thumb Condition?

The UCL at the base of the thumb is 12-14 mm in length and 4-8 mm in width. There are two portions to the ligament: the accessory UCL and the proper UCL. The accessory UCL is taut in full thumb extension, while the proper UCL is taut in 30 degrees of thumb Metacarpophalangeal (MCP) flexion. Given these properties, the accessory UCL is often disrupted through a valgus (or radial) hyperabduction force when the thumb is in full extension, while the proper UCL is often disrupted through a valgus (or radial) hyperabduction force when the thumb is in 30 degrees of MCP flexion. Situations in which this may occur include falls during skiing, goalkeeping in soccer, when a ball or racket strikes the ulnar aspect of the thumb.

How can Physiotherapy, Chiropractic and/or Massage Therapy Help with Skiers Thumb?

The key to treating thumb UCL sprains is to assess it properly. The presence of a fracture or sterner lesion requires immediate consultation with a medical doctor to determine whether surgery is indicated. If your Physiotherapist, Chiropractor, or massage therapist suspects that you have a fracture or sterner lesion, the recommendation to obtain further images should be made. Upon obtaining an X-ray and ruling out a fracture and sterner lesion, your therapist will conduct a physical stress test at the MCP joint in both extension and 30 degrees of MCP flexion to assess the level of laxity in the thumb. If a fracture or sterner lesion is present, your practitioner should be cautious with the stress test and determine whether it is necessary or indicated to assess the stability of the joint initially.

Depending on the severity of your injury, you may be immobilized in a splint or cast for 4 to 6 weeks. By 6 to 8 weeks of your injury, mobilization and strengthening exercises should be underway. Your therapist will be able to guide you through what exercises you should do, how to protect your thumb so that you can engage in your day to day activities, and when it is safe to return to sport.

Treatment of UCL thumb sprains can include manual therapy, soft tissue work, exercises, acupuncture/dry needling, taping, or splinting.

What Should be Avoided with Skiers Thumb Injury?

Avoid radially directed hyper-abduction forces in your day-to-day tasks. Avoid participating in sports without first consulting with your licensed practitioner who can provide clear guidance on the specific tasks and interests that you would like to participate in. Repetitive pinching and gripping tasks can also irritate your thumb, so limiting your participation in activities such as writing and typing may be indicated. If you must do these tasks, your therapist may be able to guide you on how to perform these tasks with greater safety and reduce the likelihood of re-injury.

How Long Does it Take to Recover from Skiers Thumb?

Generally speaking, it takes 8-12 weeks for the ligament and/or associated fractures to heal. With that said, it is not uncommon for rehabilitation to extend to 3-6 months for functional rehabilitation if your physical demands require higher functioning (i.e. playing hockey, working in construction etc.).

What are Safe Home Exercises for Skiers thumb?

skiiers thumb home exercisesIf a fracture or sterner lesion is ruled out, some safe home exercises that you can do include the following fists. Ice can also be applied to your hand to reduce the formation of swelling. Please listen to your body however, if performing any of these activities makes your pain worse, please stop immediately and consult with your certified health care practitioner first.

To get relief from a thumb pain today, book an assessment with our physiotherapist or chiropractor.  Contact us today!

Ganglion Cysts

A Ganglion cyst is a small fluid-filled sac that can develop along the tendons or your joints. They are most commonly found in the wrist and hands but they may also develop in the foot or the knee. Most cysts’ will look like a lump and may feel firm or spongy when they are touched. The majority of ganglion cysts are painless however; some may become painful, tender to the touch, cause weakness or even tingling in the area and may interfere with the joint’s range of motion.

What Causes Ganglion Cysts?

Ganglion CystSome theories suggest repetitive microtrauma may lead to the development of a cyst but there is no general consensus on this. They can also appear spontaneously, and are 3 times more likely to affect women over men. The hand on the photo belongs to my niece, who developed this ganglion cyst handwriting essays and taking notes while preparing for exams.

Signs and Symptoms of Ganglion Cysts

  • A visible lump/mass that may fluctuate in size
  • It may feel firm and tender to touch
  • The pain (if present) may increase with movement of a joint (i.e. bending the wrist)

How Can Physiotherapy Help with Ganglion Cysts?

Most cysts (38%-58%) resolve on their own if they are left untreated. However, if the cyst is painful and interfering with daily activities, physiotherapy can help to improve your pain and function.

  • Education about modifying activities/exercises
  • Role of using a more neutral grip during daily activities (wrist kept straight)
  • Finding the potential aggravating factors and help with load modification
  • Use of a brace/tape/compression (if applicable)
  • Gentle manual therapy for forearm and hands if needed
  • Shockwave Therapy / Laser/ultrasound/acupuncture to help reduce inflammation and pain
  • Exercises aiming to normalize movement of the hand/foot

If conservative management has not been effective, surgical intervention may be required to remove the ganglion cyst, if it continues to be troublesome. Physiotherapy is usually recommended after the procedure to help normalize the use of the joint affected. For instance, if the cyst is removed from the wrist, it may become stiff afterwards. Physiotherapy can help improve the range of motion with manual therapy and creating an appropriate home exercise program. Modalities such as laser and ultrasound can be used for inflammation in the area. Scar tissue massage can also be performed to help prevent the buildup of excessive scar tissue around the incision site.

Exercises for Ganglion Cysts

  • Tendon Glides (Claw, Fist, Tabletop)
  • Wrist ROM (Flexion, Extension, Ulnar Deviations And Radial Deviations)
  • Isometric Wrist Flexion, Extension, Ulnar Deviations And Radial Deviations
  • Wrist CARs Fingers Straight And Bent

To get relief from a ganglion cysts pain today, book an assessment with our physiotherapist or chiropractor.  Contact us today!

Trigger Finger

What Triggers Your Finger?

Do you have a finger that catches or clicks whenever you make a fist and is unable to extend on its own unless you passively flick it back into extension? Do you have a finger that can’t close into flexion when you make a fist but when you passively put your finger into flexion, you aren’t able to extend it again? Do you have a finger that is stuck in a flexed position and you cannot unlock back into extension no matter how hard you try? If any of the above descriptors sounds familiar to you, it may be that you have a condition called “Trigger Finger”.

Throughout your lifetime, you have a 2% chance of acquiring trigger finger. If you have it, there’s a likely chance that it is interfering with your work, your sports like golf, rock climbing, tennis, or even day-to-day activities like cooking, brushing your teeth, or holding a bag. So how does Trigger Finger work and what can you do about it?

What is Trigger Finger?

Trigger Finger is also known as stenosing tenosynovitis. Your hand is a very complex body part with numerous pulley systems throughout out the finger. These pulleys act as anchors for tendons that pass underneath them so that you are able to move your fingers into different positions. Your hand has the ability to make many different shapes, which include hook fist, straight fist, composite fist, table top fist (crimp grip for rock climbers!), and put your hand into full extension (Figure 1.)

A. Making a straight hand.

B. Making a table top fist.

C. Making a claw fist

D. Making a straight fist

E. Making a full fist

Figure 1. A. Straight hand, B. Table top fist, C. Claw fist, D. Straight fist, E. Full fist. To manage pain, ice or heat can be applied to your hand for 15 min at a time.

When you make the different types of fist, the tendons in your hand glide underneath the pulleys, which can be a source of irritation. In Trigger Finger, an enlarged flexor tendon or pulley may become entrapped with one another. Pain may be present over the area of entrapment and a subsequent trigger of the adjacent, distal joint may arise. Trigger finger usually occurs at the site of the A1 pulley where a thickening/bump can be felt. In this situation a trigger can be seen at the proximal interphalangeal joint (PIPJ) (Figure 2).

Figure 2. Trigger Finger Pathophysiology. Swollen tendon becomes entrapped underneath A1 pulley.

Less commonly, trigger finger can also be observed at the A3 pulley, where pain is felt over the PIPJ and a triggering occurs at the distal interphalangeal joint (DIPJ). (Figure 2). Regardless of where the trigger finger is, the act of making a fist can cause your finger to click, recreate your pain, or get stuck into flexion.

What Causes Trigger Finger?

The cause of trigger finger is often unknown (ie. Idopathic trigger finger), however, it can be associated with trauma, diabetes mellitus, rheumatoid arthritis, carpal tunnel syndrome, De Quervain’s tenosynovitis.

How Can Physiotherapy and Chiropractic Help with Trigger Finger?

Trigger finger can be tricky to treat, because if you, your Physiotherapist, or Chiropractor do not have the right expectations or an effective protocol in place, you may not find rehabilitation very successful, resulting in unnecessary injections or surgery. Effective treatment includes taping to correcting finger alignment, prescribing and wearing an appropriate splint (that does not need to be bulky, highly restricting or cosmetically unappealing), activity modification, self-massage, use of thermal modalities, and a set of exercises to promote proper mobility of the finger.

What Should Be Avoided With Trigger Finger?

As much as possible, you should avoid letting your finger lock or click. Therefore, work within your pain free and click free range of motion. This can be tricky to avoid, however with the right guidance and recommendations, there are ways to modify the way you do things and splints that can be used to prevent you from letting your finger lock or click.

What Are Some Safe Home Exercises I Can Do For Trigger Finger?

  • Apply heat for 15 min over the palpable bump on your hand where pain is often felt.
  • Make a straight fist, table top fist, claw grip, straight fist and composite fist without allowing your finger to trigger. Repeat 5 times per grip, every 2-3 hours (Figure 1).
  • Gently massage the palpable bump with your unaffected hand for about 5 min a day.
  • Modify the way you do things in your day-to-day to reduce the number of triggering events.
  • Purchase the proper splint and wear it correctly for the prescribed duration. (Splinting is a critical component to treating trigger finger effectively; therefore your compliance with splinting is strongly correlated to your outcome).

If you suspect you have trigger finger, consider booking an appointment with one of our Physiotherapists or Chiropractors, who will be able to guide you through your process of rehabilitation. Contact us today!