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The hand and wrist

are extremely susceptible to injury/overuse syndromes. Distal radius, colles, and scaphoid fractures, skiers thumb, and carpal tunnel syndrome can be treated with a variety of modalities and hand/wrist strengthening tools to improve and eliminate these and other hand/wrist injuries.

Carpal Tunnel Syndrome

The carpal tunnel is a structure formed by several bones and ligaments in the wrist, allowing passage of a number of muscle tendons, nerves, and arteries traveling from the forearm to the hand. As space is limited, even slight inflammation in the tunnel can cause problems, notably compression of the median nerve as it passes through the space. Signs and symptoms of median nerve compression include numbness or tingling in the hand and fingers, pain, visible loss of hand muscle (atrophy), and difficulty using the hand. Casting or surgery will be indicated, depending on the severity of the fracture, to ensure proper bone alignment during healing, followed by physical therapy to strengthen hand muscles and regain hand and wrist range of motion.

Distal Radius Fracture / Colles Fracture

The radius is the bone that runs down the lateral side of the forearm from the elbow to the thumb side of the wrist. Fracture to the distal (closest to the hand) portion of this bone is known as a Colles fracture and is the most common type of broken wrist. Injury usually occurs with a fall onto an outstretched hand and results in a “dinner fork deformity”, created by a change in position of the hand and wrist relative to the forearm. Signs and symptoms include pain, swelling, tenderness, and loss of motion in the wrist and hand.

Scaphoid Fracture

The scaphoid is a wrist bone that sits at the base of the thumb. Injury most often results from a fall onto the heel of the hand, resulting in a fracture. Signs and symptoms include pain and tenderness over the broken bone, as well as swelling and bruising. Immobilization is required until bone healing has occurred, followed by physical therapy to regain strength and range of motion in the hand and wrist. It is important to recognize that blood supply to the scaphoid is limited to the central portion of the bone. Thus, a fracture to the outer region may be complicated by further tissue destruction secondary to lack of oxygen and other elements necessary for healing (avascular necrosis).

Skier’s Thumb (Gamekeeper’s Thumb)

The ulnar collateral ligament of the thumb provides stability on the medial side (closest to the index finger) of the joint. When the thumb is forced into extension and abduction, this ligament can tear, called “Skier’s Thumb” because it commonly occurs when a ski pole becomes stuck in the ground, forcefully pulling the thumb away from the hand. Signs and symptoms include pain and tenderness on the medial side of the thumb, as well as impaired use of thumb during gripping activities. In addition to rest, ice, and medications to reduce pain and optimize healing, physical therapy is indicated to strengthen hand muscles and provide stability to the thumb joint.