Your hands, elbows, and wrists are complex structures that work together to allow daily function and activities. The hands are responsible for intricate movements and fine tactile work while under high strain and demand over time. The complex hand structure of small bones, connective tissue, muscles, ligaments, and tendons work as a unit to perform tasks. The wrist and elbow joints anchor the muscles responsible for wrist and hand movements, allowing for steady hand movements and dexterity.
Hand, wrist, and elbow pain can be debilitating and render the body parts ineffective. Since these joints are responsible for many tasks, they are also highly prone to overuse and acute traumatic injuries. Some repetitive motion or common overuse conditions include medial (golfer’s elbow) or lateral (tennis elbow) epicondylitis, tendonitis or tenosynovitis, and carpal tunnel syndrome. Additional common conditions or causes for pain include arthritic conditions, muscle strains, ligament sprains, fractures, ganglion cysts, or referrals from elsewhere in the body (e.g. nerve roots in the neck).
A sudden impact, traumatic force, or a fall on an outstretched hand (FOOSH) are mechanisms for acute or traumatic injuries of the hand, wrist or elbow. More chronic conditions like tendinitis or arthritis can be caused by repetitive motion and strain or inflammatory processes, respectively.
Physiotherapy can help relieve your elbow, wrist, or hand pain by addressing the root cause of your dysfunction, creating a treatment plan, and modifying daily activities to complement your treatment. Physiotherapists will assess your condition, physical limitations and capabilities, goals, lifestyle, and other factors. This assessment will give them a better understanding of the cause of your pain, the range of motion, strength, and function accessible to you, and the demands of your daily life.
From here, the physiotherapist can work to reduce your symptoms and promote pain relief through individualized education, ergonomic training, activity and lifestyle modifications, therapeutic exercises, and other treatments such as manual therapy or dry needling.
Elbow pain can be debilitating and affect your ability to carry out daily activities. Overuse of the joint, surrounding musculature and soft tissue can commonly cause elbow pain. However, elbow pain can also result from sports injuries or a traumatic event such as a fall. While arthritic conditions can occur, the elbow is generally less prone to degeneration from wear and tear than other joints.
Some common causes of elbow pain include:
- Fracture - A broken arm or elbow bone can cause pain in and around the elbow joint.
- Elbow bursitis - irritation of the bursa - fluid-filled sacs that cushion and reduce friction between tissues at the joints - can cause pain in the elbow joint. A fall or impact directly on the elbow or repetitive movements of the elbow joint can cause bursitis. Symptoms include aching or stiff elbow joints, tenderness on palpation, swelling, redness, or the inability of the elbow to fully extend.
- Epicondylitis - Refers to inflammation/irritation or damage to the forearm/wrist tendons and muscles inserting onto the elbow bones. Note that epicondylopathy (and/or tendinosis) typically refers to longstanding tendon dysfunction in the absence of inflammatory markers. Said differently, think of healthy tendon like uncooked spaghetti. Tendinopathy is like cooked spaghetti. While it may or may not have discrete tears in the tendon, the tissue quality has been altered, resulting in increased irritability and decreased capacity for loading cycles.
- Medial Epicondylitis / Golfer’s Elbow - individuals will experience pain on the inside of the elbow to the wrist. This characterization of pain results from irritation of the wrist flexor muscles and their tendinous attachments. Repetitive strain from golfing, racquet sports, using hand tools, or tasks requiring continuous or repetitive gripping/grasping can cause golfer's elbow.
- Lateral Epicondylitis / Tennis Elbow - symptoms of tennis elbow include aches or pain on the outside of the elbow and down the forearm to the wrist, pain and weakness when grasping or gripping. Lateral epicondylitis is often caused by repetitive activities requiring continuous gripping, painting, using hand tools, or careers like dentistry, carpentry or being a meat butcher. As the name suggests, repetitive backhand strokes or serves in tennis or other racquet sports can often cause tennis elbow.
- Sprains - ligament sprains can occur following a traumatic event. When a ligament (tissue connecting bone to bone) experiences forces exceeding what it can tolerate, small strains or tears can occur, compromising the integrity of the tissue. This can cause pain and inflammation in the area. Sprains are common in sports injuries.
- Strains - muscle strains can occur from both overuse and acute events. Similar to sprains, when demands exceed the tissue capacity, microtears and stretching can occur in the muscle fibres causing pain and inflammation. People may experience pain or tenderness, redness or bruising, reduced range of motion or strength, and swelling.
- Cubital Tunnel Syndrome - CTS occurs when the ulnar nerve is irritated or inflamed as it passes through the cubital tunnel. The cubital tunnel has borders consisting of muscle, ligament and bone on the inside of the elbow. The cause of CTS is sometimes unknown. However, CTS can occur from injury to the area, repetitive elbow flexion, or frequent weight bearing/leaning on the elbows. Conditions like arthritis, previous fracture or dislocation, or bone spurs can also cause CTS. Symptoms include aching on the inside of the elbow, weakness when gripping or grasping, hand pain, or numbness and tingling in the pinky and ring fingers.
Whatever the root cause of your elbow pain, physiotherapy teams can work to determine the aggravating factors and provide lifestyle or activity modifications, education, therapeutic interventions and exercise to reduce your pain and symptoms.
Wrist pain is a common issue affecting multiple demographics and comes from many causes. Wrist pain can result from an acute injury (e.g. sprain, strain, or fracture), long-term factors like repetitive motions, overuse, carpal tunnel syndrome (inflammation that compresses the median nerve), or arthritis.
The anatomical structure of the wrist includes the radius, ulna, many small bones, ligaments, tendons, muscles, nerves, and other soft tissue. These structures connect your hand and forearm, allowing you to bend, straighten, and rotate your hand and wrist. Injury to any of the above tissues can cause symptoms in the wrist and hand. Acute injuries to the wrist may present with severe pain that is stabbing, achy or dull, constant or intermittent, and accompanied by swelling, bruising, or discoloration. Conversely, chronic pain may be achy, dull, sharp, or burning and may be constant or intermittent. You may also experience symptoms like weakness, numbness and tingling, or loss of sensation when dealing with nerve dysfunction.
Conservative measures such as physiotherapy can effectively treat wrist pain in most cases. Other interventions should be considered if conservative methods do not provide symptomatic relief. Invasive surgical procedures may be necessary in select cases. However, physiotherapy can likely help with pain relief and get you back to your normal level of function and mitigate the need for surgical interventions.
Following a thorough assessment, your physiotherapist can work with you to determine an individualized plan of care aimed at achieving your personal goals. This plan may include various aspects such as therapeutic exercises, manual therapy, IMS/dry needling, acupuncture, or referral to other members of a multidisciplinary rehabilitation team (e.g. massage therapist, psychologist, dietitian, etc).
A variety of culprits can cause hand pain. Hand pain can often be debilitating and render the use of the hand ineffective. The anatomical structures of the hand enable significant dexterity and movement. As such, dysfunction of the anatomical structures can cause extensive implications for daily activities, work, self-care, other tasks, and overall quality of life.
Many different soft tissues, ligaments, tendons, sheaths, muscles, and bones make up the structure of the hand. These structures and the upper limb work together to enable fine tactile work and carry out tasks. Some common problems that affect the hands include arthritic conditions (e.g. osteoarthritis, rheumatoid arthritis), nerve dysfunction (e.g. carpal tunnel syndrome), ganglion cysts, tenosynovitis and other tendon problems, fractures, ligament sprains, and muscle strains.
People dealing with hand problems may experience a variety of symptoms, such as pain (e.g. stabbing, dull, achy, sharp, burning, radiating), numbness or tingling, loss of or change in sensation, swelling, weakness or difficulty gripping/grasping objects, discolouration, stiffness, or malformations (e.g. bony nodules, cysts, swollen finger joints).
Physiotherapy teams can work with you to help relieve your symptoms and treat the cause of your hand pain. Your physical therapist can assess your physical limitations and capabilities, work with you to set objective goals and support you in achieving them through a treatment plan catering to your unique needs. This plan may include therapeutic exercise, education on more ergonomic-friendly positioning techniques, activity modification, manual therapy, IMS/dry needling or acupuncture, among other things. Additionally, your physical therapy team may refer you to other healthcare professionals for services or treatment options that complement your physiotherapy plan.
Adjuncts to your physio care may include pharmacological intervention through your physician, massage therapy, psychology services, personal training, and other things. Some people may experience more complex hand pain causes and could benefit from seeing a Certified Hand Therapist. CHTs are physical therapists who have completed extensive additional training in hand therapy.
Physical therapy can help relieve your symptoms of hand pain and get you on the path to improved quality of life. If your hand symptoms impact your life, contact your physiotherapist or other healthcare providers for rehabilitation support.
How Physiotherapy Can Provide Pain Relief
Elbow, wrist and hand pain can be debilitating and significantly impact one’s quality of life. Fortunately, many treatment options and resources are available to help you return to pain-free normal life. You may consult your healthcare provider to determine the best course of action if you are experiencing elbow, wrist or hand pain. In many cases, physiotherapy is the first step to treating your symptoms. Physiotherapy teams can work with you to develop a personalized treatment plan customized to your unique needs. At REP Physio, we provide multidisciplinary services to help rehabilitate many conditions and injuries.
What We Treat:
- Wrist pain
- Elbow pain
- Epicondylitis and epicondylopathy
- Tendinitis and tendinopathy
- Intersection syndrome
- DeQuervain’s Tenosynovitis
- Muscle strains
- Ligament sprains or strains
- Arthritic conditions (e.g. osteoarthritis, rheumatoid arthritis)
- Nerve compression, irritation, or injury
- Trigger finger
- Mallet finger
REP Physio’s approach to elbow, wrist and hand pain is multifaceted. Our physio team will take thorough personal, medical and activity histories, perform objective physical assessments, provide education on treatment options, and build custom treatment plans based on your goals. Plans may include various services, including therapeutic exercise targeting strength deficits or sports performance, manual therapy, acupuncture and intramuscular dry needling. If things are not adequately addressed, physiotherapists may employ more advanced treatment options. Advanced treatment may include but is not limited to diagnostic imaging referrals, passive joint range of motion splints, referral to specialists for further evaluation, pain management intervention, and treatment.
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