June 26

Severe Wrist Pain Physiotherapy

Wrist pain is very common among many different demographics. Wrist pain can result from an acute injury (e.g. sprain, strain, or fracture) or long-term factors like repetitive stress, overuse, carpal tunnel syndrome, or arthritis. Systematic reviews show that those who work physically demanding occupations or play sports have a higher prevalence of acute and chronic wrist pain than the general population. Despite a lower prevalence, the general population still commonly experiences wrist pain. It is crucial to address wrist pain as it can be debilitating and can impact your quality of life and ability to perform daily tasks and activities. While many cases of wrist pain can be treated effectively at home, healthcare providers can determine the cause of your wrist pain and provide informed care to help treat the cause of your wrist pain and your symptoms. 

What causes wrist pain?

The wrist joint has many small bones, connecting your hand and forearm that help you to bend, straighten, and rotate your hand and wrist. Injury to these bones or surrounding soft tissue, muscle, ligaments, tendons, or nerves can cause symptoms in the wrist and hand. Wrist pain has many common causes, including different forms of arthritis, carpal tunnel syndrome or soft tissue injury, among other things. You may experience pain due to the following:

  • Carpal Tunnel Syndrome - This causes aching, burning, numbness or tingling in the hand, fingers, and wrist. CTS occurs when the median nerve gets compressed at the wrist due to swelling from repetitive movements (e.g. typing, racquet sports, sewing, painting, writing) or excess weight squeezing the nerve within the canal. Other conditions like pregnancy, diabetes, premenstrual syndrome, hypothyroidism, or rheumatoid arthritis are risk factors that may cause swelling in the carpal tunnel. The median nerve travels through the wrist and provides feeling and movement to the hand.   

  • Osteoarthritis - This type of arthritis occurs with age and overuse. The cartilage between bones wears down, causing increased friction as bones rub together. This friction can cause pain, swelling and stiffness in the joint. 

  • Rheumatoid Arthritis - RA is an autoimmune disease that often first starts in the small joints of the hands and wrists. RA can cause joint pain, swelling, and stiffness in the wrist. RA typically affects both hands/wrists. 

  • Ganglion Cysts - Ganglion cysts are benign fluid-filled lumps that form on the wrist joint or tendons. Ganglion cysts are not dangerous or damaging and are often painless. However, if the cyst is large, it may press against the nerves in the wrist and cause discomfort and symptoms like a dull ache, numbness, or tingling. 

  • Tendinitis - Irritation of the tendons crossing the wrist can cause swelling, pain with movement, or tearing. A common form of tendinitis is De Quervain’s tenosynovitis. De Quervain’s tenosynovitis presents with severe pain along the thumb side of the wrist when combining thumb and wrist movements. 

  • Acute Injury - Wrist pain following a fall or traumatic event can be a sign of an acute injury, especially when the pain presents alongside bruising and swelling. Potential acute injuries are fractures to the small bones of the wrist or hand, ligament sprains or instability, muscle strains, or bursitis. 

Diagnosing your specific wrist pain issue

If you are experiencing wrist pain, your healthcare provider may recommend physical therapy. At REP Physio, our physical therapists would be happy to assist you on your road to recovery.

When seeing you for the first time, the physio will conduct a thorough subjective assessment to gather information about your wrist pain, symptoms and their timeline, goals, previous history, occupation, and how your wrist pain is affecting your daily activities. Once we have gathered this information, we will move on to an objective assessment of your wrist. This physical assessment will provide us with quantitative data such as your grip strength, range of motion, location of pain (e.g. the base of the thumb), and the integrity of your soft tissues. From here, your physio may provide you with a requisition for imaging studies (X-ray) if they feel the study will provide valuable information to support your rehabilitation plan. 

Once we have a good understanding of your experience with wrist pain, your functional limitations and abilities, and the structural integrity of your wrist, we can work together to create a rehabilitation protocol (e.g. therapeutic exercise, manual therapy, home programming) and get you back to doing your daily activities as soon and as safely as possible. 

Don’t over rely on painkillers

While taking over-the-counter (OTC) painkillers may provide significant symptomatic relief from your wrist pain, you should understand how they work and if they are helping you recover. OTC pain medications such as acetaminophen decrease pain sensations and fever but do not treat the actual injury itself. OTC NSAID medications such as ibuprofen or naproxen provide systemic anti-inflammatory properties to reduce pain and swelling in the body. These medications can be incredibly helpful in symptom management but are unlikely to treat the cause of your pain directly.

Ice packs can provide an analgesic effect and symptomatic relief as an alternative to painkillers.

Healthcare providers may recommend directed therapies such as corticosteroid injections to calm inflammation, especially if inflammation is the root of your wrist pain. However, even corticosteroids have a ceiling effect. Your provider may only perform a few before the risk of tissue damage is too high. 

If you are experiencing significant pain, you may benefit from seeking medical advice from your healthcare provider. They will guide treatment options and advise if different therapeutic interventions are for you (e.g. physical therapy or acupuncture).

REP Physio’s process for severe wrist pain

Just as not all wrist pain is the same, not all treatment plans will be the same. When you visit REP Physio for rehabilitation from severe wrist pain, our team will work with you to determine the best course of action for your unique ailment. Our collaborative approach enables you to participate in the therapeutic process and be confident you have the most individualized and personalized treatment plan possible. The physical therapists and other staff members will work to treat the root cause of your wrist pain, not just your symptoms. 

Your treatment options will differ based on the cause of your wrist pain. For example, individuals dealing with a fracture or soft tissue injury may require immobilization of their wrist and hand for a specified duration to allow for healing or for inflammation to settle down. Immobilization using a well-fitted wrist splint is the standard practice. Once the tissue has recovered to a certain level, we may alter the periods of immobilization. You may not have to wear the splint at all anymore or may transition from wearing it 24/7 to only during demanding activities. Early rehabilitation exercises may include isometric exercises and range of motion, progressing to strengthening and loaded therapeutic exercises in the later rehabilitation stages. Finally, we will advance to work or task-related demands. 

Certain conditions and causes of wrist pain do not require immobilization. Therefore, the early stage of rehabilitation can commence even sooner. Each rehab phase has a general guideline of what type of exercises to include, but discretion lies with your physical therapist when considering the specific exercises and parameters used in your treatment plan. They will customize each stage depending on your tissue response to demands and tissue tolerance. 

In some cases, referral from elsewhere in the body can cause wrist pain, such as from irritated nerve roots in the cervical spine. In this case, your physical therapist will likely focus on treating the spine rather than your wrist symptoms. It is imperative to listen to your physical therapist and work with them to determine the best course of action, the frequency and parameters of your home program, and to get you back to a better quality of life and your typical routine as quickly and safely as possible.


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