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The wrist is created by the articulation of the radius and ulna bones of the forearm with the first row of carpal or wrist bones. There are eight small carpal bones that are located between the forearm and the long bones that make the palm of the hand. In total, 27 bones make up the hand and wrist, and there are more than 30 muscles that control them.
There are many sources of hand and wrist pain, including arthritis, fractures from falling on an outstretched hand, and overworked muscles from repetitive motions. "Texter's thumb", also known as De Quervain's syndrome, is the result of overuse of the muscles in the thumb causing inflammation and pain. Carpal tunnel syndrome is another common injury of the median nerve as it passes through the carpal tunnel of the wrist resulting in pain and tingling in the hand. Arthritis in the joints of the fingers can cause swelling and pain as well. In some instances, hand and wrist pain originate from the neck.
When examining wrist and hand pain, it is essential to start at the neck. The nerves that originate in the cervical spine innervate the arm and hand, so examining this area is crucial in determining the actual cause of hand and wrist pain. Also, the shoulder and elbow must be examined to identify any potential influences. The physical therapy exam consists of an assessment of the joints of the wrist and hand, the nerves originating at the neck, and the muscles of the elbow and forearm since many of the wrist and hand muscles originate there. After this thorough examination, physical therapy interventions will combine manual therapy, exercise, and neuromuscular re-education to address the source of the pain.
Physical therapy interventions have been shown to reduce pain and improve function for patients with wrist and hand injuries. According to an article from the Journal of Orthopaedic & Sports Physical Therapy, manual physical therapy was found to be equally effective but less costly (compared to surgery) for women with carpal tunnel syndrome. Another article from the Hand Surgery and Rehabilitation Journal found that the combination of finger strengthening and paraffin bath treatment was effective in reducing pain, improving physical function, and increasing handgrip strength in workers with hand osteoarthritis. Physical therapy can reduce hand and wrist pain with a customized rehabilitation protocol.
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