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    Wrist Pain

 Wrist Pain

Our wrists are made up of 8 carpal bones and a intricate web of nerves and ligaments. These 8 bones support an area called the carpal tunnel. This tunnel contains tendons and the median nerve.
One of the most common sites of injury is the wrist. The wrists are used in a variety of different sports such as badminton, tennis, boxing and are also extensively used when we type and in certain occupations. This repetitive motion of certain activities makes some people more susceptible to wrist pain.
The majority of falls also result in wrist pain as we naturally outstretch our hands to cushion our fall.

 Wrist Sprains


Introduction

A wrist sprain is stretching or tearing of the ligaments that support the wrist. Ligaments are strong bands of tissue that connect bones to each other. This often occurs due to a fall on an outstretched hand which causes ligaments to stretch which can be very painful. Pain will be present around the wrist and there may be some redness and bruising. The patient will complain of limited range of movement. A wrist sprain can be classed in three different grades:
1. Grade 1 Sprain: Micro tear of the ligaments
2. Grade 2 Sprain: Partial tear of ligament and mid-joint instability.
3. Grade 3 Sprain: Severe or complete tear of ligaments and significant joint instability.

Cause
• Accidental fall.
• Muscle weakness
• Inappropriate wrist guards
• Playing certain sports such as ice volleyball, squash, badminton, football and basketball are higher risk sports associated with this condition.

Treatment
• R.I.C.E: Rest (Avoid using your injured wrist and hand), Ice (Apply ice or a cold pack to the wrist for 15-20 minutes, 4 times a day for several days, Compression (Wrap your wrist in an elastic support. This will limit swelling and support your wrist) .and Elevation ( Keep the injured wrist raised above the level of your heart for 48 hours such as up on a pillow. This will help drain fluid and reduce swelling).
• Pain Killers (please consult your doctor for advice regarding appropriate pain killers).
• Wrist Braces,
• Surgery may be required if the ligament is completely torn or their is an associated fracture.
• If the sprain is very severe the wrist may be casted for a weeks to immobilize the area to allow healing.

Rehabilitation
Rehabilation exercises and wrist braces will help speed up recovery and prevent further injury.You may need to wear a brace to immobilize your wrist. If you play sports, you may need to wear a wrist brace or tape your wrist when you return to play.

Arthritis Wrist

Introduction
Arthritis of the hand and wrist occurs in one of two major forms: inflammatory arthritis, including conditions such as rheumatoid arthritis, and the more common form of degenerative arthritis is known as osteoarthritis. Osteoarthritis is the main form of arthritis and is known as the "wear and tear" disorder. It can affect any joint. The wrist is especially susceptible due to the tremendous amounts of pressure that is placed during everyday activities. Osteoarthritis causes the cartilage to erode and then causes the bone ends to rub against each other which results in stiffness and aching of the joints. Osteoarthritis can also follow a fracture or a bad sprain to the wrist.
Rheumatoid Arthritis is a systemic disease, which affects the whole body. In rheumatoid arthritis, the joint lining (synovium), normally smooth and shiny, becomes inflamed, painful and swollen. Rheumatoid arthritis can affect all the joints and muscles in the wrist. It affects more women then men and can be inherited. The insides of the joints become swollen and stiff. It affects the wrist by causing stiffness, swelling, and the loss of motion. One common symptom of rheumatoid arthritis of the wrist is diminished grip strength. The fingers of the hand are able to move because of the connection of tendons within them to the muscles of the forearm.
There is another form of arthritis that you should be aware of called infectious arthritis. Infectious arthritis (septic arthritis) is infection in the fluid and tissues of a joint usually caused by bacteria, but sometimes caused by viruses or fungi. The patient will have swelling of the wrist accompanied by heat. He or she will also have a fever and touching the wrist will cause extreme pin. In such as case visit your local accident and emergency department as soon as possible.

Symptoms
Rheumatoid arthritis
• Painful, swollen joints.
• Tendons are no longer able to work on stable joints, often resulting in an unnatural rotation of the wrist.
Diminished grip of the fingers.
Osteoarthritis
• Stiffness and pain in a particular joint.
• Your wrist may fill with fluid and feel tight, especially after use. When all the articular cartilage is worn off the joint surface, you may notice a squeaking sound when you move your wrist. Doctors call this creaking crepitus.
Causes
Rheumatoid arthritis
• Autoimmune disease which can be inherited.
• May be due to a virus.
Osteoarthritis
• Wear and tear disorder due to repetitive use of a particular joint in the body.
• Weak cartilage and bone structure is also a contributing factor.
• A bad sprain or wrist fracture can actually damage the articular cartilage. The cartilage can also be "bruised" when too much pressure is put on the cartilage surface. The cartilage surface may not look any different. The injury often doesn't show up until months later.

Treatment
Osteoarthritis of Wrist
• Treatment is usually conservative, surgical intervention is rarely considered.
• Nonsteroidal anti-inflammatory drugs may be prescribed by the doctor to control the pain.
• Heat therapy and products such as cryotherepy/cold therapy are very good to alleviate discomfort.
• Wrist brace and supports will help to reduce your pain during activity. Range-of-motion and stretching exercises can improve your wrist motion. Strengthening exercises for the arm and hand help steady the wrist and protect the joint from shock and stress.
Rheumatoid Arthritis of wrist
• There is no cure for rheumatoid arthritis. In the absence of infection, cortisone injections directly to the wrist can be very helpful in relieving pain and improving flexibility.
• As with osteoarthritis, Nonsteroidal anti-inflammatory drugs may be prescribed by the doctor to control the pain.
• Heat therapy such as the reusable hot and cold pack will reduce discomfort to the wrist.
• Cortisone is a very powerful anti-inflammatory medication. When injected into the joint, cortisone can help relieve the pain. Pain relief is temporary and usually only lasts several weeks to months. There is a small risk of infection with cortisone injections.
• Surgery is only recommended if it can stabilize the joints and deliver pain relief. Sometimes the one or more of the eight bones of the wrist may be replaced with a prosthesis, helping improve the function of the joint.
• Wrist braces and supports will reduce pain. discomfort and allow the patient to carry out daily activities in less pain.

Rehabilitation
Wrist strengthening exercises will help together with heat pads and wrist supports to reduce pain.

Carpal Tunnel Syndrome Syndroment

Introduction
Carpal tunnel syndrome affects about 1 in 100 people at some point in their life. Men and women of any age can develop it, but it is most common in women in their 30s, 40s and 50s.
Sometimes carpal tunnel syndrome is triggered by a person’s occupation, and can lead to the person being unable to work. Most cases of carpal tunnel syndrome can be prevented by stopping or reducing the activity that stresses the fingers, hand, or wrist, or by changing the way in which activities are done.
Carpal Tunnel Syndrome is a condition where there is excessive pressure on the median nerve. This can be caused by swelling in the carpal tunnel and/or thickening of the transverse carpal ligament, which forms the roof of the carpal tunnel
Pinching or compression of this nerve by the transverse carpal ligament sets into motion a progressively crippling disorder which eventually results in wrist pain, numbness and tingling in the hand, pain consisting of a “pins and needles” feeling at night, weakness in grip and a feeling of in coordination.

Symptoms
Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can awaken patients from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.

As the disease progresses, patients can develop a burning sensation, cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles, particularly those near the base of the thumb in the palm of the hand.






Treatment

Carpal tunnel syndrome treatment usually begins conservatively, and moves to more aggressive and invasive techniques if the symptoms of carpal tunnel syndrome persist.
The initial carpal tunnel syndrome treatment steps include some medications and splints
Doctor at A+ clinic may ask you to rest your wrist or change how you use your hand. Doctor may also ask you to wear a splint on your wrist. The splint keeps your wrist from moving but lets your hand do most of what it normally does. A splint can help ease the pain of carpal tunnel syndrome, especially at night.
Putting ice on your wrist, massaging the area and doing stretching exercises may help too.
Cotisone injecions provide temporary relief as is it injected directly into the affectd area to decrease inflammation around the nerve.
Surgical treatments are available and effective in the treatment of carpal tunnel syndrome. The most common procedure is the carpal tunnel release. A carpal tunnel release involves making an incision in the fibrous sheath around the carpal tunnel. By releasing tension in the carpal tunnel, the pressure is removed from the nerve.

Rehabilitation
Exercise wil help to strenghthen the wrist and prevent the symptoms of carpal tunnel syndrome.

Tips for relieving carpal tunnel syndrome
• Prop up your arm with pillows when you lie down.
• Avoid using your hand too much.
• Find a new way to use your hand by using a different tool.
• Try to use the other hand more often.
• Avoid bending your wrists down for long periods.




Introduction
A colles fracture is defined as a break across the end of the large bone of the forearm called the radius.

Cause
As with most types of wrist fractures a fall is the primary cause of a colles fracture. The impact of the fall and bodyweight causes the radius to buckle. The young and elderly are particularly susceptible to this fracture as children's bones are soft and elderly patients bones tend to be brittle. In the elderly a condition called osteoporosis can often lead to a colles fracture.
Osteoporosis is a bone disorder. The bones become thinner, lose their strength, and are more likely to break. People with osteoporosis have a higher risk of fractures. Their bones can fracture even during everyday movements, such as bending or coughing. Osteoporosis is not a form of arthritis, although it can cause fractures that lead to arthritis.It is more common in women than men and people with osteoporosis usually fractured the wrist first. This typically occurs between ages 50 and 70 in women.

Treatment
• Elevate the wrist and place in a sling.
• Place a ice pack on the wrist to reduce the swelling.
• Do not attempt to move the wrist
• Visit a doctor for x-rays and casting
Generally fracture need reduction (putting back in position) and a very specialized plaster is applied. The plaster is generally stay for 6 weeks. The doctor at A+ clinic will regularly get the X-ray done to make sure that the fracture is well aligned. At 6 weeks the plaster is removed at the clinic and rehabilitation is started.

Rehabilitation
Rehabilitation begins by maintaining the range of movement in the fingers, thumb and shoulder, on the side of the affected wrist. This will help to prevent stiffness in these areas. The rehabilitation last for 3-4 weeks.

Introduction
The scaphoid is one of the small bones in the wrist (carpal bones), and the one that is most likely to break. The scaphoid is a kidney shaped bone and sits below the thumb.A scaphoid fracture often occurs when a individual falls on an outstretched arm. The scaphoid which is also known as the navicular is damaged.
Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures. They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults. The break usually occurs during a fall on the outstretched wrist. It’s a common injury in sports and motor vehicle accidents. The angle at which the wrist hits the ground determines the injury. If the wrist is bent at a 90-degree angle or greater, the scaphoid bone will break; if the angle is less than 90 degrees, the lower arm bone (radius) will break.
It has its own blood supply which is why a fracture can damage this blood supply causing delayed or no healing to the fracture. A complete loss of blood supply to the bone can cause death to the bone. This condition is called avascular necrosis (Avascular means no blood supply, and necrosis means dead.).
Often patients present with wrist pain following a fall and the x-ray does not immediately show damage to the scaphoid. Persistent pain and follow up x-rays can be required to correctly diagnose the condition.
 



Symptoms
The symptoms of a fresh fracture of the scaphoid bone usually include pain in the wrist and tenderness in the area just below the thumb (snuff box). You may also see swelling around the wrist. The swelling occurs because blood from the fractured bone fills the wrist joint. Thin people will see a bulging of the joint capsule. The joint capsule is the watertight sac that encloses the joint.
Pain may subside, then return as a deep, dull aching and gripping anything may be painful.
Treatment
• If fracture is incomplete or undisplaced casting is for 9 to 12 weeks. This is necessary to hold the scaphoid bone very still while it heals.
• If fracture is displaced surgery such as screw fixation, scaphoid debridement and bone grafting may be needed.

Rehabilitation
The amount of time the patient needs to wear the cast depends on what part is fractured and whether the bones heal well. When the doctor at A+ clinic is certain the bones have healed, the cast will be removed. The wrist will probably be stiff and weak from being in the cast.
Following the casting it is recommended to wear a wrist support and carry out wrist strengthening exercises to help strengthen and stabilize the muscles around the wrist joint.

Wrist Tendonitis


 

Introduction
Wrist Tendonitis (DeQuervains Tendonitis) can be defined as an irritation and swelling of the sheath or tunnel which surrounds the tendons of the thumb. Typically the pain will be present at the front of the wrist. Pain will be initiated when grasping an object or pinching the fingers, Some patients present with a lump in the wrist directly above the carpal tunnel. This indicates that the condition has advanced as there may also be a balloon of joint fluid formed in that area. Localized swelling may be present and making a fist or bending the wrist will initiate pain.

Cause
•
This is commonly a over use injury which results in inflammation of the lining around the tendon.
• Biomechanical condition with the wrist.
• Inappropriate technique with certain racket sport such as tennis, badminton or contact sports such as boxing.
• A fall.

Treatment
• R.I.C.E: Rest (Avoid using your injured wrist and hand), Ice (Apply ice or a cold pack to the wrist for 15-20 minutes, 4 times a day for several days, Compression (Wrap your wrist in an elastic support. This will limit swelling and support your wrist) .and Elevation ( Keep the injured wrist raised above the level of your heart for 48 hours such as up on a pillow. This will help drain fluid and reduce swelling).
• Anti-inflammatories (seek advice from doctor before commencing this treatment)
• Stretching exercises.


Rehabilitation


The exercises above will help to strengthen the wrist. Please note that these should only be attempted when the initial tendonitis has subsided and you wish to strengthen the wrist. If any pain is initiated from these exercises then you should immediately cease the exercises. Wrist supports will also help to speed up recovery and prevent further injury.

                                                      Wrist Gout

Introduction
Gout is a condition in which uric acid, a waste product that occurs naturally occurring within the body, rises above normal levels. Rather than being flushed by the kidneys and through the urine, as it normally is, it forms crystals and deposits in the joints. These deposits give rise to inflammation of the joints, causing pain, swelling, redness and tenderness of the area.
Most typically the joint affected is that of the big toe, but gout can also affect the wrist Uric acid crystals may also form deposits in other areas such as under the skin or in other soft tissues, and in the kidney or urinary tract.



Gout of the Right Wrist: Note swelling and redness over right wrist area. Left wrist is normal.

Cause
The cause of gout is an inflammation in your joint resulting from an accumulation of urate crystals. Uric acid is a waste product formed from the breakdown of purines. These are substances found naturally in your body as well as in certain foods, especially organ meats — such as liver, brains, kidney and sweetbreads — and spinach, asparagus and mushrooms.
Obesity can be linked to high uric acid levels in the blood. People who are overweight should consult with their doctor to decide on a reasonable weight-loss program. Fasting or severe dieting can actually raise uric acid levels and cause gout to worsen.
Crystal deposits also cause another condition, known as false gout (pseudogout). But rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it's more likely to attack large joints such as your wrists.

Treatment
• Nonsteroidal anti-inflammatory drugs (NSAIDs) taken orally (by mouth) or corticosteroids, which are taken orally or injected into the affected joint.
• Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption.
• Certain anti gout medication like allopurinol, colchicines, probenecid etc. are advised under NSAIDs cover to overcome active rise in serum uric acid level.
• It is suggested that you wear a splint on your wrist.

Rehabilitation
Prevention with diet and a healthy lifestyle is better than cure. However, during a gout attack on the wrist you may find that an elasticated wrist support will help also a reusable hot and cold will reduce the inflammation. Freeze the cold pack and apply it to your wrist.

Wrist Exercises Exercises

The following hand and finger exercises should be done during the rehabilitation of an wrist injury, provided they do not initiate any pain. Please refer to your physician if in doubt.

                     Recommended Products to Strengthen the Wrist


                              
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Indications:
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• Carpal Tunnel Syndrome
• Arthritis
 

          
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