Hand and wrist pain

The human hand and wrist is a complex mechanism to perform functional activities which are integral for daily tasks. 

The hand and wrist have a total of 29 bones arranged to roll, spin and slide allowing the hand to explore and control the environment and objects. The wrist joint is where the forearm bones (radius and ulna) meet the carpal bones of the hand. Both the wrist and hand are supported by a large number of ligaments, tendons and muscles to enable very fine and complex movements of the hand. 

Common causes of musculoskeletal related pains tend to originate from bones, ligaments, tendons and muscles. These symptoms tend to settle with time and good self-management.

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Carpal Tunnel Syndrome (CTS)

What is it?  

The carpal tunnel is a canal formed between the small bones of the wrist (carpal bones) and a ligament that lies across the front of the wrist.  The median nerve is one of the structures that passes through this canal. 

In Carpal Tunnel Syndrome (CTS) the median nerve becomes compressed within the canal. 

Symptoms include pins and needles, pain, aching and/or numbness commonly in the thumb, index, middle and half the ring finger, but you may feel that the whole hand is affected. You may feel weakness of the hand which can cause poor grip, leading you to drop objects. Your skin may feel more dry than usual. 

In most cases, there isn’t an obvious cause for CTS.  It is more common in manual workers, especially with jobs involving a lot of wrist movement, so overuse of the hand may be a factor. 

The following are all associated with CTS: pregnancy, obesity, an underactive thyroid, diabetes, any arthritis affecting the wrist and the menopause.  

Dealing with Carpal Tunnel Syndrome 

Night-time pain can be relieved by gently shaking your hand and wrist or hanging your hand over the side of the bed. 

You may be offered a wrist splint that keeps your wrist straight at night. See the instructions at the end of this leaflet to learn how to bend the bar to ensure your wrist is flat, i.e. not bent back or downwards. Remove it in the day unless you are doing aggravating activities e.g.holding a phone. 

Watch out for red marks on your skin due to rubbing or pressure points or a rash due to heat or allergy to the material. 

Elastic or Neoprene splints may be hand-washed or machine-washed in an ‘easy care’ load (40°).  Make sure the Velcro straps are fastened before putting the splint in a washing machine or place it in a pillow case.

Exercises

There is some evidence to suggest exercising the nerve can help the oxygen and blood flow.  Repeat this sequence x5 a few times a day.

Imagine you are holding some seeds as in the first picture, then gently move your arm away from your body as if scattering them.  If adding in the final 2 movements in the pictures cause symptoms, only exercise up to picture 5.

If you have been provided with a neoprene wrist splint,  follow these fitting guidelines:

  1. Undo the velcro straps and place the open splint on a table. Place your hand palm down against the splint with the big knuckles of the fingers just over the edge of the splint material.
  2. Do the 3 straps up over the back of the wrist/ forearm.
  3. The strap closest to the fingers goes through the thumb web and fastens on the back of the hand.

How to bend the bar in the splint to fit

When you receive the bar is bent to position the wrist to bend approx. 45 degrees backwards splint.

Remove the bar from the pocket and create a new bend at the wrist level in the opposite direction to the one already there. Your wrist should be straight but the end of the bar will still be bent.

 

 

Slide the bar back into the pocket at the wrist end of the splint; you can remove the splint to do this.

 

 

 

It should look like this when on correctly

NB:  Ensure the splint is not too tight as you will be wearing it overnight

How to avoid Carpal Tunnel Syndrome

Avoid sleeping with your hands held bent or curled downwards – this compresses the front of the wrist and can irritate the median nerve, causing pins and needles into your hand.

Try to avoid over gripping or typing too forcefully. This may cause swelling around the tendons that also pass through the tunnel, and so irritate the median nerve.

Taking regular breaks at work if you are using your hands repetitively will help, especially if you introduce gentle movement exercises of the wrist and fingers such as:

Stretch your hands, fingers, and wrists often.  Rotate wrists in circles and flex and extend your hand and fingers.

Don’t smoke – this will affect the circulation in your hands and feet and may make CTS symptoms worse.

De Quervain’s Tenosynovitis

What is it?  

De Quervain’s tenosynovitis is caused by friction between the extensor pollicis brevis (EPB) and the abductor pollicis longus (APL) tendons of the thumb.  This creates a thickening and narrowing of the area in which they are housed over the bony prominence on the thumb side of your wrist. This causes inflammation and pain which becomes worse on moving the thumb or wrist and you may feel an associated ‘creaking’ around the tendons. 

 The symptoms can start following prolonged or unusual activity such as gardening, DIY, or use of a gaming console 

 It is also common in new mums although whether this is due to hormonal changes or repetitive lifting of the baby is unclear. 

How to deal with it 

The majority of symptoms associated with De Quervain’s tenosynovitis will settle with rest and the correct changes to activityThumb movements such as gripping/pinching may worsen symptoms, so stopping the aggravating activities will help to settle the inflammation and pain. 

Change your actions to reduce the stress on your wrists and take frequent breaks to rest if you are using your wrist a lot. Avoid repetitive and sustained wrist movements, particularly where the wrist is bent towards the palm and the thumb is spanning widely.  

For new mums this may mean trying alternative ways of lifting your baby without scooping up under the arms and if finding bottle feeding painful try a bottle with a handle. If breastfeeding, try to relax your thumb and wrist once you have positioned your baby.  Avoid steering a pram one handed, this is very stressful for your wrist. 

Swelling and pain can also be eased by applying an ice pack/frozen peas wrapped in a damp cloth for 10-15 minutes at a time, 3 times a day to the area.

  • Please note only use ice if you have normal skin sensation  
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn 

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

You mabe offered a splint that immobilises the wrist and thumb.  There is evidence that only using the splint during painful activities can help but sometimes it is necessary to wear the splint continuously for up to 6 weeks to rest the tendons.  If you do need to wear the splint continuously, please take it off a few times a day for hand hygiene and to gently exercise the wrist and thumb to prevent stiffness.

  • Move the wrist in a handshake action within comfort  x5 
  • Bend the tip of the thumb joint whilst keeping the wrist still  x5 
  • Bend the middle thumb joint whist keeping the wrist and thumb tip still  x5

Once you have your neoprene wrap follow the fitting guidelines: 

The splint has two bars in it, one along the wrist and the other on the outside of the thumb. The thumb bar will need bending to fit. Follow the instructions below.


1. When you remove the bar from its pocket it will be straight.

2. Bend it to the contour of your thumb and wrist for comfort. Slide it back into the pocket. 

3. Undo the velcro straps and place the open splint on a table.  Slide your thumb through the thumb hole until the splint is snuggly fitting in to the thumb web. Place your hand palm down against the splint with the big knuckles of the fingers just over the edge of the splint material.

4. Do the 3 straps up over the back of the wrist/ forearm. 

5. The strap closest to the fingers goes through the thumb web and fastens on the back of the hand. 

 

The final fitting should look like this. Watch out for red marks on your skin due to rubbing or pressure points or a rash due to heat or allergy to the material.

Elastic or Neoprene splints may be hand-washed or machine-washed in an ‘easy care’ load (40°).  Make sure the Velcro straps are fastened before putting the splint in a washing machine or place it in a pillow case.   

How to avoid it?  

The best way to prevent de Quervain’s tenosynovitis is to avoid repetitive movements as discussed above.  Once you have identified the causal activity, change your actions to reduce the stress on your wrists and take frequent breaks. 

Wear a thumb and wrist support as necessary but once you feel able to stop using it continually to avoid weakening and stiffening hand (usually 6 weeks) 

Osteoarthritis of the thumb base

What is it? 

Osteoarthritis refers to joint pain with limitation of movement, which can affect daily activities. Contrary to most thoughts, osteoarthritis is not caused by ageing and does not necessarily get worse.  

In osteoarthritis we see changes to the cartilage of the joint as well as other secondary changes such as inflammation. Cartilage helps our joints move freely.   Changes to the cartilage can lead to pain, stiffness, and loss of movement.  This can in time lead to weakness around the muscles of the joint. 

Causes of thumb osteoarthritis  

Osteoarthritis in the carpometacarpal joint (CMC joint) at the base of the thumb is the most common cause of pain in this area. The CMC joint is formed where the metacarpal bone of the thumb meets the trapezium bone of the wrist.   

Due to the movement required at the base of the thumb, you rely on your ligaments and bony structures to maintain stability. Damage or overuse can place high loads through the base of the thumb and lead to degeneration. A good point to remember is that any pressures placed through the tip of the thumb during pinching activities are multiplied by around twelve times through the CMC joint.

Symptoms of thumb osteoarthritis

Pain is the primary symptom associated with thumb osteoarthritis. Initially, pain is present with movement or activity (e.g. turning a key, opening a door, lifting a cup). If the osteoarthritis progresses, pain may be present even during inactivity or rest. Other symptoms of thumb arthritis include:

  • Difficulty gripping objects
  • Swelling, stiffness, or tenderness at the base of the thumb
  • Enlarged appearance and altered posture of the CMC joint
  • Limited range of motion

Treatment of thumb osteoarthritis

Early osteoarthritis of the thumb can be effectively managed using non-surgical treatment options.  These treatments aim to reduce the pain caused by wear and tear of the joint:

  • Pain relief
  • Exercise
  • Splinting
  • Joint protection

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

  • Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice or heat therapy

Heat may be helpful for stiff and painful joints by resting your hand on a covered hot water bottle or microwaved wheat pack, or moving your hand in a bowl of warm water.

Do not use heat therapy on a joint that is hot and swollen as this will make it worse. Instead consider ice therapy to ease pain and swelling

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

 

  • You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
  • Check the skin regularly during and after the ice pack application
  • Stop if there is excessive pain, numbness or tingling
  • Do not put ice directly on to the skin as this may cause a burn.

Exercise

National guidance states that simple exercise to strengthen muscles around the base is helpful in the early stages. The following exercises target those muscles. Repeat just once a day

Place the palm of your hand on a table.

Bring your thumb away from the index finger and then back again.

Ensure the movement is occurring from the base of the thumb.

Repeat 5-10 times.

Rest the side of your hand on a table.

Bring your thumb away from the palm and then back to the index finger.

Ensure the movement is occurring from the base of the thumb.

Repeat 5-10 times.

With your thumb, touch each finger-tip, trying to make an “O”shape.

Run your thumb down the finger to the palm.

Try doing this with each finger in turn.

Repeat 5-10 times.

Put your forearm on a table.

Start by resting the thumb on the index finger.

Slowly lift the thumb off the index finger, moving from the base of the thumb. Keeping the tip of the thumb bent may help.

    Repeat 5-10 times.

Strengthening exercises

If the above are pain free you can try the two below

Place your hand on a table with palm down and fingers straight. Put an elastic band around your thumb and index finger.

Pull the thumb away from the index finger. Repeat 5-10 times

 

 

 

Place your hand on a table with the palm facing up and a broad elastic band around your thumb and index finger.

Lift your thumb straight up.

Splinting

The goals of splinting are to increase stability, reduce pain, decrease inflammation, improve function, and reduce the mechanical stress that may be causing the instability. Splinting generally will not prevent abnormal joint posture, but can provide rest and support and make functioning more comfortable. You should wear the splint when doing activities that are painful. Remove at all other times.

  1. Slide your thumb through the thumb hole, ensure it fits snuggly into the web space of the thumb.
  2. Fasten the main body of the wrap on the back of the wrist using the wide Velcro fastening.
  3. Take the long strap and guide it around the palm aspect of the thumb, fastening it to the Velcro at the base of the thumb.

 

4. Gently pull the strap and take it through the thumb web to fasten at the final Velcro strap on the back of the hand.

 

 

 

Elastic or Neoprene splints as pictured may be hand-washed or machine-washed in an ‘easy care’ load (40°).  Make sure the Velcro straps are fastened before putting the splint in a washing machine or place it in a pillow case.

Joint protection

Joint protection strategies are also shown to help reduce pain in this condition. The link below will take you to the Versus Arthritis patient information on this subject.

https://www.versusarthritis.org/about-arthritis/managing-symptoms/joint-care/

How to avoid it? 

There is little you can do to avoid this condition as it is mostly genetic. It can however be aggravated by trauma, e.g. a fall onto the hand.

 

Joint Protection Top Tips

General

USE TWO HANDS & MODIFY TASKS

Spread the load. Adapt objects to create a larger surface area to grip.

Extra grip can be added to pens, cutlery, brushes or hand rails by using tape. Cycle tape is a good option which can be found in a range of colours in cycle shops such as Halfords.

PACE YOURSELF

Take breaks, don’t try to do too much and intersperse heavier jobs with lighter ones. You can achieve more over three days of moderate activity than in one day of doing too much, followed by two days of exhaustion.

SLIDE, DON’T LIFT

Particularly in the kitchen, try rearranging the locations of items so that you can slide things along sides and work surfaces instead of carrying them.

WARM HANDS UP BEFORE STARTING THE DAY

If hands are stiff and sore first thing when you wake up, fill a sink with warm and soapy water or apply baby oil and gently exercise and massage your hands in the water.

 

In the bathroom

TRANSFER SHOWER GELS & SHAMPOOS INTO PUMP BOTTLES

Pressing down on a dispenser can be an easier motion to perform than squeezing a bottle.

TOWELLING BATH ROBES

Since towels can be heavy, try wearing a towelling robe while using a hand towel, rather than relying on a single large towel, or use a micro towel or a tea towel for light quick absorption.

LONG HANDLED AIDS

If you have difficulties reaching underarms to wash, use a long-handled sponge or create something similar by taking a long-handled washing up mop and putting a flannel over it.

A fly swot can be used in a similar way by attaching a flannel over the end piece creating a device to wash your feet and between the toes.

ELECTRIC TOOTH BRUSH

Electric tooth brushes require less repetitive movement from the wrist and hand but teeth are still properly cleaned.

LEVER TAPS

If you have difficulties gripping and twisting yours taps, have lever taps fitted, these can be purchased from a DIY store. You may also be eligible to have them fitted by social services.

 

In the kitchen

WRINGING CLOTHS

Wring a dishcloth by winding it round the tap and then crossing the two ends over each other and twisting.

COOKING VEG/ RICE

Vegetables can be bought pre-chopped and kept in the freezer for when you need them. They can be microwaved or steamed alternatively to being boiled, meaning there is no need to lift heavy pans to drain.

Boil in the bag rice or microwavable rice makes cooking it much easier as there is no need to drain the rice.

To cook potatoes, place a metal colander inside the saucepan so that you only need to pick up the colander and potatoes once they are ready. Once the pan is cooled, you can safely pick it up with two hands to dispose of the water.

OPENING BOTTLE TOPS AND JARS

Use nut-crackers (the type with inside serrations) to unscrew small bottle tops.

Silicon grips can be purchased to help you open jars. Alternatively wear a rubber glove or use a rubber non-slip matt.

LARGER GRIPS

Kitchen utensils can be purchased which have large rubber handles making them easier to grip. Alternatively you can wrap tape round the handles or fit on some tubing.

Kitchen knives with saw like handles can also be purchased making cutting much easier.

THERMAL MUGS

These are  insulated so they don’t get hot on the outside – holding a thermal mug by wrapping both hands around it can be more comfortable than holding a standard mug by its handle.

SHOPPING

Most major supermarkets will deliver to your door if you order online; some will also let you place orders over the phone. Or use a foldable trolley to transport your shopping e.g. www.reisenthel.com

LIGHTWEIGHT APPLIANCES

Smaller appliances such as kettles, irons and vacuum cleaners can be purchased in lightweight and compact travel versions.

MAKING A CUPPA

Only fill the kettle with just enough water using a jug; once the kettle has boiled, lift it while keeping one hand on the handle and the other hand on the front with a tea towel to protect against the heat.

KITCHEN TROLLEYS

Kitchen trolleys can be used to help transport heavier and larger items between kitchen surfaces or to the table.

ELECTRIC GADGETS

Let gadgets such as electric razors, toothbrushes and can openers do some of the work for you.

SAFETY CAP BOTTLES

Try using nut crackers on bleach bottles. You can also contact ARUK or you pharmacist to dispense your medication without safety cap.

 

Getting Dressed

FASTENINGS

Replace fiddly buttons with Velcro. You can also do this to your children’s clothing if you dress them.

Zips can be made easier to pull by tying some ribbon on to them.

PUTTING ON COATS/JACKETS

Jackets/ coats with a silky lining can be helpful as they allow wrists to slip more easily through the arm holes.

SHOES

You can buy coiled shoe laces if you find regular ones difficult.

Long handled shoe horns and elastic laces help to put on footwear.

 

Examples of helpful gadgets and adapted devices

Pouring Devices

Topster Milk Carton Pourer

Betterware  Lakeland

Adapted Handles

Using pipe lagging or gripoball on handles can increase the surface area of an object making it easier to grip. www.gripoballs.com

Alternatively OXO do a range of utensils with large rubber handles.

www.OXOuk.com

Stockists include: Dunelm Mill, Homesense, Lakeland

Plugs

Easy Pull Plug Removal Aid by SK

Knitting

Bamboo knitting needles

www.knittingaid.com

Whether you’re right or left handed knit any stitch with complete freedom and support. Use your needles, Ease painful joints, Use one handed.

Dressing

Innovative fastenings make dressing easier for those who may suffer from restricted movement or lack of finger dexterity

www.theablelabel.com

www.peta-uk.com

Etac Butler Buttoner Round. A great helper when buttoning or using a zip

www.etac.com/products/small-aids-for-daily-living

Cutting

  • The angled handle of these tools keeps your hand and wrist in a natural position, making cutting and grating smooth and simple. Despite being stainless steel they are very lightweight which is ideal for someone who has very weak hands. The “soft-feel” black

Etac ergonomic knives

Pill cutter

Opening Devices

  • The JarKey (or JarPop) is a jar opener that opens jars, not by twisting the lid, but by lifting the edge of it, so that the vacuum inside is released. When the vacuum is released, it is easy to unscrew the lid. Jarkey
  • This One Touch product works as a tin and jar opener.
  • Multi Opener. Six openers in one. Removes safety seals, metal bottle caps, ring pulls, jar lids, bottle tops and has an enclosed blade for slicing open sealed bags.
  • Key Grip.
  • Tap Turner
  • Wire chip pan basket.

Other information:

More useful tips can be found on the National Rheumatoid Arthritis Society website:

www.nras.org.uk/useful-tips

Wessex DriveAbility – www.wessexdriveability.org.uk  02380554100

Other Stockists examples:

Steamer Trading cook shop- www.steamer.co.uk

Lakeland – www.lakeland.co.uk

Salamander Cookshop Wimborne – http://www.salamandercookshop.com

Poole Mobility – www.poolemobility.co.uk

The Range – www.therange.co.uk

Dunelm Mill- http://www.dunelm.com

Betterware- https://www.betterware.co.uk

Nottingham rehab suppliers- www.nrshealth.co.uk

Trigger finger and thumb

What is it?  

Trigger finger or thumb is a common disorder characterized by snapping, catching or locking of the finger flexor tendon leading into the palm of the hand. Sometimes there is also a reduced ability to bend the finger. It is commonly associated with pain in the palm; a tender, palpable bump at the base of the affected digitand a reduction in hand use. 

It is often caused by overuse of the finger tendons involved in repetitive or forceful gripping but can be more common with some other conditions such as diabetes, gout, or rheumatoid arthritis 

It is usual to be more aware of it first thing in the morning, and then again through the day on gripping or straightening the finger or thumb involved. 

How to deal with it?  

If this is a new problem that you can relate to overdoing a task, a short course of nonsteroidal anti-inflammatories (e.g. Ibuprofen either in tablet form or gel that you rub in) can help.  Follow the instructions on the packet and discuss with a pharmacist if you are unsure if ibuprofen is suitable for you. 

If this is a persistent problem, applying heat using warm (not too hot) water several times throughout the day may help.    

The use of a splint that stops the tendon from moving so far that it catches may help manage the symptoms.   Splints worn on the palm of the hand that restrict movement of the MCP / big knuckle of the finger are the most useful design of splint and are available on line.  These are also suitable for a trigger thumb. 

How to avoid it? 

Avoiding overuse of hand can help prevent trigger finger or thumb.  

If you begin to experience stiffness and swelling in your fingers, rest youhand and try alternating activities to keep your fingers from becoming inflamed.

Dupuytren’s Disease

What is it?  

Dupuytren’s contracture happens when the palmar fascia, a tissue under the skin near your fingers becomes thicker and less flexible.  

The exact cause is unknown, but it’s been linked to: 

  • having a family history of the condition 
  • smoking 
  • drinking lots of alcohol 
  • having diabetes or epilepsy 

Dupuytren’s contracture mainly affects the ring and little fingers, but can affect any finger including the thumb. You can have it in both hands at the same time. It tends to get slowly worse over many months or years. If the contracture worsens it can limit your ability to use your hand in a normal way.

How to deal with it?  

Sometimes, in early disease there can be some pain when there is pressure applied to the nodules, e.g.: with sustained gripping.  It is also possible to get some palm pain even at rest. In both cases the pain commonly subsides with time. There are no treatments to prevent progression of the condition. There is no evidence that trying to stretch the affected finger or using a splint is of any benefit.  Steroid injections are also not indicated.  You should continue to use your hand as normally as possible.  

If your finger is bent into your palm to the extent it is causing problems with function an operation can be done to try to straighten the finger as much as possible. The only other indication for an operation is where the Dupuytrens is causing the small joints in the hand to bend in.  

How to avoid it? 

There is little you can do to prevent this from happening as it is usually a hereditary condition. 

Osteoarthritis of the wrist

Coming soon.

Other causes of wrist and hand pain

Coming soon – Referred pain, Ganglions, Wrist tendinopathies, Osteoarthritis of the fingers

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Soft tissue injuries

Wrist and hand injuries

Minor injuries to the wrist and hand such as a mild sprain or strain should settle with time and can be managed at home. 

A soft tissue injury to the wrist or hand may result in the following: 

  • Pain
  • Swelling
  • bruising
  • Stiffness and loss of function 

The pain can be particularly strong in the first three weeks as this is the inflammatory phase of your body healing itselfTypically, these injuries last 4 to 6 weeks depending on the severity.

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet. 

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

https://www.nhs.uk/medicines/ibuprofen-for-adults/

https://www.nhs.uk/medicines/paracetamol-for-adults/

For up to date guidelines on the government about Ibuprofen use and Coronavirus (COVID-19)

https://www.gov.uk/government/news/ibuprofen-use-and-covid19coronavirus

Early Management

Protect by minimising use of the affected hand and initially avoiding stretching the area which could cause further injury. 

Rest can be beneficial in the very early stages of the injury (days 1-4). Complete rest, however, is not advisable. In the early stages, gentle active movements and specific exercises can help decrease pain and swelling, they also promote good tissue healing with less unwanted scar tissue and joint stiffness. It is important to make sure you keep the shoulder and elbow moving as normal, so that these joints do not stiffen up. 

Ice pack/frozen peas wrapped in a damp cloth, placed on the swollen area for up to 20 minutes at a time, 3 times a day. So long as there is swelling you will need to continue ice therapy, often beyond the third week.   

  • Please note only use ice if you have normal skin sensatio 
  • Check the skin regularly  
  • Stop if there is excessive pain, numbness or tingling  
  • Do not put ice directly on to the skin as this may cause a burn 

Compression of the wrist and hand can be achieved by using a tubigrip or crepe bandage. It should compress firmly but not restrict blood flow and create a tourniquet.  Remove if there are signs of poor circulation, or if you start to experience pins and needles or numbness. 

Elevation. If you have swelling in your wrist or hand sit on a chair and place your elbow on cushions so that it is level or slightly higher than your shoulder. In this position, point your hand towards the ceiling then open and close your hand as this will help to reduce any swelling further.

Early Mobilisation and recovery

After 72 hours is important to start using your wrist and hand normally again. Start to do normally everyday activities. You should also try doing these exercises 3 – 4 times a day. Repeat each one 10 times. 

1. Rest your forearm on a table with your hand over the edge. Using your wrist only, move your hand down towards the floor, and then back up towards the ceiling the ceiling in a patting motion 

2. Rest the palm of your hand on a table. Without moving your forearm, slide your hand one way and then the other. 

3. Bend your elbow and tuck it into your side. Turn your palm as far as possible upwards, without moving your elbow, now turn the hand back over again as far as possible.

 

 

 

4. Touch your thumb to the tip of each finger. 

 

 

 

 

5. Support your elbow on a table make a fist bend your fingers into your palm as tightly as you can and feel them stretching. Now stretch your fingers as wide as you can and feel them stretching.

 

 

 

6. Hold your hand with the palm of your hand facing upwards. Touch your thumb to the base of your little fingerNow stretch the thumb out the opposite way 

As you start to do these exercises you may feel there is some discomfort, however, this is normal and you should continue. If you have discomfort and pain for more than 2 hours after these exercises, then you shoulder reduce the number and gradually build up again. 

Further progression on wrist exercises can be found following the link below: 

https://www.poole.nhs.uk/pdf/Wrist%20Injuries.pdf 

Recovery time and returning to activity 

It usually takes 6 weeks to heal from this type of injury, however everyone recovers from injuries at different rates. You may be back to normal in 2 weeks however in some cases it can take up to 3 months. 

Returning to work – Gradually build up your strength and function, practice similar tasks at home that you would do at work. Start doing this little and often ensuring there is no pain or swelling. 

Returning to hobbies/sport – it is advised not to return to these activities until you have full strength and range of movement without pain or swelling. If you play sport that involves different actions of the wrist and hand, practice the specific activities such as throwing a ball and build this up before returning. 

Go to an urgent treatment centre or A&E if you: 

  • have severe pain 
  • feel faint 
  • are dizzy or sick from the pain  
  • heard a snap, grinding or popping noise at the time of the injury  
  • are not able to move your wrist or hold things
  • have a wrist that’s changed shape or colour, such as blue or white 

These might be signs of a broken wrist or bone in your hand 

See a GP or physiotherapist if: 

  • the pain is severe or stopping you doing normal activities 
  • the pain is getting worse or keeps coming back
  • the pain has not improved after treating it at home for 2 weeks
  • you have any tingling or loss of sensation in your hand or wrist
  • you have diabetes – hand problems can be more serious if you have diabetes 

Further links  

External links for further information on wrist and hand pain 

https://www.csp.org.uk/conditions/managing-your-bone-joint-or-muscle-pain/managing-your-hand-pain  

https://www.versusarthritis.org/about-arthritis/conditions/hand-and-wrist-pain/ 

https://www.nhs.uk/conditions/hand-pain/ 

https://www.nhs.uk/conditions/hand-pain/wrist-pain/ 

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