GENERAL INFORMATION

Our wrist is made up of 8 small bones (carpal bones). These bones are held together by ligaments.

In addition to the many small muscles in your hand, nerves, tendons and blood vessels pass through the wrist to supply your hand.
The nerves for your arm and wrist leave your spinal cord at
your cervical spine (your neck).
Compression of the nerves any where along their course
can cause pain/tingeing/numbness/burning.
You can strain or sprain the ligaments or muscles from a sudden movement, improper movement, or through over use.
Compression of the nerves as they leave the spine
at the neck (Cervical Radiculopathy)
or as they leave the chest (thoracic outlet Syndrome)
can cause symptoms any where in the arm
Both of these conditions can fool you because pain is felt in the arm/wrist/hand but not in the neck.

The nerves can be trapped as they pass through your chest and arm pit into the arm (THORACIC OUTLET SYNDROME OR FIRST RIB SYNDROME) this can cause symptoms any where in the arm. The median nerve can be trapped as it passes through the carpal tunnel (a tunnel formed by the carpal bones that make up the wrist) in the wrist. This produces symptoms in the thumb and first two fingers of the hand.

The major muscles that move the wrist start at the elbow, therefore improper use of the wrist can cause pain all the way up to the elbow.

WRIST / FOREARM TENDONITIS
Tendonitis is an over use injury that can occur with over use of any muscle. The tendon is the tissue that attaches the muscle to the bone.

Common wrist/forearm problems include tendonitis of the muscles that extend your wrist, (bend wrist back). The technical name for this is lateral epicondylitis, also known as tennis elbow. You don’t have to play tennis to get tennis elbow.

Lateral epicondylitis (tennis elbow) can cause wrist/ forearm or hand pain.
Working at the computer with your hand bent up toward you is a common cause of this type of tendonitis. It is often confused with carpal tunnel syndrome.

See below for detailed information.

Carpal tunnel syndrome is usually caused by pressure on the medial nerve
(seen in orange above) as it passes through the carpal tunnel (formed by the bones below (gray) & the ligament above( white)
This is usually caused by sleeping with the wrist in a curled position or sustained direct pressure on the wrist.
Using a gel wrist rest & placing the wrist rest under the forearm, not directly under the wrist is advised.

Remember, the standard approach for joint pain
is to start with the least
invasive treatment and progress to more invasive.

An example of least invasive to most invasive would be:
rest – physical therapy – medication –
bracing- injections – surgery (usually the last resort)

Many people with tennis elbow think they have Carpal Tunnel Syndrome.

Tennis Elbow / Wrist Extensor Tendonitis
Test for this syndrome by:

Pressing hard along the outside of the muscular part of the elbow. Pain is an indication of tendonitis.

Stretching the muscle.  If it feels tight this is an indication of tendonitis.

Stretching for the extensor muscle.

A less common problem is tendonitis of the wrist flexors,( muscles that bend wrist forward). The technical name for this is medial epicondylitis, also known as golfer’s elbow. You don’t have to play golf to get golfer’s elbow.

Golfer’s Elbow / Wrist Flexor Tendonitis
Test for this syndrome by:
Pressing hard along the inside of the muscular part of the elbow. Pain is an indication of tendonitis.

Stretching the muscle.
If it feels tight this is an indication of tendonitis.

Tendonitis / inflammation can also occur in the muscles that move your wrist toward your little finger, (Ulnar Deviation) toward your thumb (radial deviation), turn your palm up (Supination) and turn your palm down (Pronation).
See the wrist stretching section for specific exercises for these muscles.

Common shoulder problems include tendonitis and bursitis. It is common to feel pain in the middle of the upper arm due to either of these conditions.

RSI / CTD

A condition known as RSI, (repetitive stress syndrome) or CTD, (cumulative trauma disorder) develops from continuous low level stress on any muscle or joint. It is becoming more common in the wrist and arm from the increased use of computers and other motions involving your arms such as working with an espresso machine.

RSI / CTD is difficult to treat. It often involves tendonitis of all the wrist muscles, mild carpal tunnel syndrome, as well as problems at the wrist, shoulder and neck.
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First Aid-remember even if you are feeling pain in the wrist the source of pain is at the elbow. Treat the ELBOW with ice, massage the muscles just below your elbow, etc as explained in the
see the  Home Treatment page.

RSI /CDT IS PREVENTABLE IF IT IS CAUGHT EARLY. IF YOU HAVE AN ACHE IN YOU HANDS AND THAT LASTS AFTER YOU STOP WORK, KEEPS GETTING WORSE, TAKES LESS AND LESS TO PRODUCE PAIN AND LONGER AND LONGER FOR THE PAIN TO GO AWAY GET IT CHECKED. ONE OR TWO PHYSICAL THERAPY SESSIONS CAN STOP RSI BEFORE IT BECOMES A DISABLING CONDITION.

Sex or Age Most Affected
Adults of both sexes, usually between ages 20 and 40.

SIGNS & SYMPTOMS 
Pain, deep ache, numbness or burning of the hand, wrist, arm or shoulder.
limited range of motion (less than normal movement) of fingers, wrist or shoulder. Check your other wrist to find out what is normal for you.
Stiffness or soreness of the muscles at the hand, elbow, or shoulder.

CAUSES
Repeated use of the arm or wrist in an awkward position
bending the wrist with typing, using the phone, operating a machine or playing sports.
Working with your arm held away from your body. (reaching forward or to the side and keeping the arm in this position).
Postural strain ( improper position when sitting – reaching )
Falling and landing on an out stretched arm. This is a common cause of a wrist fracture.
Swelling of the wrist. This can compress the median nerve as it passes through the carpal tunnel.
Often there is no obvious cause.
Risk Increases With
Working at a desk for long periods.
Repeated bending the wrist or reaching out with the arm.
Participation in sports without proper training. Especially golf, tennis, racquetball and baseball.
Sharp increase in athletic activity (weekend athlete)
Playing musical instruments. Proper training and following a program where you gradually increase the amount of time you play can prevent injury.
How to Prevent

REMEMBER – ELBOW CLOSE TO BODY – WRIST STRAIGHT – REST ELBOW, FOREARM OR WRIST ON FIRM SUPPORT
Rest your arm in a comfortable position when you are using your arm and wrist
Take frequent breaks at work, or when learning a new sport or instrument, to stretch your arms.
Get proper training when taking up a new sport or learning a new instrument.
Use proper equipment on the job or with sports.
Learn how to sit properly.

HOME TREATMENT The goals of self-care are to relieve pain, promote healing and avoid re-injury. Immediately after an injury and for the next few days, the most important home treatments include:
Ice pack or cold massage applied to the shoulder, elbow or wrist.

 

 

First aid # 5 SHOULDER STRETCHES

You should be standing.
Bend over at the waist and lean your good arm on the edge of a table.
Let your sore arm hang down freely.
Swing you sore arm in a circle then forward and back and side to side.
Repeat 5-15 times in each direction.
Stop if this increases your pain.
(note use caution – forward bending can cause low back pain)

click here for picture

First aid # 6 ROTATOR CUFF STRETCHES

Basics
Rotator cuff tendonitis is usually caused by impingement ( pinching ) of the tendons.
This is not “no pain no gain.”
Feeling a “stretch” and feeling better after is ok.
Feeling a “pinch” in not ok. If you feel a “pinch” don’t go as far into the stretch to avoid the “pinch” or go back to using ice for a day or two.

Stretch #1
Stand at a door frame reach up and put your hand at the top of the door frame. ( It is good to use the other hand to help lift your arm up and lower it back down)
You should feel a stretch in the arm pit ( no “pinch” or pain at the top of the shoulder)
Hold to 10-15 seconds
Stretch #2
Reach behind your back with the GOOD arm
Grab the sore arm by the wrist and gently slide your sore arm behind your back until you fee a gentle stretch.
Hold to 10-15 seconds
Stretch #3
Stand facing a door frame with your elbow at your side.
Bend your elbow to 90 degrees
You should be close enough to have your hand and wrist beyond the door frame and resting against the wall.
Turn your body so the wall pulls your arm out to the side (keep the elbow at 90 degrees) until you fee a gentle stretch.
Hold to 10-15 seconds

(Use caution – sometimes you don’t feel pain until the day after you exercise.)

Physical therapy is indicated for Acute ( severe ) pain that does not respond to rest or for Chronic ( less severe, but lingers over several weeks/months years) pain. Physical therapy can be prescribed by your doctor and is generally covered by insurance. A physical therapist is licensed to treat you without a doctor’s prescription but in many cases he/she may advise you to see a M.D. to rule out a more serious problem. Generally, physical therapists and M.D.’s work together to provide you with the best care. A physical therapist can instruct you in a basic program of arm care including maintenance exercises and a first aid program to prevent a minor injury from becoming a major injury.

DON’T LIVE WITH PAIN – THERE ARE SIMPLE TREATMENTS INCLUDING SLOWLY PROGRESSIVE EXERCISE PROGRAMS THAT CAN HELP MOST EVERYONE WITH CHRONIC ARM OR WRIST PAIN. THIS IS USUALLY COVERED BY INSURANCE. IF YOU NEED HELP A PHYSICAL THERAPIST CAN ASSIST WITH REDUCING PAIN AND SETTING UP A HOME PROGRAM.

CALL YOUR DOCTOR IF: Top of page

You fell and landed on your arm and have pain when you try to use the arm. You have a dull ache that came on without an obvious injury and has lasted for a few weeks.
New or unexplained symptoms appear.
Physical therapy should be prescribed when you have been treated by your M.D. but pain persists beyond 1-2 weeks or if you have had multiple episodes of pain over the past year.

Probable Outcome

Gradual recovery, but arm symptoms tend to reoccur. A home program can prevent continued arm pain.

Physical therapy can help you prevent long term problems.