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Hand Pain
This particular topic really is handy!
by James Wilson BSc (Hons) Ost Med. DO - find out more about James.
Our hands and wrists are incredible structures and are one of the defining features which make us human – we can perform incredibly detailed and precise movements such as writing, operating a computer mouse, threading a needle and playing many musical instruments. At the same time there is potential for remarkable strength; for example grip strength is a massive part of athletic events such as “deadlifting” where the world record is a lift in excess of 450kg (over 1,000 lbs in old money!).
The huge capabilities of the wrist and hand are very much enabled by their structure, which, as you would expect, is relatively complex. There are 27 bones held by numerous ligaments, operated by numerous muscles and controlled by divisions from three main nerves.
Maybe unsurprisingly problems in the wrist and hand are quite common. Frequently though this is due simply to how much we use (or mis-use) our hands rather than failure of particular structures.
Common complaints of the wrist and hand
Symptoms of pain, swelling, stiffness, pins and needles, numbness and weakness are regularly described.
Causes of the above include: Muscle Strains, Ligament Sprains, Tendonitis, Repetitive Strain Type Disorders, Osteoarthritis, Rheumatoid Arthritis, Lunate Subluxation, Nerve Entrapment Syndromes, Ganglions, Fractures.
Carpal Tunnel Syndrome (CTS)
The wrist is formed by eight carpal (wrist) bones arranged in two parallel rows with joints in between. A thickened membrane called the flexor retinaculum helps hold the bones in a semi-lunar shape so that between the bones and membrane is a tunnel. Within this carpal tunnel run nine muscle tendons and also the median nerve.
The median nerve can be irritated or compressed within the tunnel, termed carpal tunnel syndrome. This can be caused by problems:
- Locally with the joints / bones or muscle tendons,
- Thickening or shortening of the flexor retinaculum or
- Due to problems or changes elsewhere in the body which result in swelling accumulating underneath the retinaculum and therefore compressing the nerve (e.g. During pregnancy or in organ failure).
This therefore is a type of nerve entrapment syndrome and classically causes pain, swelling and numbness at the base of the thumb and of the palm surface in the index, third and fourth fingers. In cases of late diagnosis or inadequate treatment there may be wasting and weakness in the muscles at the base of the thumb. This will lead to significant problems with pinch gripping (i.e. gripping between the thumb and fingers such as when holding a pen).
The symptoms are often worst at night, or after the activity which causes the problem.
Treatment of CTS
Before we talk about treatment it is worth mentioning that there are other conditions which can cause very similar symptoms. Nerve irritation can occur in the neck and at the shoulder for example.
This, in my opinion, often leads to an over-diagnosis of CTS and therefore application of ineffective treatment; for example treating for CTS is not going to work well if the main source of nerve irritation is in the neck!
Likewise in cases where CTS is believed to be due to swelling in the carpal tunnel, the reason for this swelling must be sought as the swelling could be a sign of something far more serious.
Physical treatment of diagnosed CTS (such as that applied by your local osteopath!) would include drainage work to decrease local swelling, improving function of the carpal joints where needed, assessment and treatment of existing issues in the elbow, shoulder, neck, mid-back and ribs.
Advice would also be given regarding reducing aggravating or causative factors such as poor desk-based or driving posture. Supports, taping and splinting are often used, as well self-stretching the soft tissues.
As with so many conditions, success rates of treatment tend to be higher the earlier the symptoms are dealt with. Dependant on the cause of the CTS treatment may be effective in reducing symptoms in as little as five days, but frequently symptoms will take several weeks to truly clear.
A final thought
There are many conditions other than CTS that effect the hand and wrist, many of which we can successfully treat as Osteopaths. There is a lot we can do for and advise on in cases of osteoarthritis for example – the details of which will have to be contained within a later topic!
Our hands are fascinating and unique - take care of your hands and they will serve you well.
Further information is available on our website www.molfordhousesurgery.co.uk. Alternatively I am always pleased to answer any questions you may have. You can call me at Molford House Surgery on 01769 574830.
The information provided on these pages is intended as a general guide only and in no way constitutes a complete service for diagnosis or treatment. You must not rely solely on this information and it is therefore your responsibility to seek a professional opinion should you be concerned about your particular case.
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