Continuing Professional Development

The team at Complete Physiotherapy are passionate about being the best they can be in order to give their patients’ the best treatment. Today some of the team members were learning more about the wrist and hand including new assessment and treatment tools.

There are common injuries that make up our daily practice but there are also injuries that we don’t see often yet shouldn’t be missed.

De Quervain’s

This is an injury often seen as a ‘repetitive injury’ and can be debilitating. It is caused by inflammation of the tendons (extensor pollicis brevis and abductor pollicis longus) as they pass over the radial styloid (thumb side of the wrist joint). It can start as an acute injury and progress into a chronic injury (> 12 weeks).

Patients often present with thumb sided wrist pain, swelling and crepitus (creaking of the wrist on movement).  It is oftern very tender on palpation and there is weakness of the thumb movements.

Image result for de quervain's tenosynovitis

Diagnostic ultrasound scanning is considered the best modality for analysing the tendons.

Physiotherapy management  includes:

  • Splinting
  • Electrotherapy including ultrasound
  • Graduated strengthening
  • Acupuncture or dry needling
  • Taping

Skier’s Thumb

Image result for UCL ligament thumb

Is a nasty injury that occurs when we fall onto a ‘hyperabducted thumb’. It causes a complete or partial rupture of a ligament in the inside of the thumb (ulnar collateral ligament). Partial tears can be treated by Physiotherapy with bracing for 4-6 weeks but complete tears need to be managed surgically within less than 10 days from the injury to avoid the ligament retracting.

Patient’s often present with pain and laxity of the thumb, tenderness over the thumb joint (first metacarpal joint) and complications of this injury include:

  • Joint instability
  • Chronic laxity
  • Pain / weakness
  • Early onset of osteoarthritis

Scapholunate Ligament tear

This injury can occur when falling onto an outstretched hand or through trauma. It involves the rupture of the ligament that attaches the scaphoid bone to the lunate. It is commonly misdiagnosed as a wrist sprain but left untreated can result in the collapse of the carpal bones (SLAC). This injury is often accompanied by wrist clicking with pain and on XRAY there is a defomity of the lunate (‘humpback’). We also see gapping of the space between the Scaphoid and Lunate (Terry’s sign). Image result for scapholunate ligament

Often our patietns are able to precisely localise pain and there is tenderness over this area with some associated swelling.

Treatment:

Partial tears of the ligament can be treated with a non-surgical approach using appropriate strengthening to enhance stability and proprioceptive retraining.

There are negative effects of gripping as this would increase the collapse of the carpal bones.

Do you suffer from any of these injuries and need advice? Come in and speak to one of our Chartered Physiotherapists and see if they can help or call on 01189462299.