This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Triangular fibrocartilage injury:
The triangular fibrocartilage is a piece of tough soft tissue like cartilage that sits in the joint on the little finger side of the wrist. It provides stability and congruency to the joint during movement and function. Pain around the area can be due to traumatic falls onto the hand or by repetitive activity that causes trauma over time to the area such as playing golf. This can also cause clicking or catching within the joint.
Physiotherapy techniques such as joint mobilisations, specific soft tissue techniques, taping including kinesio taping and stabilisation exercises can help control the pain from fibrocartilage injury.
Ulnar nerve entrapment:
The ulnar nerve passes very close to several small bones in the wrist near the base of the 5th finger. It can become compressed, inflamed or irritated by long periods of cycling or gripping, particularly on uneven or bumpy ground. Symptoms can include numbness, tingling or shooting and burning pains that can spread down into the 4th and 5th fingers if severe.
Physiotherapy treatment can look to correct poor biomechanics and hand positions with function and offer advice on management to prevent future injury. Acupuncture, soft tissue techniques, specialised splinting techniques and nerve gliding exercises can be provided to aid in healing and pain relief.
Ulnar styloid fracture:
The ulnar styloid is the small prominent bone on the end of the outer wrist. It can be injured when a wrist is fractured during a fall and a small piece of the end bone is avulsed/pulled off with the force. This can cause aching and pain localised to the area and the border of the wrist, particularly with lifting and carrying.
Your physiotherapist can provide specialised splinting, joint mobilisation, stabilising exercises and taping techniques to reduced pain and improve function of the wrist. Specialised equipment can also be utilised to aid in bony healing and speed up recovery after fracture.
Repetitive strain injury:
In todays electronic, computer based world repetitive injury is common due to our use of computers on a regular and often excessive daily amount. The repetitive nature of many roles will encourage inflammation of tissue, altered nutrient flow and poor tissue health pleading to pain. These pains can be odd, sharp, shooting, aching or random in nature. Possibly not linked directly to a specific injury and could come and go.
Your physiotherapist can fully asses the underlying causes of the symptoms, direct you towards computer health techniques, provide pain relief with specific soft tissue techniques and provide wrist stabilising exercise and stretches targeted to your condition. Acupuncture has also been shown to relieve a large part of repetitive strain injury if started quickly. A workstation assessment can also take place which can correct any problems that may be contributing to your pain.
Osteoarthritis and Rheumatoid Arthritis
Osteoarthritis can occur in any joint in the body and is a the process of 'wear and tear' where the cartilage covering the area of bone that makes up the joint is gradually worn away over time. Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.
We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment which includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function.
Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.
We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:
- Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
- Wheelchair assessments
- Splinting
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants who can help you.
Complex Regional Pain Syndrome
This condition as the name suggests is complex. The pain is often constant and of a burning type. The body part affected is often very sensitive to touch and just a stroke can cause pain. There can be changes in temperature and colour of the body part and on occasions growth of excess hair and swelling. The wrist can be affected by this syndrome and the symptoms can extend over the hand and up the arm. The exact cause of it is not clearly known and can happen with no cause but there can be an event before it occurs such as a fracture. 'The sympathetic nervous system' has been shown to be involved which controls blood flow and skin temperature.
Physiotherapy can help with this condition by keeping the part of the body affected moving and stop it stiffening up. They can help to use techniques to desensitise the area and acupuncture can help the pain in some cases. Your physiotherapist will also recommend a top London pain consultant to you who can use treatments to block the sympathetic nervous system from firing and provide appropriate medication to help with the pain.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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