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.
Osteoarthritis of the thumb:
The base of the thumb can commonly become stiff and painful with gripping, pinching and lifting activity. Osteoarthritis commonly affects an older population but can occur earlier with excessive lifting or trauma that may change the joint loading and therefore the cartilage health. Pain is usually aching in nature but can be sharp and localised to the base of the thumb and wrist.
Physiotherapy techniques such as specialised splinting, both functional and resting splints can be useful in managing symptoms. Likewise, taping techniques, soft tissue release, joint mobilisations and targeted strengthening can provide symptom relief. For persistent pain, acupuncture can provide pain relief.
Wrist fracture (distal radius):
A fall on an outstretched hand can cause fracturing of the wrist bones. One fracture is known as a 'colles fracture' which gives the wrist a dinnerfork like looking deformity. Commonly this requires plaster immobilisation and ultimately the wrist becomes stiff from this period of immobility. As the bones heal it is imperative that normal movement patterns are restored as well as normal flexibility and strength.
Techniques such as joint mobilisations, mobilisations with movement, specific soft tissue release techniques and joint strengthening exercises can be effectively used by your physiotherapist to achieved normal movement and functional use of the wrist in daily activities.
Scaphoid fracture:
The scaphoid bone is found at the base of the thumb near the wrist joint. It is a small bone held tightly between the long bones of the fingers and the wrist. With trauma to the wrist and heavy falls it can be injured or even fractured. This results in wrist pain and sometimes thumb pain that can be severe. This injury is sometimes missed in X-Ray investigation initially due to the nature of the injury and small size of the bone.
Your physiotherapist can assess the injury and identify any local scaphoid injury, directing you to the appropriate and best course of treatment. Taping techniques, mobilisations and splinting can be utilised to reduce pain and aid in healing.
Wrist impaction syndrome
Impaction describes the bones being impacted into each other and can affect a number of bones in the wrist and hand. It is usually related to repetition of weight bearing activities, ie golf, racquet sports, weight lifting or gymnastics.
Your physiotherapist can help you to manage the problem and avoid the aggravating factors. Anti-inflammatory advice is often given. Surgery is only required when the injury is extensive. We can recommend a top London hand and wrist consultant in this case.
De Quervains tendinopathy:
The tendons that run into the thumb run in a sheath to protect them and ensure smooth and efficient movement across the wrist bones. These tendons can become inflamed, degenerate and painful after periods of unaccustomed repetitive such as painting and decorating. New mothers can be susceptible due to the repetitive nature of picking up and lifting a newborn baby. The pain can be sharp over the outer wrist and base of the thumb, normally can be reproduced by feeling and often there is crepitus or 'crunching' as the thumb is moved.
Physiotherapy can be highly effective in reducing symptoms of De Quervains tendinopathy by introducing specialised splinting, active rest, advice and activity modification advice, graduated loading exercises and acupuncture.
Rheumatoid Arthritis
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 can recommend a top London pain consultant 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 up the arm or over the hand. 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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