Elbow, Wrist & Hand Pain

Tennis Elbow is a colloquial term used for the condition know as lateral epicondylalgia, or more accurately, a common extensor tendinopathy. Tennis Elbow is a painful condition that affects the outside aspect of the elbow, at and around the lateral epicondyle, where the tendons of the forearm responsible for extending the wrist and straightening the fingers attach via a common tendon.

Tennis Elbow is an overuse injury that often develops over time due to excessive load, that is, any level of activity that is higher than previously accustomed. Activities that require highly repetitive use of the extensor group, particularly under resistance, may result in a tennis elbow. As the name suggests, it is a common injury seen in tennis players, but is also common in all racquet, stick and club sports, any activity requiring heavy or repeated gripping, typing, repetitive lifting or carrying. Tennis elbow usually builds gradually, resulting in lateral elbow pain and weakness of the forearm, wrist and hand. Gripping is often difficult and painful. When present for more than 3 months, neurological symptoms may also start to develop. Treatment options vary, and often combination treatments are used, but are always conservative to start with. Graduated strengthening of the extensor muscles is a key component of rehabilitation. Prognosis varies greatly between individuals depending on their level and type of activity. Physiotherapy should commence as soon as possible to prevent chronicity. The goals of physiotherapy are:

• Make an accurate diagnosis

• Identify any loading errors in your training or activity

• Educate you about your condition

• Provide manual therapy where appropriate

• Design a loading program specific to you

• Plan out your return to sport and activity

Golfer’s Elbow is a colloquial term used for the condition know as medial epicondylalgia, or more accurately, a common flexor tendinopathy. Golfer’s Elbow is a painful condition that affects the inside aspect of the elbow, at and around the medial epicondyle, where the tendons of the forearm responsible for flexing the wrist and fingers attach via a common tendon. It is less common than Tennis Elbow.

Golfer’s Elbow is an overuse injury that often develops over time due to excessive load, that is, any level of activity that is higher than previously accustomed. Activities that require highly repetitive use of the flexor group may result in a tennis elbow, including golf, as well as other racquet and club sports, in gym go-ers, any activity requiring heavy or repeated gripping, typing, repetitive lifting or carrying. Golfer’s elbow usually builds gradually, resulting in medial elbow pain and weakness of the forearm, wrist and hand. Gripping is often difficult and painful. Occassionally neurological symptoms associated with the ulnar nerve may develop. Treatment options vary, and often combination treatments are used, but are always conservative to start with. Graduated strengthening of the flexor muscles is key. Prognosis varies greatly between individuals depending on their level and type of activity. Physiotherapy should commence as soon as possible to prevent chronicity. The goals of physiotherapy are:

• Make an accurate diagnosis

• Identify any loading errors in your training or activity

• Educate you about your condition

• Provide manual therapy where appropriate

• Design a loading program specific to you

• Plan out your return to sport and activity

The Ulnar Collateral Ligament (UCL or MCL) of the elbow is the major stabilising ligament of the inside aspect of the elbow. It is located on the inner-side of the elbow closest to your ody, limiting how much the joint collapses “inwards” or “opens up”. The UCL is often injured in contact sports where players make contact with opponents and the elbow if forced into a valgus position, and in overhead and throwing athletes who place a significant amount of stress on the inside of the elbow joint (these are usually a more chronic type of injury). These injuries are graded I-III based on severity. Symptoms will vary depending on severity and which other structures are involved, but may include pain, localized swelling or an elbow joint effusion (large global swelling of the elbow), a loss of elbow range of motion, tenderness along the inside of the joint, a feeling of instability, and a loss of strength. Often the elbow will not straighten or bend fully. These injuries are almost always managed conservatively, without surgical intervention. Recovery can take anywhere from several weeks to several months. Following injury, physiotherapy should commence right away. The goals of treatment are to:

• Educate you about your injury

• Assist you in acute injury management, and to minimize pain and swelling

• Protect the injured structure

• Commence early rehabilitation

• Plan out your return to sport and activity

Carpal Tunnel Syndrome is a compressive neuropathy of the median nerve which occurs at the wrist. The median nerve is one of the major nerves supplying the skin and muscles of the forearm and hand. The carpal bones are the 8 small bones that make up the wrist joint, and are arranged in two rows that form a “tunnel”. When the median nerve becomes compressed in this tunnel, it may result in pins and needles, numbness and weakness in the hand and forearm, and night pain is extremely common. There are many reasons why the median nerve may become compressed inside the carpal tunnel, including:

• a swelling of the tendon sheaths that run through the tunnel

• the accumulation of swelling (for example during pregnancy)

• prolonged positioning of the wrist that causes compression of the nerve

• Exposure to repetitive movement and vibration.

Risk factors for the development of carpal tunnel syndrome include

• female sex

• obesity

• pregnancy

• rheumatoid arthritis

• smoking and alcoholism

• diabetes mellitus

• hypothyroidism

Treatment is generally conservative and often includes the use of night splints. Occasionally injections may be utilised, and in some cases carpal tunnel releases may be surgically performed.

DeQuervain’s tenosynovitis is an inflammation of the tendon sheath of two muscles that operate our thumb. The Abductor Pollicis Longus and Extensor Pollicis Brevis are two muscles with long tendons that pull the thumb out and away from the palm. The tendons of these muscles are located on the back of the wrist, on the thumb side, and can be easily seen when you spread your thumb wide. The tendons are encased in sheaths that act to lubricate their movement, and when exposed to highly repetitive movements or prolonged positions the sheaths can become inflamed, resulting in a tenosynovitis. DeQuervain’s Tenosynovitis results in tenderness, swelling and pain at the point which these tendons cross the wrist, and in some cases can extend along the length of the tendons. Occasionally crepitus (or a creaking-like sensation) can be felt with movement. It is extremely common during and after pregnancy, in racquet sports, bowlers, rowers and canoeists, and occasionally in golfers. Treatment is usually conservative and may involve the use of a splint, improving mobility and regaining strength. The goals of physiotherapy are too:

• Make an accurate diagnosis (and differentially diagnose this from an Intersection syndrome or other condition)

• Educate you about your condition

• Commence treatment and make modifications specific to you and your activity

• Plan your return to activity or sport

A Mallet finger is a flexion deformity of the finger that results from a traumatic extensor tendon injury. The long extensor tendon located on the back of the finger, that attaches to the last bone in our finger, avulses (or tears) off from the bone, resulting in a flexion of the tip of the finger. It commonly occurs when a ball strikes the tip of the finger causing it to forcefully flex, and is a very common injury seen in cricketers, baseball catchers, basketball and netballers, and football receivers. The finger is usually tender, and you are unable to actively straighten out your finger. X-rays need to be taken in this case to exclude a fracture or subluxation of the joint. Moderate to large avulsion fractures, subluxations, fracture-dislocations, or injuries in children all require specialist review, as surgery is often required. If the injury is uncomplicated, the injury can be managed conservatively with a splint and will require rigorous physiotherapy to ensure full function of the finger is regained.

A Jersey finger is a traumatic flexor tendon injury, where the long tendon responsible for flexing or bending the finger (located on the palmar surface of our finger) avulses or tears off the last finger bone. This leaves you unable to bend or flex your finger at will, with the finger resting in a slightly extended position. The affected finger is usually tender and sometimes swollen. Jersey fingers occur during grip when the fingers are forced out into extension, for example when holding on to an opponents jersey who is running away from you. This injury most commonly affects the ring finger. Jersey fingers almost always require surgery to repair the tendon or stabilise any associated fractures, to ensure that function is restored to the affected finger.