James Grigg
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Wrist & hand pain

We as nation often take our hands for granted and only really notice they are there when there is a problem. Think what you couldn't do on a daily basis if you couldn't move your hands. That may give an idea of how much you use and rely on them each and every day. Some of us take care of our bodies. For example; people exercise, have sports massages to help muscles recover, eat healthily etc. But how many people look after their hands. Nearly a quarter of all the bones in our bodies are in our two hands, should we look after them more? We think the answer is obvious!

Repetitive strain injury (RSI)

Due to the technology revolution, the nation as a whole are required to work for longer periods whilst sat at computer desks. Most RSI conditions are reported in the hands and forearms. Constant use of the smaller tendons in our fingers, to type at the desk or repeated use of our mobile phones, can cause irritation, inflammation and wear and tear to these tissues.

Treatment of RSIs can be difficult as you cannot just simply say stop using a computer. But what we can do, is make sure the movements required to do these repetitive movements are actually being executed in the most energy efficient way possible.

We look to see, are the muscles moving optimally? Are the joints freely moving in all three dimensions? Are the elbow and shoulder joints moving correctly and not causing excessive strain on the smaller muscles in the hands? All of this is of value when assessing and treating RSIs. Some people can type for twice as long as another and not experience symptoms. This might be because all of there joints are able to move well when performing tasks. Therefore the person who is experiencing problems, and is typing for far less time, might just not be able to use there anatomy as well as the other person. As a result, inflammation and injury can occur.

The good news is that when everything is moving well, then most people should be able to cope with long hours of computer work. It is when things are not moving well, that the repetitive actions lead to excessive stress and ultimately pain.


Typing at a computer is a skill that requires efficient movement of the whole upper limb, neck and shoulder blades

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition that often causes pain, pins and needles, numbness and weakness into the palm and fingers of the hand. The reason for these symptoms is due to compression of a nerve (the median nerve) as it passes through the wrist in a narrow channel formed between bone and soft tissue. This channel is known as the carpal tunnel. Compression of this nerve maybe due to inflammation as a result of a repetitive strain type injury, possible trauma and/or fracture.

The location of symptoms is important in diagnosing carpal tunnel syndrome. The median nerve supplies the palm of the hand as well as the thumb, 2nd, 3rd and one side of the 4th finger. People with a compression of this nerve usually feel the symptoms described above in these locations.

Most people in their lifetime have experienced pins and needles in their hands at some point, usually when sitting or leaning in an awkward position. This is quite common as we compress arteries and or nerve tissue throughout the body. Carpal tunnel syndrome however will produce higher intensities of pins and needles for longer periods of time as well as pain.

Treatment needs to focus on increasing the space for which the nerve can travel through, reducing inflammation, improving mobility and re-gaining movement patterns throughout the whole arm. Surgery can sometimes be required, but very often symptoms can completely resolved with the appropriate treatment strategy.

N.B. Carpal tunnel symptoms can be experienced without there being any compression on the nerve in the wrist. The median nerve actually travels in-between the vertebrae in the neck. If there is a problem in the neck, symptoms of carpal tunnel can be experienced. Likewise, any compression on the nerve as it passes from the neck to the wrist, can also create symptoms. Accurate diagnosis is needed to determine the best treatment plan.