Hand and Wrist

The hand is a complex biomechanical organ devoted to the manipulation of our environment. With the ability to execute the finest of precision grips (picking up and threading a needle) or the power grips used for lifting and carrying, our hand function is also essential in communication, sensory feedback, identification and expression of sentiment. Even the most minor of  injuries can have a devastating impact on our functional independence. Treatment will be individually tailored to your needs and may include any of the following:

• Techniques to reduce swelling
• Scar tissue management
• Tissue massage and release
• Range of movement exercises
• Joint mobilisations in the hand, wrist and forearm
• Adaptive postures/functional retraining
• Scapula stability exercises
• All aspects of post-operative rehabilitation for the hand and wrist
• Education and advice
• Fracture management

 

Examples of Conditions Treated:

Carpal Tunnel Syndrome
The first two rows of small bones in the hand are called carpals. If you bend your elbow and turn your palm upwards (as though you are holding a tray) you will see a natural dip in the centre of your hand at the point where it joins your wrist. This dip is formed by the shape of the carpals making a small “valley”. The valley is bridged by a ligament and forms the carpal tunnel. The median nerve and a number of tendons travel through the carpal tunnel to enter the hand. If anything happens to reduce the space within the tunnel, or increase the size of the tissues in it; the median nerve will be squeezed and a patient will experience the symptoms of carpal tunnel syndrome.

Dupuytren’s Contracture
Most of the muscles that curl your fingers into a fist are located  in the “palm” side of the forearm. They have long tendons that run down through the wrist to enter the hand, cross the palm and attach to the fingers. There is a triangular shaped piece of connective tissue lying just under the skin and covering the palm.  It is called the “palmar fascia” or the “palmar aponeurosis”. It has roles in keeping the tendons of the palm in place and preventing the fingers of the hand from bending too far backwards. The aponeurosis separates into thin bands that wrap around fingers and bones. In Dupuytren’s Contracture, these bands thicken and shorten preventing the finger bones from being able to straighten. It normally affects the little and ring fingers.

Trigger Finger
Tendons are bands of connective tissue that attach muscles to bones. The muscles contract, pull on the tendons and movement occurs at bony joints. Special ligaments exist that form an arch on the surface of the finger bone called a pulley. They help hold the tendons in place against the finger bones and create a tunnel for the tendons to glide through when the fingers bend and straighten. If something happens to cause a nodule or a thickening in the tendon, it doesn’t glide freely through the tunnel anymore as the nodule prevents smooth movement. There may be the sensation of clicking and if a nodule actually gets trapped by a pulley, a finger can “lock” in a bent position.