Wrist pain can be a mysterious symptom that often occurs after an injury to the distal arm. Initial diagnoses frequently include an injury in or around the wrist such as distal radius fracture, carpal tunnel syndrome, osteoarthritis, rheumatoid arthritis, de Quervain’s, repetitive strain injury, fibrocartilage complex injury, tendonitis, or bursitis. Time and again, the initial injury is treated and appropriately healed, but the patient continues to report stubborn wrist pain.
Treatment for wrist pain can present a challenge for doctors and therapists. Immobilizing the wrist has often been thought of as the treatment of choice. However, prolonged immobilization is known to cause sensorimotor dysfunction within the wrist.
A lack of sensorimotor control within the ligaments of the wrist results in pain with a cause or causes that cannot be easily identified with X-rays or MRIs. In other words, the carpal bones and ligaments within the wrist become out of practice with their intricate movements during functional activities, thus causing pain for the patient with even the simplest of tasks. The good news is that therapy can help. Your hand therapist at Makovicka Physical Therapy has special training in treating wrist pain.
Makovicka Physical Therapy uses therapeutic interventions that train the patient to have conscious proprioceptive awareness of the wrist during simple movements and gradually, under a therapist’s supervision, transition through multiple phases until they can perform unconscious control of the wrist during daily functional activities. The transition from conscious to unconscious control of wrist movements improves sensorimotor control within the carpus through neuromuscular re-education, thus eliminating pain and improving functional activity tolerance.
Neuromuscular re-education treatment consists of kinesthesia, joint position sense, and sense of force or resistance training to restore afferent information arising from neural receptors that contribute to postural control, joint stability, and motor control. The therapy focus will include activating muscles that stabilize the carpus and limiting the use of overactive muscles that can be potentially harmful to stabilizing ligaments. Common exercises include isometrics, gentle weight-bearing, dart throwers motion activities, and dynamic exercises such as using a body blade. Therapists will also educate patients on the proper use of taping and splinting as well as pain and edema management.