Wrist pain is an extremely common ailment that many individuals experience in their lives. People will notice wrist pain quite quickly as we do nearly everything in our day to day lives with the use of our wrist. We need them for helping our hands perform specific activities, supporting the digits in necessary functions, and more (2). From typing on a computer to grabbing a glass of water, we desperately need the stability and strength of our wrist to perfect these daily behaviors. However, it is these daily behaviors (such as constant typing on a computer) that may end up contributing to the wrist pain we experience overtime (4). Wrist pain may spread to other parts of the hand and the arm. You may experience decreased mobility, stiffness, pressure, pain, tenderness, and more (7). Having instability, injury, or pain in this region can affect all of these basic daily activities, inhibiting our ability to exist and function effectively. Chronic wrist pain adds another level of difficulty, but luckily physical therapy and routine exercises and modality treatments can help ease discomfort and improve mobility and functioning.

There are several common wrist pain conditions that affect individuals:

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that involves the compression of the median nerve with possible friction rubbing from inflamed flexor tendons (tendonitis) or from shifting of the wrist bones narrowing the tunnel in the wrist, whether through overuse, poor posture/form, arthritis or a traumatic injury (2). According to the American College of Rheumatology, carpal tunnel syndrome actually affects around 4-10 million individuals in the United States (6).

Ganglion Cyst

A ganglion cyst is a type of cyst that occurs more often in women from the ages of 15 to 45, but can also affect men (2). It resembles a ball sac of fluid on the back of the bony area of the wrist. However, despite being benign, it can be a hindrance to your mobility and occasionally can cause pain.

De Quervain’s Tenosynovitis

This type of condition occurs primarily due to consistent and repetitive motion of the hand. It is centered in the thumb, but the pain can also occur in the wrist where the thumb meets the joints of that area.

Wrist Fractures

It’s quite common to fracture some bones that are in the hand or the wrist specifically. The problem is, some of the bones are so small that sometimes individuals do not feel the pain of a fracture until it has partially or fully healed in a slightly off position with malalignment. The delayed diagnosis and treatment of fractures can eventually lead to chronic pain of the wrist (2).

Arthritis

Rheumatoid arthritis and Osteoarthritis can both occur in the wrists and contribute to ongoing chronic pain and discomfort (2). Rheumatoid Arthritis will cause joints to experience inflammation and swelling, adding pain to the affected joints in the region (2). Osteoarthritis will cause degenerative wearing of the joint cartilage surfaces causing increased friction, stiffness, and irritation with the addition of reduced lubrication.

Tendinitis

Tendinitis is another type of inflammation that instead occurs in the tendons of the bones and can affect the wrist (2). Tendinitis occurs most often due to repetitive aberrant motions of the area (2). The entire hand may be affected by multiple areas of tendinitis over time. According to statistics, the occurrence of tendinitis of individuals who work full-time is 1.1 per 100,000 individuals (7).

Tenosynovitis

Tenosynovitis is inflammation of the sheath or what can be considered as the outer skin that encases the tendon. This causes friction , heat, inflammation and painful irritation as the tendon slides with its attached muscle during contractions. An example of a type of tenosynovitis is trigger finger (2). This condition may cause one or more fingers, including the thumb, to become stuck in a bent position (2).

How Physical Therapy Can Help

A physical therapist can start with a full examination of your condition, assessing your medical history, your mobility, any previous injuries, your strength levels, and more. The physical therapist may want to know more about your daily activities, whether at home or at work, that you perform which may be causing any pain or stiffness (7). The interview will cover how long you’ve had the pain for and how much it debilitates you in your everyday life. You will most likely be asked to perform a specific set of movements and exercises to test your flexibility and strength levels. Sometimes, a physical therapist may ask for diagnostic information like x-rays or MRIs in order to have more information about the affected area.

Following an examination and assessment, the physical therapist will then begin exercises and modalities that are uniquely created to help aid in your condition – by reducing pain overtime, increasing strength, increasing mobility, and increasing flexibility. Sometimes, the exercises and modalities can reduce inflammation and tension as well. Exercises that stretch the area are extremely important because stretching prevents the tissues from straining, which is often the culprit in stress injuries of the wrist (6). Maintaining a relationship with a physical therapist and performing the necessary exercises weekly can go a long way to preventing many of the conditions mentioned above, such as carpal tunnel syndrome and arthritis.

Sessions can include education on proper posture and form to reduce tension to the wrist. The PT may teach you the proper way to perform certain daily activities, like typing, in a way that reduces chance of injury and pain. It can include recommendations of modalities, such as heat and ice treatments if flare-ups occur. The physical therapist may do weekly manual therapy, such as massages or manual techniques and movements to help aid in mobility and also reduce tension and inflammation.

In general, it is important to first see your primary care physician and other specialists for a baseline assessment of your health before you do physical therapy. If any procedures or treatments need to be done prior to physical therapy, it is necessary to get those done before being referred for PT treatment.

Wrist exercises (to strengthen muscles, increase mobility, and reduce pain overtime):

Wrist flexion and extension (1,2)

Lay your arm on a table, making sure your hand, palm down, is over the edge of the table at the wrist. Bend at the wrist to bring your hand upward as you curl it into a fist, knuckles toward you. Then let your hand fall down, releasing the fist, with fingers extended out and pointing toward the floor. Repeat 10 times a day. This exercise works to relieve symptoms of both arthritis and carpal tunnel syndrome (2).

Hand flips (1)

Sit down in a chair and lay your arm on your thigh, with your palm downward. Then, flip your hand over at the wrist so that your palm is up, keeping your forearm FLAT on the thigh the entire time. Then flip back and forth between these motions with your hand only, keeping the forearm steady. Repeat 10 times a day.

Wrist Radial and Ulnar Deviation (1)

Hold your arm and hand out in front with the palm facing down. Then bend at the wrist as far as you can to the left, hold, and then to the right, and hold again. Continue performing this exercise on either side for 10 times a day.

Supination and Pronation (2)

You can do this exercise standing or sitting in a chair. Hold your arm at your side but bend your elbow at 90 degrees. The elbow should be against your hip, and have your forearm point straight out in front of you with your hand in a fist shape. You can also hold an object in your fist for extra weight, such as a can of beans or a hammer (5). Begin by slowly turning your wrist as far as you can in one direction, essentially rotating the wrist until your lowest knuckles face the ceiling, hold, and then slowly rotate back to start. Then, perform again by rotating the other direction. Perform 10 times a day.

Wrist extensor (1)

Extend your arm in front of you, bending at the wrist so that your fingers point toward the floor below. Then, use your other arm to bend your wrist/hand farther down until you feel a stretch in the forearm. Hold the stretch for 20-30 seconds. Repeat 2-4 times a day. It is ideal to do this stretch without pain. Once you feel more comfortable with the stretch, just add more time to the hold, while making a fist with your hand instead of having the fingers pointing for more of a challenge.

Wrist flexor (1)

Same as the last exercise except the other direction. Have your arm extended in front of you, bending at the wrist UPWARD so that your fingers point to the ceiling this time. Then, use your other arm to pull the hand back, feeling the stretch in the forearm as you bring that hand toward you, keeping the fingers pointed to the ceiling. Hold the stretch for 20 to 30 seconds and repeat 2-4 times a day. As you begin to feel comfortable, increase the stretch time while also making a fist with your hand instead.

Intrinsic flexion (1)

Have your hand extended in front of you. Completely straighten the hand until your fingers point ahead of you, parallel to the rest of the hand. Bend your fingers at the first joint where they connect to the hand, keeping the fingers entirely straight and the hand stable. Hold, and then raise the fingers back so they are pointing in front of you, parallel to the ground. Repeat 10 times a day.

Thumb flexion and extension (2)

This a great exercise for those who may be experiencing the De Quervain’s Tenosynovitis condition mentioned previously. Begin with your thumb outward, fingers extended. Then, bring your thumb over your palm inward. Hold the position and then release it. Repeat 10 times a day.

MP Extension (1)

Place your hand on a table with the palms up. Then, place your hand with wrist pain on top of the hand on the table, wrapping the fingers around the thumb of the hand below – as if you’re making a fist. Slowly begin uncurling the joints of the hand with wrist pain until only the top two joints of the fingers are bent. The fingers should resemble a “hook.” Then hold this position, before moving back to start with the fingers wrapped around the thumb. Repeat 10 times a day.

Extended arm (4)

Extend your arm outward at the shoulder straight in front of you, and allow your palm to face upward toward the ceiling. Use your free hand to hold the fingers of the extended hand and press them down toward the floor. Then, gently pull them back toward your body. Hold the stretch for 10-15 seconds. Repeat the stretch on the other arm.

Finger Flexion/Extension (3)

Hold your hand in front of you in a fist. Extend the fingers out as wide as you can, hold for 5-10 seconds, and then bring it back into a fist as tight as possible. Hold again for 5-10 seconds. Then repeat the sequence 10 times a day.

Tendon Glides (2)

Hold your hand flat in front of you and extend the fingers out. Then, make what is called a “hook fist,” where you bend at the second knuckles only, bringing the tips of the fingers straight down, but the upper knuckles remain straight with the rest of the hand. Return to a flat hand. Then, make a full fist, with the fingers curled and thumb around the knuckles. Return to a flat hand. Then, bend at the highest knuckles closest to the palm, letting your fingers point all the way straight. Return to flat hand. Then, make a straight fist, with the fingers straight at the second knuckles and thumb straight up rather than curling across the knuckles. Then, back to a flat hand. Repeat 10 times a day.

Fist clenching (2)

Place your hand on your thigh with your palm upward. Then, make a fist with your hand. Without moving the rest of your arm, bend at your wrist until your fist moves toward the rest of your body (2). Hold, and return to start. Repeat 10 times a day.

Thumb touches (6)

With one hand in front of you, bring your thumb to your pinky finger, and then back to start. Then bring the thumb to your ring finger, and then back to start. Repeat with the other two remaining fingers. Repeat on the other hand. Perform 10 times a day on each hand.

Tennis Ball (2)

Use a tennis ball or those stress relief balls. Squeeze the ball with all of your fingers and the thumb together, and then slowly release (2). Repeat 10 times a day.

Prayer Stretch (3)

Begin by placing your palms together and elbows out like you are going to do a prayer. Then, lower the wrists down until you feel a stretch, usually around where your hands reach your belly button (3). Hold the stretch for 5-10 seconds and then return to start.

Desk press (4)

Sit in a chair and place your palms facing upward under a desk or table nearby. Press your hand upward against the bottom of the surface. Hold the press for 5-10 seconds. Repeat 10 times a day. This exercise immensely improves the strength in your muscles from your wrist up to your shoulders.

Thumb exercise (4)

Make a fist with your hand and point your thumb upwards like a thumbs-up pose. Then use your other hand to gently pull back the thumb toward yourself, but add resistance with your hand and wrist to make the gentle pull more challenging. Hold and return to start. Repeat 10 times a day.

Figure-8s (4)

Interlace your fingers in front of you. Keep your elbows against your sides at the waist/hips. Then, move the interlaced hands in figure-8 motions in front of you (4). Let the wrists rotate fully on the movements so that you are able to take turns with which wrist ends up on top of the other (4). Rest and then repeat 10 times a day.

Overhead stretch (4)

You can perform this exercise seated or standing. Interlace your fingers together, and then lift them overhead. Then, turn your palms up toward the ceiling, essentially rotating the wrists on the movement. Hold the stretch for 15-30 seconds.

By Ashley Gresko

Blog Editing Consultant for Health Industry Designs

References:

1) https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=bo1655

2) https://advancephysicaltherapist.com/wrist-pain/

3) https://www.toc.md/physical-therapy/handwrist-exercises/

4) https://www.healthline.com/health/chronic-pain/wrist-and-hand-stretches

5) https://www.rickysinghmd.com/wrist-tendonitis/

6) https://www.nbcnews.com/better/lifestyle/wrist-stretches-relieve-pain-ncna1040146

7) https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-wrist-tendinitis

8) https://www.webmd.com/pain-management/exercises-carpal-tunnel-syndrome