Keeping you bodywise: Repetitive stress conditions – hand and upper extremity

by TOI Admin September 17, 2012

 

By: Adrienne D. Riveros, MOTR/L

Every year, many people suffer from repetitive stress conditions and are unaware of the simple strategies that may help manage or alleviate their symptoms. This article will describe some of the most common repetitive stress conditions, explain the basic anatomy and give pointers on how to effectively manage these conditions.

Carpal Tunnel Syndrome (CTS) –

            What is CTS?

Carpal tunnel syndrome is the most common nerve compression of the upper extremity. It is typically characterized by pain, tingling and numbness in the fingers and hand. Among other things, it can be caused by:

 

  • Repetitive stress (i.e. assembly line work)
  • Swelling in the area of the carpal tunnel (i.e. pregnancy)
  • Ganglion cyst
  • Direct trauma to the carpal canal (i.e. falling on an outstretched wrist; hitting wrenches with the heel of the hand during machine/mechanic work)
  • Prolonged hyperextended or hyperflexed positions of the wrist (i.e. sleeping with wrist(s) in awkward positions)

The carpal tunnel refers to a canal located at the base of the hand.  It is bound on three sides by the carpal bones. The transverse carpal ligament covers the canal and can be thought of as the “roof” of the carpal tunnel. The tendons that flex your fingers and thumb pass through the carpal tunnel, in addition to the median nerve. The median nerve gives sensation to the thumb, index, middle and half of the ring finger. As the carpal tunnel is unable to expand, inflammation, a cyst, an injury to this area, etc. may cause pressure on the nerve. If this occurs, some common symptoms are numbness, tingling, pain and/or muscle weakness. You may also have difficulty moving your thumb toward the base of the small finger, as this motor action is controlled by the median nerve.

            Treatment Options

Common treatments of CTS include decreasing repetitive stress, splinting with a wrist support at night, range-of-motion/nerve gliding exercises, nonsteroidal anti-inflammatory drugs (NSAIDS), a cortisone injection administered by a physician and surgery for severe cases.

TIP: Many people in manual labor jobs tend to use the heel of their hand like a hammer. Instead of hitting wrenches, handles, boards, etc. with your hand, try to use a different tool in place of your hand.

 

Tennis Elbow (Lateral Epicondylitis) –

            What is Tennis Elbow?

Tennis elbow refers to a condition near the outside of the elbow where the symptoms include pain, inflammation, soreness and stiffness. The condition typically occurs when the forearm extensor muscles are used repetitively. Over time, this can cause small tears to develop in the tendon that attaches these muscles to the bone at the outside of the elbow. Some common activities with repetitive wrist motion that can cause tennis elbow include:

  • Playing tennis
  • Prolonged use of a screwdriver, hammer, pliers, wire strippers or other tools
  • Painting

            Treatment Options

The most common treatment option is to stop or decrease the repetitive stress as much as possible. Icing and anti-inflammatories are also very beneficial. If the condition fails to get better or worsens, a visit to the physician may be necessary. They may choose to administer an injection or may send you to therapy. Among other things, therapy may include a wrist support splint to limit the strain on the forearm muscles, education on a counterforce band or Tendon Trak (takes the load off of the irritated tissue), stretches and range of motion exercises and/or Iontophoresis (medicated patches). It is very important to note that, even after a person is feeling better, it is still necessary to ice and stretch for a length of time to prevent the condition from returning.

TIP: If you are a tennis player, make sure you have the right size racquet. A racquet that is too big can put unnecessary strain on your extensor muscles. Adjust your string tension to a lower level, as strings that are too tight can increase the amount of strain in the arm.

 

Thumb CMC joint arthritis (Basilar joint arthritis) –

            What is CMC joint arthritis?

The thumb CMC joint refers to the carpometacarpal joint or the basilar joint. It is located at the base of the thumb. This is a complex joint that allows the thumb to flex, extend and oppose to the other fingers for gripping, pinching, picking up objects, etc. This joint sustains a large amount of wear and tear over time which makes it prone to arthritis. (The anatomy and the mechanism by which the arthritis can occur in the CMC joint are discussed in detail in “Basilar Joint Arthritis” by Dr.Arthur Sharkeyin this issue.)

            Treatment Options

There are numerous treatment options for thumb CMC joint arthritis ranging from very conservative to surgical. Conservative treatment focuses on improving functional use, improving or maintaining joint mobility and reducing pain. Below are a few of the most common therapy-related treatments:

  • Splinting – soft, pre-fabricated thumb splints can be purchased over the counter, or plastic c-splints can be custom fabricated especially for a person’s hand by a hand therapist (physical or occupational therapist). Splinting helps to support your joint, allow it to rest and often helps to decrease pain. Splints can be worn at night and as needed during the day for pain or heavy activity.
  • Heat or cold – Applying heat can help to decrease pain and stiffness. Applying cold can help to reduce pain due to inflammation or overuse. Alternating between the two can also help to reduce inflammation. Heating pads, hot packs, paraffin units, ice packs and contrast baths are several examples of common modalities that are used. (Care should be taken to avoid burns or frostbite.)
  • Gentle range-of-motion (ROM) exercises – Your physician or a hand therapist can provide a person with appropriate ROM exercises if the joint(s) become stiff. Exercises are prescribed on a case-by-case basis depending upon the location of the limitations.
  • General joint protection – Care should be taken to avoid loading the painful joint(s). Many daily activities can be modified by using larger joints to perform the task. An example would be moving a heavy casserole dish – instead of using a pinch motion to hold the side handles, slide the dish onto the palms of your hands. By making a simple change to his common task, the load is transferred from the thumbs to the wrists and elbows.
  • Adaptations and Modifications – There are many simple modifications that can be made around the home to help with activities that are usually painful. One example would be using a jar opener or dycem to open jar lids. Another would be enlarging the handles of common tools such as pens, tools and kitchen utensils. Door knobs can even be changed to the lever style.

TIP: There are many treatment options for thumb CMC joint arthritis. Your physician or hand therapist can guide you through a treatment plan that is custom to your needs.

From an acute onset of tennis elbow to a gradual onset of thumb CMC joint arthritis, the functional impact of repetitive stress conditions can be debilitating. Please note that the information presented in this article is only a basic guideline. If you are having symptoms that do not subside with common treatments or the symptoms get worse, it may be necessary to consult your physician. Among other things, your physician may refer you to hand therapy to find a course of treatment that best fits your needs.

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