Name My Pain

Chronic Back of Hand and Wrist Injuries (Thumb side) Name My Pain
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De Quervains tenosynovitis
This injury has a sub acute onset, due primarily to over use type activities, like racket sports, ten pin bowling, rowing and canoeing. Pain is felt in the tendon above the thumb with activity, in severe cases there may be crepitus (cracking and grinding) with movement.
Tenosynovitis results from overuse of the muscle and the tendon that attaches that muscle to the bone. When the tendon is overused it sustains small microscopic tears. In order for the body to repair these tears it creates inflammation, and that inflammation can cause pain, stiffness and swelling.
These types of injuries typically are ignored at first. As the pain initially decreases with warming up, and then is not present during activity. But the discomfort returns when the athlete cools down. If not addressed this process continues and worsens the condition, so that pain becomes more present during activity, and worsening more after finishing, until ultimately there is constant pain, and limitations to all activity.

To reproduce this pain and help to diagnose this injury place thumb in to the palm of the hand and then the wrist is bent (flexed) towards the little finger (ulnar) side of the persons hand, pain should be felt on this test in the area to be positive.

De Quervans Test, Bend (Flex) thumb across hand.

Hand & Wrist

With thumb bent (flexed) across wrist, Wrist is flexed away from thumb and will reproduce pain.

Hand & Wrist

De Quervans Test, (Bend) Flex thumb across hand.

Hand & Wrist

With thumb Bent (flexed) across wrist, Wrist is flexed away from thumb and will reproduce pain.

Hand & Wrist

Ganglion formation
Ganglions are synovial cysts. This injury primarily occurs due to previous ligamentous injury to the wrist, it can be a relatively painless swelling within the area of the cyst.
Generally complaining of intermittent wrist pain and reduced movement. There may or may not be swelling present.
Ultrasound is best for diagnosis if this condition is suspected.

Triangular fibrocartilage complex tear
Most common in sports where there is a compressive force applied through the wrist, e.g. gymnastics, diving, golf and racket sports.
There is generally pain on the top of the wrist and hand, with a clicking sensation with movement, and a loss of grip strength.

The best test to see whether this is the condition you are suffering from is sitting in a chair, with hands on the chair attempt to rise using hands to push or ‘Press’ off and pain should be reproduced, as displayed below.

Hand & Wrist

Press off Test, pushing up from a chair with hands will reproduce pain.

Wrist tendinopathy
Wrist tendinopathies occur through overuse or excessive activity at a particular tendon and point. Tenderness and occasional swelling and crepitis (cracing and grinding) with movement are characteristics of this injury.
Tendinopathy’s result from overuse of the muscle and the tendon that attaches that muscle to the bone. When the tendon is overused it sustains small microscopic tears. In order for the body to repair these tears it creates inflammation, and that inflammation can cause pain, stiffness and swelling.
These types of injuries typically are ignored at first. As the pain initially decreases with warming up, and then is not present during activity. But the discomfort returns when the athlete cools down. If not addressed this process continues and worsens the condition, so that pain becomes more present during activity, and worsening more after finishing, until ultimately there is constant pain, and limitations to all activity.

 

Carpal tunnel syndrome
Presents with burning sensation on the front (Volar aspect) of the wrist, with numbness or pins and needles (parasthesia) in the thumb, index finger, middle finger and thumb side (radial side) of the ring finger. Nocturnal pins and needles (parasthesia) is also common, where pain can radiate to the forearm, elbow and shoulder.
The test to determine whether this is our condition, tap on the front middle wrist, where hand meets forearm, and tingling/altered sensation should be felt.(seen below)

Hand & Wrist Carpal Tunnel

Tap on the front middle wrist, where hand meets forearm, and tingling/altered sensation should be felt.

Hand & Wrist Carpal Tunnel

Injury to the distal radial epiphysis
Most common in the young elite gymnasts.
Presents as pain and limitation to wrist extension, like when you lean on your hands. Minimal swelling and tenderness locally. Generally occurs due to excessive repeated loads and weight bearing through an extended wrist.

Kienbocks diease
Presents as chronic wrist pain on the front or the back of the wrist and hand (due to necrosis or death of the lunate bone) due to repeated trauma to the wrist, with a loss of grip strength.
Most common in athletes in their 20’s and in boxers, and combat sports.
If you are involved in combat type sports or training and are experiencing this type of ache an MRI scan could be required for a diagnosis.

Kienbock Kienbock
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