- Arthritis occurs when the bones on the ulnar side of the wrist are rubbing together. An example of this is Ulnar Impaction Syndrome (UIS). UIS is most commonly found in middle aged patients and is typically due to a positive ulnar variance. It can also occur when there is an increased dorsal tilt of the distal radius. UIS can also occur from activities that cause loading of the ulna. The ulna and the lunate are most affected by the impaction. Typically, this is diagnosed with radiographs, but if it is early in the disease process it may be undetectable. If there is continued suspicion of UIS an MRI can be ordered.
Arthritis Treatment Options Include
- Activity Modification/Joint Protection Principles
- Pain Management Techniques for ulnar wrist pain
- Patient Education on Disease Process
- Heat: Moist Hot Packs, Paraffin Wax
- Contrast Bathes
- Pain-free Range of Motion of the Wrist
- Neoprene Wrist Wraps: The neutral warmth created by the neoprene provides pain relief while providing gentle support
- Custom Ulnar Based Orthosis for Pain Relief. Wear at night and during activities that exacerbate symptoms.
2.) Wrist Tendonitis (ECU and FCU)
Extensor Carpi Ulnaris Tendonitis. This is one of the first things to check for when evaluating a patient with ulnar sided wrist pain. First perform an ECU synergy test. The patient places their elbow at 90 degrees, the forearm is in full supination, the wrist is in neutral and the digits are in full extension. The therapist grasps the thumb and middle finger and uses the other hand to palpate the ECU. The patient then abducts the thumb against resistance. The therapist ensures there is muscle contraction of both the FCU and ECU. Re-creation of pain along the ulnar aspect of the wrist is considered a positive test for ECU tendonitis (ulnar tendonitis).
Flexor Carpi Ulnaris Tendonitis. The patient places their forearm in supination while resting it on the table. The therapist places the patient’s wrist in ulnar deviation and slight wrist extension. Resistance is applied over the fifth metacarpal in the direction of extension and radial deviation while the therapist uses the other hand to palpate the FCU for pain and tenderness.
Tendonitis Treatment Options Include
1.) Pain free range of motion, moving the joints and gliding the tendons provide synovial nutrition to the joints and the surrounding tissues
2.) Have patient wear custom ulnar wrist support for 3 weeks all the time and then an additional 3 weeks night-time only (for a total of 6 weeks)
3.) Inflammation reducing treatments, ice, heat, ultrasound, interferential, instrument assisted soft tissue mobilization
4.) Provide instruction on activity modification
3.) TFCC Injury
- TFCC Injury: The triangular fibrocartilage complex is a network
of ligaments, tendons and cartilage. Did
you know it is the main stabilizer of the wrist? It supports gripping activities weight-bearing,
and supination/pronation. A TFCC injury
can occur out of nowhere. So, what are
the signs of TFCC Injury?
- Pain that gets worse with gripping and rotation (such as opening a door)
- Pain with weight-bearing
- Feeling of instability
- Can be atraumatic or traumatic. Type 1 tears are traumatic. This can occur by falling on an outstretched hand or with excessive forearm rotation. Type 2 tears are degenerative or chronic.
- A positive Fovea Sign. This is when the therapist applies external pressure to the fovea of the ulna bone. If there is pain this can indicate a TFCC injury. Remember check the other wrist as well!!!
TFCC Injury Treatment Options Include
- Decrease inflammation: icing, heating, contrast baths, interferential, ultrasound
- Instruct patient to stop performing activities that exacerbate symptoms. This is typically activities like golf
- Instruct patient on avoiding hand motions such as heavying grasping, wringing and motions that turn and twist your wrist to avoid ulnar wrist pain when twisting
- Wear a custom wrist support. Typically wearing schedule is wear the splint for 3 weeks all the time and three weeks night-time only (for a total of 6 weeks)
- If the patient cannot tolerate immobilization, supportive tape can be applied
- Work- station modification: Provide instruction on good posture and ergonomics
- After pain has subsided and splint wear is no longer indicated begin a proprioceptive wrist program
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