The Wrist & Hand
The hand and wrist give us with the ability to complete a huge range of day to day activities, from fine motor skills to strong gross movements.
Unfortunately, our function can be affected by an injury or through a variety of conditions of the hand and wrist.
The information below explores different conditions and injuries that may be problematic and that can impact on your daily life.
What is Carpal Tunnel Syndrome ?
Carpal Tunnel Syndrome is a condition where the median nerve is compressed within a tunnel structure in the wrist.
Causes:
Coming soon.
·Symptoms:
Altered sensation in the thumb, index, middle and ring fingers in the palm side of the hand
Pain
The symptoms can be worse at night or when completing certain activities which involve the wrist in a bent or extended position.
Treatment:
Coming soon.
Exercises:
Coming soon
Further Resources:
https://www.bssh.ac.uk/patients/conditions/21/carpal_tunnel_syndrome
https://www.nhs.uk/conditions/carpal-tunnel-syndrome/
Last reviewed Dec 2025. To be reviewed Dec 2026.
What is De Quervain’s Tenosynovitis?
De Quervain’s tenosynovitis is a condition where two tendons become irritated when they enter a tunnel around the wrist and thumb. The sheath that cover the tendons become inflamed and painful. De Quervain’s is not harmful, but can be troublesome.
Causes:
The exact cause of De Quervain's tenosynovitis is unclear in many cases. However, repetitive thumb and wrist movements, such as lifting babies or using scissors, can contribute to its cause.
Symptoms:
· Swelling over the thumb side of the wrist and lower forearm, specifically at the
point of pain.
· Tenderness at the base of the thumb and wrist.
· Occasional clicking or snapping of the tendons.
Treatment:
· A thumb splint can be used to rest the tendons and ease the pain.
· An exercise program will help maintain the movement in your thumb.
· Avoiding strenuous activity, heavy lifting or activities that produce the symptoms,
may settle the inflammation.
· Anti-inflammatory gel/medication may help to reduce the pain and inflammation.
If your symptoms fail to settle, steroid injections can be an effective way to treat this condition. Surgery can also be considered if all other methods have failed.
Exercises:
Complete the exercises below 3-4 times a day, 5-10 repetitions for each exercise. The suggested repetitions are a guide only. If you are unable to tolerate the pain, then reduce the repetitions or stop.
1.
Bend the tip of the thumb, gently rest on the middle of your middle of your index finger. Keep the tip in this position, and gently rock the thumb side to side.
2.
Bend the tip of the thumb, keeping in this position; gently lift the thumb up with your non-affected hand.
Slowly lower the affected thumb back down without help.
3.
Start with your hand in a straight position.
Move your thumb away from your palm, hold for 5 seconds, then move it back to the straight position.
Further Resources:
https://www.bssh.ac.uk/patients/conditions/19/de_quervains_syndrome
Last reviewed Dec 2025. To be reviewed Dec 2026.
What is a distal radius fracture?
Distal Radius fracture is when the larger bone in the forearm (the radius) is broken at the end closest to the wrist.
The end of the bone towards the wrist is called the distal end. The ulna is the smaller of the two bones of the forearm, the tip of this is often broken as well; this is called an ulna styloid fracture.
Causes:
Most wrist fractures occur from falling onto an outstretched hand. Fractures can occur even in healthy bones, particularly when there is severe trauma, such as with car accidents or falls from a height.
Weak bones (for example, osteoporosis) tend to break more easily. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.
Symptoms:
Pain
Aching/stretching sensations
Swelling
Bruising
Deformity
Dry skin
Reduced hand and wrist movement
Treatment:
If the forearm bones are in a good position after the fracture, a cast is normally applied until the bone heals (approximately 4-6 weeks). It is normal to feel some pain and discomfort after the cast has been removed, as your hand and wrist will feel stiff and vulnerable. You may be given a temporary splint for comfort when your cast is removed; do not wear this all the time as it will restrict your movement and delay the recovery process.
General Advice:
Swelling is common and will reduce your normal wrist movement. Try to keep your hand elevated above heart level and do your hand exercises regularly. Do not keep your arm down at your side for long periods, as this may increase the swelling in your hand.
It is important to get as much movement back into your wrist as soon as you can.
You can use your hand for light tasks; heavy repetitive tasks should be avoided for the first 10-12 weeks.
Do not drive in your cast or splint. When your cast is removed you need to be sure you have enough strength and control to drive safely.
Most people return to work once the cast is removed. It is usually about 12 weeks after the injury before you can return to a heavy manual job.
Exercises:
It is normal to feel a stretch and/or discomfort when doing the exercises, but they should not be painful. Please perform the exercises 4-5 times a day, 5-10 repetitions of each one. This is only a guideline and can be varied depending on your level of pain and stiffness.
1.
WRIST FLEXION / EXTENSION:
With your forearm supported on a table. Bend your wrist up and down, do some with your fingers straight and some with your fingers bent.
2.
WRIST ULNAR AND RADIAL DEVIATION:
With your forearm supported on a table. Move your wrist from left to right,
as if waving.
3.
FOREARM SUPINATION AND PRONATION:
With your forearm supported on a table, keep your elbow tucked into your side.
Turn your hand over.
Additional Exercises:
Please perform the exercises below 5 times a day, hold each position for 5-10 seconds, repeat 5 times.
This is only a guideline and can be varied depending on your level of pain and stiffness.
Put your hands together in a prayer position; keep your palms together.
Slowly lower your hands, moving your elbows out to the side.
2. Keep your elbow against your side. Start in a handshake position. Turn your forearm so your hand is facing palm up. Using your other hand (as shown) apply pressure to assist pulling your forearm further around. Keep your elbow still during this movement.
Last reviewed Dec 2025. To be reviewed Dec 2026.
What is Dupuytren’s?
Dupuytren’s presents as firm nodules beneath the skin in the palm of the hand. In some cases, they develop to form cords that prevent the finger or thumb from fully straightening.
Causes:
It is a common condition that usually occurs in middle age or later in life, and is more prevalent in men than women.
Symptoms:
Firm nodule beneath the skin in the palm of the hand.
Management following surgery:
Swelling Management
It is normal to have ongoing swelling after your surgery. There are some simple techniques to encourage the swelling to reduce;
Move your fingers regularly
Keep your arm elevated above the level of your heart when resting in the first few weeks after surgery.
Do not keep your arm down by your side for long periods of time.
Wound Management:
On your first appointment, your bulky dressing from surgery will be replaced with a lighter dressing. It is important that you keep the dressings clean and dry. Do not adjust the dressings yourself without medical advice.
If you are experiencing any of the symptoms below, please seek medical advice as soon as possible.
Increased redness
Increased heat
Increased pain
Increased swelling
Discharge from the wound
General feeling of being unwell
A bad odour coming from the wound
Once your wound is fully closed and dressings are no longer required, start washing your hand under running water only, do not soak the wound. Pat your wound dry with a clean towel.
Scar Management
Scars are a normal part of the healing process. However, sometimes scars can become thickened, lumpy and stick to surrounding soft tissues, which, may restrict movement. Regular massage using non- perfumed moisturiser for at least 10 minutes per day is recommended to prevent this occurring.
Splint
You will be provided with a thermoplastic splint to wear at night only. The splint helps extend your finger and to keep it in a good position at night. It is important that you;
Clean the splint with warm soapy water or a baby wipe regularly.
Make sure your splint does not get too hot, e.g. In a bath or on a radiator.
Must not drive with the splint on.
Use your hand for light activities during the day.
Do not adjust the splint yourself.
Wear the splint at night for up to twelve weeks after your surgery.
Bring your splint with you to every appointment as it will likely require remoulding.
If the splint starts to rub or if you feel that it no longer fits, please contact the hand therapy team as soon as possible.
Further Resources:
Last reviewed Dec 2025. To be reviewed Dec 2026.
What is Mallet Finger?
A mallet finger is when the fingertip hangs down towards the palm and cannot be straightened using your muscles.
Causes:
It is usually caused when the fingertip is forced to over bend.
There are two types of mallet finger:
1. Soft tissue mallet: This is when there is a tear to the tendon that straightens the end of the finger.
2. Bony mallet:
This is when the tendon pulls a small piece of bone off, and uses a fracture. An x-ray will confirm if this has occurred.
Symptoms:
Pain
Swelling
An inability to straighten the fingertip
Treatment:
The injured finger is placed in a plastic splint to hold the end joint in a straightened position. This allows the tendon ends, or bone, to stay in a good position for healing. If the end joint of the finger is not held straight at all times, the end of the finger is likely drop and is unlikely to heal.
Your splint must be worn at ALL times, day and night.
· For soft tissue mallet injuries, wear the splint for at least 8 weeks.
· For bony mallet injuries, wear the splint for at least 6 weeks.
When you tape your splint to your finger, make sure that the middle joint if left free.
If you want to clean your finger, wash it on a flat surface. Do not lift your hand off the table without supporting the fingertip with your other hand. You must keep your end joint straight at all times.
DO NOT try to test your finger bybending it or pushing it down at any time.
If the mallet splint provided in A&E does not fit well, you may be referred to Hand Therapy for a custom-made splint.
Exercises:
It is important to maintain movement in your fingers and to continue using your hand functionally.
Do the exercises below with the splint on:
Perform 5-10 repetitions, 3-4 times a day, straightening the fingers up after each bend.
Expectations:
A good outcome is a straight fingertip, but sometimes a small drop of the fingertip may be present long term. Swelling, redness and tenderness can often continue around the end joint for a few months, but these symptoms eventually settle. It is normal for bony mallet injuries to leave a small bump over the joint, but this should not affect finger function.
Further Resources:
https://www.bssh.ac.uk/patients/conditions/28/mallet_finger_injury
Last reviewed Dec 2025. To be reviewed Dec 2026.
What is Thumb Osteoarthritis?
Thumb osteoarthritis (Carpometacarpal Joint (CMC joint) is the joint at the base of the thumb.
Osteoarthritis at this joint is the gradual wearing away of the cartilage covering the ends of the bones at the joint (the trapezium and the first metacarpal). This leads to the trapezium and the first metacarpal bones rubbing together, causing pain and making it difficult for you to use your thumb.
Causes:
COMING SOON.
Symptoms:
COMING SOON.
Treatment:
COMING SOON.
Exercises:
COMING SOON.
Further Resources:
https://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis
Last reviewed Dec 2025. To be reviewed Dec 2026.
Trigger finger is a condition that causes catching or locking of a finger when it is bent into a fist or straightened. This is due to thickening of a tendon tunnel on the palm side of the hand or a nodule that forms at the mouth of the tunnel, most commonly at the base of the finger.
Further Resources:
https://www.bssh.ac.uk/patients/conditions/18/trigger_fingerthumb
https://www.hand-therapy.co.uk/_userfiles/pages/files/triggerfinger_nhs_england_leaflet.pdf
For more information, download an information pack below
Volar plate injuries occur when the middle joint in the finger is bent too far backwards. This can cause the ligament on the palm side of the finger to tear or pull off a small piece of bone (avulsion fracture).
Further resources:
https://www.bssh.ac.uk/patients/conditions/1021/volar_plate_injury
For more information, download an information pack below.
