What kind of wrist and hand problems can we treat?
by Damian Moore M.Ost

Wrist and hand problems rarely occur in isolation, unless they are the result of a traumatic injury, and even then the likelihood is that there will be an impact on the functioning of other structures.  This is unsurprising when you consider that the whole upper extremity is designed to position the hand in space, so poor function in one area is bound to have a knock on effect elsewhere.  When you rotate your wrist you rely on a joint just next to the main elbow joint and you use muscles located in the forearm and, believe it or not, your biceps muscle.  The nerve supply to the hand passes from the neck and shoulder and right through the arm.  Problems with the wrist and hand require a wide perspective.

Displacement of the carpal bones

Sometimes the bones of the wrist move very slightly out of place.  This can be painful and can contribute to other problems, see below.  There are effective osteopathic techniques to restore them to their correct position, although it should be noted that if there is an underlying condition cause, then they are likely to displace again, so part of our investigation is to understand why it has happened and give you strategies to help prevent a recurrence.


Repetitive strain injury, tenovsynovitis, enthesitis, epicondylitis

These problems are often felt in the arm rather than the wrist but it can be the wrist which is generating the problem.  If the wrist joints are not functioning properly then muscles have to work in a different way to normal and inappropriate stresses occur, causing muscle tightness and eventually inflammation, either where the muscle meets the tendons,  where the tendons the bones, or irritating the tendon within its sheath .  This might cause tennis or golfers elbow, rsi, or it may cause pain on one side of the wrist or other.  There might be multiple posture and activity related ‘insults’ adding together to cause these problems and I can advise on these as well as helping resolve joint dysfunctions and reducing inappropriate muscle tone.


Sensation changes in the hand including carpal tunnel syndrome

Carpal tunnel syndrome is caused when the median nerve becomes irritated in the carpal tunnel,  this can result in loss or altered sensation  to part of the hand, when this is tested it is usually defined to about half of the palm of the hand and at least the top half of the index and middle fingers,  but it may feel as though it is the whole hand.  The carpal tunnel is a narrow space through the carpus (wrist) which is covered with a thick membrane.  The dorsal branch of the median nerve passes through here and can become compressed.  This may be because the architecture of the area has changed, for example, sometimes one of the bones in the wrist pops slightly out of place, these patients respond well to osteopathic treatment.  If the problem has occurred because there is an ongoing instability it may recur if the wrist isn’t strengthened or supported, or activity modified and we can advise on that.  The problem may also be due to swelling in the area.  Diabetics and those with reduced thyroid function suffer particularly from this because sugary proteins stick to the thick membrane and via osmosis attract water to the area, causing swelling.  The stickiness also prevents the nerve moving freely within the tunnel.  Any condition which causes fluid-retention or swelling in the area, including both osteo and rheumatoid arthritis and even pregnancy can cause carpal tunnel syndrome, fortunately it usually goes away after pregnancy

The carpal tunnel is not the only place where the nerves can be compressed and irritated.  Cyclists and motorists may irritate the ulnar nerve where it passes into the hand via the tunnel of Guyon, and there are numerous points between the neck and the hand which can cause or contribute to a problem. 

So how can we help?  We can investigate to see if the joints of the wrist are functioning correctly and treat where appropriate.   We can use massage techniques to help relax muscles which may be impinging on the nerves that run through them and to gently encourage excess fluid in the area to return up the arm.   We can look for dysfunction in the neck which may be irritating the nerves at their roots.  We can evaluate your posture and in particular how it impacts on the brachial plexus, this is where the nerve roots divide and recombine to become the named nerves that run into your arm, this area is particularly vulnerable to postural changes and can be very amenable to treatment.  Finally we can advise you with exercises and activity modifications to help manage your condition. 

Osteopathic treatment will not cure every nerve problem in the hand but it does relieve the symptoms for many and allows them to carry on without the need for surgery.


Other problems in the hand and wrist

If you find you are dropping items because of sudden loss of sensation or power in your hand, if you notice wasting of any muscles, or if you have pain in your hand or wrist following an accident please see your doctor or visit accident and emergency.