Common Conditions

The human shoulder is one of the largest and most complex structures in the body. It comprises of the humerus, the acromium, the clavicle and scapula coracoid. Other important shoulder structures include the rotator cuff muscles/tendons which support and move the shoulder, the bursa (sac of fluid that cushions and protects the rotator cuff tendons) and the labrum (cuff of cartilage that forms a cup for the humeral head). These structures when injured can be very painful and debilitating, affecting our ability to use the rest of our arm functionally. The physiotherapists in our team are able to treat a variety of these shoulder conditions including shoulder instability, rotator cuff tendinopathy and tears, bursitis, labrum tears and adhesive capsulitis.

These conditions are associated with overuse of the tendons of the forearm and elbow. “Tennis elbow /lateral epicondylitis“ and “golfer’s elbow/ medial epicondylitis” are common examples where there is pain to the outer or inner side of the elbow, respectively. The symptoms experienced include pain at rest, with movement or with functional use of the elbow, as well as swelling and tenderness of the affected tendons in the upper forearm near the elbow. You may have difficulty gripping and lifting heavier objects.

If you are experiencing any of these symptoms or issues please make an appointment to see one of your experienced therapists.

Fractures in the elbow can include those to the distal humerus, proximal ulna or proximal radius. Dislocations occur when the elbow is forced out of its normal position due to trauma. Both of these injuries cause sudden and significant pain, swelling and loss of joint movement. Due to the complexity of the elbow joint, stiffness can be a significant issue so early management of these injuries is essential to regaining movement, strength and function. Our therapists are highly experienced in treating these complex injuries.

Fractures in the elbow can include those to the distal humerus, proximal ulna or proximal radius. Dislocations occur when the elbow is forced out of its normal position due to trauma. Both of these injuries cause sudden and significant pain, swelling and loss of joint movement. Due to the complexity of the elbow joint, stiffness can be a significant issue so early management of these injuries is essential to regaining movement, strength and function. Our therapists are highly experienced in treating these complex injuries.

Radial tunnel syndrome is a peripheral nerve condition resulting from compression of a branch of the radial nerve (the posterior interosseous nerve) near the elbow. The symptoms experienced usually pain along the top of the forearm muscles and back of the hand (often worse at night) and may affect sleep.

Cubital tunnel syndrome is caused by irritation, trauma or compression to the ulnar nerve as it passes along the inside of your elbow (at the “funny bone). Symptoms of cubital tunnel usually include pain in the elbow, weakness in the hand as well as numbness and tingling into the little and ring fingers. The symptoms are often exacerbated by our sleeping position (elbows bent), repetitive or sustained bending at the elbow or leaning on your elbow.

The TFCC is an important structure in the wrist, made of fibrous tissue and cartilage, that supports the joints between the radius and ulna near the wrist and also helps connect the forearm with the ulnar side (little finger side) of the wrist. Injuries to the TFCC can occur through natural wear and tear or through injury/trauma such as a fall onto an outstretched hand or wrist twisting when a drill bit catches. The most common symptoms include ulnar sided wrist pain, clicking or popping when turning the forearm, pain when weightbearing, weakness and restricted range of motion. In cases of severe tears or instability surgery may be warranted however many of these cases are conservatively managed via splinting and specific strengthening programs. The therapists at HOHT specialise in the management of these complex wrist injuries and will work with you to achieve a strong and functional wrist.

A wrist fracture refers to a broken bone. There are 8 small carpal bones in the wrist which connect with the 2 long forearm bones (radius and ulna). Although a broken wrist can refer to any any of these 10 bones, the most commonly broken bone is the radius.

It is important to understand if your fracture is stable or unstable. A “non displaced fracture” means that the bones have not moved out of place and are stable enough to be treated in a cast or splint. Some “displaced” fractures can also be reduced and are stable enough to be treated conservatively in a cast or rigid splint. Other fractures are unstable such as a comminuted fracture where the bone is broken into many pieces and these require surgery to realign and stabilise the bone otherwise a deformity is likely to occur. Regardless, all fractures need prompt medical attention and investigations such as X rays for correct management.

The human wrist is a very complex part of our anatomy, required to be both mobile yet stable in order to generate grip strength and to withstand weightbearing forces. Ligaments are strong tissues that connect bone to bone. Injuries to the wrist ligaments are common and are often referred to as a “sprain” however the severity of these injuries can vary from mild sprains to severe tears or rupture. They often occur as a result of trauma such as a fall or a sudden twisting movement. Partial ligament tears and mild to moderate sprains can often be managed conservatively with splinting and specific exercise. Complete ruptures however will require surgical intervention. In both instances your wrist needs to be assessed and treated by a health professional.

Arthritis is a very common condition in the wrist. It refers to a process whereby the joint cartilage (the smooth joint lining that covers the ends of the bones) deteriorates. Without a smooth joint surface, the bones rub against each other causing pain and joint damage. The 2 most common types of arthritis to affect the wrist are:

• Osteoarthritis (OA)– articular cartilage that covers the ends of the bones gradually wears away over time. It affects the whole joint including bone, cartilage, ligaments and muscles.
• Rheumatoid arthritis (RA)–a common inflammatory form of arthritis, an auto immune disease whereby the body’s immune system attacks its own healthy tissues such as cartilage and ligaments, causing inflammation and joint damage.

Wrist arthritis often presents with pain, swelling, reduced movement or stiffness as well as weakness in the muscles surrounding the joint.

There is currently no cure for arthritis, but there are a number of treatments that may help reduce the inflammation, relieve the pain and loss of function it can cause. Conservative/nonsurgical treatment options may include soft (neoprene) or rigid (thermoplastic) splinting, exercise, or education on joint protection strategies and adaptive devices. In conjunction with your Rheumatologist and/or GP your hand therapist can assist you with these interventions.

Wrist tendonitis usually occurs as a result of repetitive or sustained stress on the tendons which move the wrist. A layer of lubricated tissue called a tendon sheath surrounds over tendons at the wrist. Overuse can irritate the sheath leading to inflammation and thickening thereby making it harder for your tendons to glide smoothly through the sheath, causing pain when moving the wrist and fingers.

The symptoms of wrist tendonitis usually include difficulty performing certain movements such as opening jars or lifting babies, pain and swelling around the wrist, stiffness or catching /creaking sensation especially in the morning when starting to move. Reduced wrist range of motion and grip weakness is also common.

In conjunction with advice from your GP (who may initially prescribe anti inflammatories) there are various conservative (non surgical) treatments that can alleviate the symptoms of tendonitis. These include splinting, graded exercise to regain range of motion and strengthen the weakened tissues as well as education regarding activity modification to prevent recurrence. Your hand therapist can assist you with these interventions.

Ganglion cysts are small non cancerous lumps that most commonly develop over a joint or tendon. Ganglion cysts are typically filled with a jelly like fluid, with sizes varying from pea size up to 2.5cm in diameter. The mass may appear over time but can suddenly reduce or disappear entirely. The ganglions can sometimes be painful if they press on a nearby nerve or interfere with joint movement. The cause of ganglion cysts is unknown however they most commonly occur in women between 20-40 years of age and joints/tendons that have been injured in the past are more likely to develop ganglion cysts.

Although ganglion cysts are not harmful, they may need surgery to remove them they become too large, are painful and interfere with movement. After surgery a splint, specific exercises and scar massage are required to ensure return of movement, strength and function. Your hand therapist can assist you with these interventions.

Patients with De Quervain’s tenosynovitis have painful thumb extensor tendons (the structures which lift the thumb away from the palm) on the thumb side of the wrist. In De Quervains, these tendons run through a tunnel-like structure which usually allows for pain-free, fluid motion. Inflammation of these tendons, or the outer tunnel can result in impaired gliding of the tendons causing pain and restricted movement.

A number of factors can lead to De Quervain’s including repetitive thumb and wrist movement such as scissor or secatur use. Changes in hormones and swelling associated with pregnancy followed by breastfeeding and repetitively picking up a new baby is also a common cause of De Quervains. When new mothers develop this condition it typically appears 4-6 weeks after delivery.

Patients with De Quervains often describe a feeling of sharp or dull pain and swelling at the base of the thumb or the thumb side of the wrist. Other symptoms may include a crackling/catching sensation (crepitus) during thumb movement and restricted or tight thumb movement.

This condition is not uncommon and the therapists at HOHT can help by fabricating a custom made orthosis that limits wrist and thumb range of movement to allow the thumb tendons to rest, decrease inflammation and promote healing. The splinting phase is followed by graded mobilisation and specific exercises to regain movement and strength and to prevent recurrence.

Arthritis at the base of the thumb, otherwise known as the CMC joint or basal thumb joint, is a very common source of arthritis and pain, especially in women over 50 years of age. This joint has a wide range of motion, allows our thumb tip to oppose our finger tips and is subject to repeated stress during hand function such as carrying and pinching. This stress can lead to degenerative changes to the cartilage creating direct contact between bones causing pain and possible deformity over time. There can be a genetic pre disposition in developing this arthritis condition. Additionally, trauma to the thumb such as a severe fall can predispose the joint to arthritis. Other inflammatory conditions such as Lupus and Rheumatoid Arthritis can also cause deterioration of that joint.

The main symptoms experienced with CMC joint arthritis is pain during pinching, grasping or gripping tasks such as opening jars or turning keys. Swelling and/or stiffness at the base of the joint, reduced range of joint motion, tenderness over the joint and progressive grip and pinch weakness are other common symptoms.

Arthritis cannot be cured but it can be managed, The hand therapists at HOHT can provide exercises, advice on joint protection techniques as well as custom made thermoplastic and/or soft thermal splints to help manage your symptoms and slow progression of the condition.

Trigger thumb is a very common but treatable problem that can also occur in the fingers. It refers to catching or locking which occurs when you bend or straighten the thumb, particularly with pinching and gripping. The flexor tendons that bend the thumb travel through a lining called a tendon sheath (or tenosynovium). The tendons and their sheath travel through a series of pulleys through which they should glide smoothly, much like a fishing line travelling through the eyelets on a fishing rod. These pulleys keep the tendons close to the bone, improving their mechanical force and preventing bow stringing of the tendon. If the tendon, its sheath or the pulley becomes inflamed the tendon cannot glide properly under the pulley and it can even become stuck in a bent position.

Trigger thumb can be caused by overuse, direct trauma or repetitive thumb movement. Other contributing factors include diabetes, arthritis, or increased swelling in the hand.

Symptoms of trigger thumb include pain and swelling directly over the A1 pulley (palmar surface of the thumb joint adjacent to the thumb webspace), stiffness or loss of thumb motion as well as abnormal sensations and movements such as popping, catching or locking which can occur either when bending or straightening the thumb. In severe cases the thumb locks and you may have to use the other hand to straighten it.

In more mild or early presentations conservative management of this condition can include fabrication of a custom made orthosis, swelling reduction techniques, activity modification and specific exercises to glide the tendons safely without aggravation.

In severe cases your GP or specialist may recommend a corticosteroid injection to reduce the inflammation in conjunction with hand therapy intervention

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If you are experiencing any of these triggering issues please book an appointment with one of our therapists.

Ligaments connect bone to bone. The collateral ligaments the thumb are important structures that provide stability during pinching tasks. Thumb ulnar collateral ligament injuries are more common than radial collateral ligament injuries and usually occur when the thumb is overstretched/hyperextended away from the hand causing a sprain, partial or full tear to the ligament. This results in instability and pain.

Thumb UCL injuries are also often called Skiers thumb or Gamekeepers thumb due to injuries sustained when a ski pole hyperextends the thumb forcefully or through overuse respectively.

Symptoms of either UCL or RCL injuries usually include pain and swelling around the inside/web side or outside of the thumb joint respectively. The thumb may feel weak and unstable when it is loaded during pinch or gripping activities.

In cases where the ligaments are either sprained or partially torn conservative management with hand therapy is appropriate. A hand therapist can fabricate a custom made orthosis/splint to support and immobilize the thumb to allow healing of the ligament, followed by exercise to regain movement, strength and function. Patients who have sustained complete ligament tears (or rupture) will require a surgical opinion. In either situation hand therapy intervention is required. If you have any of these symptoms please make an appointment to see one of the therapists in our team.

Carpal tunnel syndrome is a condition affecting one of the main nerves in the wrist. The carpal tunnel is a space formed by the 8 carpal bones with a thick band of tissue called the transverse carpal ligament forming the tunnel “roof”. 9 tendons travel through this tunnel along with the median nerve which controls feeling to the skin of the thumb, index, middle and ½ of the ring finger as well as controlling the muscles of the thumb.

While the exact cause of CTS usually unknown direct trauma to the wrist or anything else causing extra swelling in the carpal tunnel such as inflammation to the tendons travelling through the wrist will result in the median nerve being compressed. There are many other factors that can contribute to increased pressure within the carpal tunnel such as ganglion cysts, diabetes, fluid retention in pregnancy, arthritic spurs, repetitive motion of the wrist or working with the wrist bent while at work or home, infections, wrist fractures and dislocations to name a few.

The symptoms of carpal tunnel can include pain, weakness and clumsiness in the hand as well as numbness and tingling into the index, middle and ring fingers and thumb. The symptoms are commonly worse at night and can be aggravated by sleeping with the wrists bent.

Non surgical treatment options including wrist splinting at night, activity modification, neural gliding exercises and inflammation reduction strategies.

If you have any of these carpal tunnel symptoms one of our hand therapists can assist you with these conservative strategies.

Mallet finger is a common injury where the end joint of the finger is bent and does not straighten. It occurs when the tendon which keeps the end of the joint straight is damaged either by rupture or a small bone fragment connecting the tendon to the bone is broken (avulsed). It usually is caused by a forceful event such as a blow from a hard ball or if the finger gets caught while making a bed.

This injury is characterised by the tip of the finger being unable to straighten after injury. It has been also called drop finger. There is often also pain and swelling to the end joint of the finger.

These injuries can usually be treated non surgically using specially designed splints that immobilises the joint in the correct position and promotes natural healing. This process may take 6-8 weeks followed by therapy to regain movement and strength. These injuries require immediate treatment and if left untreated a mallet finger can develop into a deformity of the whole finger called a swan neck deformity.

If you have this injury please make an appointment to see one of our therapists as soon as possible.

Trigger finger is a very common but treatable problem that can also occur in the thumb as well as the fingers. It refers to catching or locking which occurs when you bend or straighten the finger, particularly when gripping. The flexor tendons that bend the fingers travel through lining called the tenosynovium. The tendons and their tenosynovium travel through a series of pulleys through which they should glide smoothly, much like a fishing line travelling through the eyelets on a fishing rod. These pulleys keep the tendons close to the bone, improving their mechanical force and preventing bow stringing of the tendon. If the tendon, its sheath or the pulley becomes inflamed the tendon cannot glide properly under the A1 pulley and it can even become stuck in a bent position.

Trigger finger can be caused by overuse, direct trauma or repetitive finger movement. Other contributing factors include diabetes, arthritis, or increased swelling in the hand.

Symptoms of trigger finger include pain and swelling directly over the A1 pulley (palmar surface of the finger knuckle joint), stiffness or loss of finger motion as well as abnormal sensations and movements such as popping, catching or locking which can occur either when bending or straightening the finger. In severe cases the finger locks and you may have to use the other hand to straighten it.

In mild or early presentations this condition can be conservatively managed with hand therapy which can include fabrication of a custom made orthosis, swelling reduction techniques, activity modification and specific exercises to glide the tendons safely without aggravation.

Boutonniere deformity, which is French for buttonhole, results from damage to the tendon (called the central slip) which straightens the middle joint of the finger causing it to remain flexed/bent. This then results in an imbalance in the finger tendons whereby the end joint of the finger also hyperextends.

This injury can be caused by a cut to the central slip tendon over the middle joint (PIP joint) of the finger, by a PIP joint fracture or dislocation. It can also result from joint damage caused by rheumatoid arthritis.

Treatment of these injuries requires early intervention to prevent fixed contractures which are much harder to resolve. If the injury was caused by a laceration an open wound will likely require surgery followed by splinting.

Closed injuries can be usually treated non surgically using a custom made splint that keeps the PIP jt straight but allows the other uninvolved joints to move. This splint will need to be worn continuously for approximately 6 weeks. Following the immobilisation phase your therapist will then prescribe appropriate exercises to gradually mobilise and strengthen your finger.

Arthritis is an inflammatory condition of the joints. There are several types of arthritis but the most common type is osteoarthritis. Osteoarthritis is a chronic and degenerative condition whereby the joint cartilage (the smooth joint lining that covers the ends of the bones) deteriorates and the joint capsule, ligaments and muscles surrounding the joint also become inflamed, further destabilising the joint. Without a smooth joint surface, the bones rub against each other causing pain and joint damage.

Within the hand, OA is most commonly found in the base of the thumb near the wrist and the smaller joints of the fingers. OA is often seen in people over 40 years but may affect people of all ages. The most common cause is wear and tear and may be present in people with past history of injury or heavy/repetitive use of their hands (work, hobbies, and sports). Other causes include traumatic injuries, fractures and joint dislocations. Genetic predisposition may also be a factor in developing OA.

This condition commonly causes pain (especially after repetitive/heavy activity), stiffness (especially in cold weather/or in the morning) and weakness when gripping/pinching. Joints are usually enlarged and bony spurs may develop as joint deterioration progresses.

Hand therapy treatments to assist patients with hand arthritis can include education regarding joint protection, custom made soft thermal neoprene or rigid thermoplastic splints to support unstable and painful joints as well as gentle exercises to improve or maintain joint mobility and strength. If surgical intervention is required such as synovectomy, joint replacements (arthroplasty) or joint fusion (arthrodesis) then hand therapy is also often required for post operative splinting, scar management, oedema control and exercises.

Dupuytrens contracture is a condition where thickening of the underlying fibrous tissues in the palm cause the fingers to contract into flexion towards the palm and are unable to be straightened. This is caused from excessive production of collagen which is deposited under the skin. It commonly occurs in the little and ring fingers but other digits may also be involved including the thumb. This condition usually progresses slowly over many years and is not usually painful but in some cases progression may be rapid and uncomfortable.

The cause of dupuytrens contracture is unknown however there are certain risk factors that can increase your chance of developing this condition including age (more frequently occurring from 40 years onwards), smoking, drinking, diabetes, heredity (tends to run in families), ancestry (northern Europeans and people of Scandinavian descent are more commonly affected) and gender (more common in males than females).

Symptomatically Dupuytren’s contracture is initially characterised by firm lumps/nodules/cords within the palm of the hand that can progressively worsen to cause your finger/s to bend in towards the palm. You may not need treatment for Dupuytrens contracture if the condition is not affecting your ability to perform daily activities.

Treatment options will vary depending on the severity of the condition. Conservative options in the early stages can include heat, massage, gentle passive stretches, steroid injections to relive local inflammation, collagenase injections to break down collagen and weaken the contracture, needle aponeurotomy via a needle to break up the contracting tissue. When conservative options fail to improve the condition and your quality of life is adversely affected, surgery may be required following which hand therapy is imperative to ensure you regain full use of your hand post-operatively.

Hand therapists work closely with Surgeons (Hand, Plastic, Orthopaedic) to provide patients who have undergone hand surgery (either elective or post trauma) with post operative rehabilitation. Examples of hand surgery include tendon repairs, nail bed repairs, amputation/terminalisation, skin grafts, nerve repairs. Post operative hand therapy usually includes and is not limited to wound/scar management, oedema, management, splinting and mobilisation.

At Hands on Hand Therapy we are able to fabricate a variety of splints to address the needs of patients with neurological conditions. These can include but are not limited to, static resting splints to maintain soft tissue length, support flaccid structures and prevent the development of contractures, functional splints to support weakened or non functional joints whilst allowing uninvolved joints to move and static movement blocking splints such as elbow extension splints to prevent involuntary movements. If you have any queries regarding whether or not a splint may be beneficial please contact our clinic and one of our therapists will discuss this further with you.