Ok, maybe not all in the wrist, but it's certainly an important and overlooked body part to exercise and stretch to maintain optimal performance. Without proper management, wrists are left susceptible to a variety of different injuries. The complexity of the hand and wrist make it very important to treat the injury promptly. It is common to take a healthy hand and wrist for granted. Once injured, you will soon realize just how frequently it is used on a daily basis. Lifters, contact sport participants, anyone that has ever fallen or could potentially fall in the future, listen up! This article is for you.
Anatomy 101, class is in session! The wrist is a joint made up of the radius and 8 carpal bones arranged in two rows (scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid and trapezium). The ulna is the second major bone of the forearm, but does not have direct attachment to the carpal bones. The bones of the wrist are held together by four major ligaments, which include palmar radiocarpal, dorsal radiocarpal, ulnar collateral and radial collateral. There are a variety of tendon attachments connecting muscles, which provide motion throughout hand and wrist; more on these next semester in Anatomy 201. The nerves of the wrist include median, radial and ulnar. These nerves supply the hand and wrist with signaling for both sensory and motor function. Without going too crazy, let’s move on to common wrist injuries.
Whether it is an acute injury or a pain worsening with time, wrist injuries need to be properly diagnosed by a Sports Medicine or Hand and Wrist Specialist to develop an appropriate treatment plan. A few common injuries include sprain, fracture, tendonitis and carpal tunnel.
- Wrist sprain:
- Often a result of a fall, catching a barbell in improper position or jamming on another participant in contact sport
- Ligament is stretched or torn
- Treatment involves period of immobilization/rest depending on severity, followed by gentle stretching and strengthening.
- Recovery ~2-12 weeks; severe cases may be longer
- Often a result of a fall or jamming on another participant in contact sport
- Common fracture sites include distal radius and scaphoid (carpal bone at base of thumb)
- Treatment is dependent on location and severity. Displaced fractures or joint surface involvement typically require surgery. Non-displaced and away from joint can typically be treated with cast or splint with follow up imaging. After bone healing is identified, gentle stretching and strengthening may begin.
- Recovery ~8 weeks in adults, ~4-6 weeks in children; severe fractures can be 6 months-1 year for full resolution.
- A result of repetitive motion or stress over time leading to inflammation
- Treatment involves PROPERLY performed rehabilitation program focused initially around resolution of pain followed by strengthening to prevent recurrence.
- Recovery is patient dependent based on duration of symptoms before initiating treatment and compliance with exercises and avoiding aggravating factors.
- Carpal Tunnel:
- Common causes include excessive gripping, repetitive movements or even frequent desk work/typing
- Result from inflammation around passageway of median nerve.
- Numbness, tingling, sharp and shooting pain. Nerve distribution thumb, pointer and middle fingers, part of index finger.
- Treatment includes bracing, cortisone injections and NSAIDs in mild cases or at initial onset. Carpal tunnel release surgery in more severe cases or failed conservative treatments.
- Generally back to most normal activities by the time incision heals (2-3 weeks).
Proper stretching and strengthening exercises are not only important in recovery, but also in the prevention of injury. Stretching exercises include wrist circles, L-stretch with both palms facing each other and back of hands facing each other, kneeling on all fours and loading wrists, assisted wrist flexion/extension, and individual finger stretches. Strengthening exercises include wrist extension/flexion with dumbbell or barbell, radial and ulnar deviation with hammer or light weight, towel twists, stress ball or grip squeeze device, pronation and supination resistance (can be done holding handle of hammer and rotating palm to sealing and back to floor). Good rep ranges would be 8-12 for 3-5 sets. Start low and build over time. Focus on form and quality of repetition.