Wrist + Hand

Wrist pain is a common and costly occupational problem affecting thousands of people every year.

Repetitive stress injuries (RSI) to the hand and wrist have six common forms, with carpal tunnel syndrome (CTS) being the most prevalent. The wrist is comprised of two forearm bones, the ulna and the radius, and in the space at the end of them, eight wrist bones. (See illustration)

The common feature of many RSI’s or wrist complaints is loss of joint space — a narrowing and compression of the wrist compartment. What could cause the normal relations of the bones, tendons and nerves to alter sufficiently to result in this painful compression of wrist space?

A common feature of patients complaining of wrist pain is additional pain and tenderness in the forearm and elbow.

The muscles that move the fingers and hand start above the elbow (see illustration). Misalignment of the elbow joints results in a defensive tightening of the muscles that operate the wrist and hand, which then causes distress and pain. Activity, especially repetitive movement, makes the distress worse. This indicates that thickening and shortening of these tissues could be part of the syndrome.

It has been shown that these tendons increase in mass with exercise, i.e. stress. Certainly this condition could cause carpal collapse and loss of joint space in the hand and fingers as well. Also thickening of the tendons through the wrist region causing stenosis could be a consequence of contraction of the flexor-extensor groups.

Deformations of tendons and ligaments have two main components: time and weight.

Persistent passive stretch to reform ligaments and rehydrate discs is used in spinal rehabilitation. Can a similar approach be used on the forearm and muscular and tendonous structures of the hand and fingers? Studies done on intervertebral discs and spinal ligaments indicate that, to overcome the natural elastic deformation of these tissues, a constant stretching force for 12 -15 minutes must be achieved. Increase in length of these tissues occurs only after the natural flexibility of the tissues has been reached. The steepest part of the change curve (length graphed against time) is 20 to 25 minutes after the beginning the session, and there is little change after that.

Pilot experiments were done to determine the amount of weight that was necessary to provide elongation of the forearm muscles without harm. Approximately one pound of weight was found to work for a small hand, one and a half pounds for a medium size hand and two pounds for a large hand. If there was too much weight on the hand, the subject could not tolerate a 15-minute session, thus it was easy to gauge the correct weight.

The concept of passive persistent stretch as a means of increasing carpal space and relieving RSI is not discussed in the literature. Pain in the elbow and forearm is a commonly associated symptom with RSI, but is not mentioned in most references. The flexors and extensors of the hand and wrist originate in the elbow region and the tightening and shortening of these muscles with activity is a reasonable expectation. Compression of the carpal region results from this tightening, and can be the source of pain and other symptoms in some of those diagnosed with RSI.

A home device that can be used daily for relief of these types of symptoms would be desirable for many reasons.

I have developed such a device, called the Wrist Relief Glove, which costs about $70 + shipping. The treatment time is 12 weeks or less; after that, those patients with a positive response tend to use it intermittently when they re-injure themselves. Thus it can be used more often, with less cost, than frequent physical therapy or chiropractic office visits would require.

As with most clinical studies and procedures requiring long-term use of a device, consistency of patient compliance with the therapeutic program was a problem. This will be the case for most people who would receive this device. This is one of the major problems with any fitness or rehabilitation program. One way to help patients overcome this challenge is through education about the basic concepts of stretch and increasing the carpal compartment.