12 Nov Exercises To Improve Wrist Pain
Wrist and hand pain can be debilitating since we rely on our hands for an endless amount of everyday tasks, and even more so with the use of smartphones. Studies have shown that smartphone usage with poor mechanics and joint position can significantly increase the incidence rate of carpal tunnel (3). Another study showed 50% of the participants had a positive test for a thumb pathology called De Quervain’s tenosynovitis from using their cellphones (4). These pathologies are due to wear-and-tear associated with overloading the tissues around the wrists and hands. Luckily, we can take measures to [P]Rehab these pathologies. This article will show you exercises to improve wrist pain on your own!
What Causes Wrist Pain?
Two common pathologies of the wrist include De Quervain’s Tenosynovitis and Carpal Tunnel Syndrome. While they present similarly, differentiating between the two is important to help guide treatment. They both occur close to the wrist area, yet in slightly different areas. Often times, they may be due to overuse of the upper extremity, yet there are also other predisposing factors as well. We will describe each of their causes below in more detail, as well as excellent exercises you can perform for each of these diagnoses specifically!
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Wrist Pain: What Is Carpal Tunnel Syndrome
Carpal tunnel syndrome is often due to overuse of the wrist flexors, which causes inflammation in a band of tissue that surrounds the wrist called the flexor retinaculum. Beneath the flexor retinaculum lies nine tendons (the tendons of flexor pollicis longus, flexor digitorum superficialis, and flexor digitorum profundus) and a nerve called the median nerve that supplies sensory and motor information to the wrist and hand (3). When this nerve gets entrapped, it can cause tingling, pain, and even motor weakness in the hand.
There currently are two peak age frequencies. The first and biggest peak is between 45-59 years of age, 75% of which is female. The second peak is between 75-84 years of age, 64% of which is also female. Some other predisposing factors include female sex, age, obesity, smoking, and excessive alcohol consumption.
Carpal Tunnel Common Signs and Symptoms:
- Numbness, tingling, and or pins and needles in the palmar (palm side) of the hand, from the thumb to the ring finger
- Pain in the wrist at night
- Weakness of the hand/wrist
- Feelings of wanting to “shake the hand out” for relief
- Night pain is a very common complaint
- May notice aggravation of symptoms with gripping of objects
- If it becomes more progressive, may have more intense numbness and tingling, and potential weakness as well as atrophy of the thenar muscles (thumb side muscles)
Carpal Tunnel Diagnosis: Phalen’s Maneuver
This is a diagnostic test for Carpal Tunnel Syndrome. Compress the backs of your hands together with your fingers touching. Hold this position for 1-2 minutes. A positive test is pain in the wrist or numbness/tingling of the fingers.
Wrist Pain: What is De Quervain’s Tenosynovitis?
De Quervain’s tenosynovitis is also usually due to overuse of the wrist but presents differently than carpal tunnel syndrome. Overuse of the thumb side of the wrist and the thumb itself causes inflammation in two muscles called the abductor pollicis longus and extensor pollicis brevis. Wringing a washcloth, gripping a golf club, mouse usage, and hammering a nail can exacerbate symptoms (2). As a clinician, it is important to rule out intersection syndrome, which looks very similar to DeQuervain’s, but it includes a different compartment of our wrist. With intersection syndrome, the patient usually will complain of pain about 4 centimeters from the wrist, more proximal (higher up) than where DeQuervain’s is.
DeQuervain’s Common Signs and Symptoms:
- Complaints of an insidious and gradual onset
- May describe crepitus in the wrist with certain motions
- Pain on the thumb side of the wrist
- Weakness of the thumb
- May describe a burning sensation
- Increased pain with ulnar deviation, thumb flexion, and adduction
- Turning of a doorknob is likely a common aggravation
DeQuervain’s Diagnosis: Finklestein’s test
This is a diagnostic test for De Quervain’s Tenosynovitis. Grip your thumb with your other fingers, and move your hand into ulnar deviation (pinky towards the outside of your elbow). A positive test is pain over the thumb side of the wrist.
Although exercise prescription for these two pathologies might be slightly different, a similar approach can be applied. Find below exercises for wrist pain!
How To Reduce Wrist Pain
Step 1: Modify the stressful stimulus when possible
A temporary modification in physical loading is recommended to allow tissue healing. Limit the activities that increase symptoms when possible. Studies have shown that plyometric movements could be particularly harmful or dangerous for vulnerable tendons. A plyometric movement is when the muscle is “actively and forcibly stretched.” Plyometrics of the wrist would include activities such as throwing, tennis serves, and power lifts like cleans. Due to tissue vulnerability, these activities should be reduced temporarily if possible (1).
Step 2: Progressively reload the tendon(s)
Add exercises (isometric, concentric, and eccentric) to target the tendons to facilitate healing and remodeling (1). For carpal tunnel, progressively load the finger flexors and thumb flexors. For De Quervain’s, begin to load the thumb extensors and thumb abductors. You’ll find some exercises below!
Step 3: Prevention
Studies show that holding a smartphone in ulnar deviation of the wrist while simultaneously using your phone can lead to an increased incidence of carpal tunnel (3). Holding your phone with a neutral wrist or resting your hand on a surface could improve wrist health.
Exercises to improve carpal tunnel include targeting the finger and thumb flexors to progressively load the tendons that lie beneath the flexor retinaculum. A median nerve glide is also recommended to decrease symptoms.
Exercises To Improve Wrist Pain Related To Carpal Tunnel
Current treatment strategies for carpal tunnel include splinting, activity modification, NSAIDs, and in some cases, corticosteroids. Placing the wrist in a netural position may be best to have optimal pressure reduction, specifically with a slight extension bias (wrist slightly bent backward). Moreover, tendon and nerve gliding exercises may maximize the relative excursion of the median nerve in the carpal tunnel and the excursion of the flexor tendons relative to one another. We will dive into some exercises to improve wrist pain related to carpal tunnel below!
Median nerve glide
- HOW: Extend the shoulder, elbow, wrist, and fingers as far back as you can. Then flex all of these joints back to the starting position, repeat back and forth. Move slow and controlled with this exercise.
- FEEL: You will feel the tension in the front of your arm with this movement.
Finger Flexor Strengthening
This exercise will target the flexor digitorum superficialis in addition to the flexor digitorum profundus of the hand.
Have your palm face up towards the ceiling with your wrist neutral. Start with a band barely on the end of your pointer finger, while stabilizing the band with the opposite hand. Barely hover the finger in which you are targeting the return to starting position and perform with your middle, ring, and pinky fingers. You will feel the muscles on the front of your finger and wrist work with this exercise. Avoid moving multiple fingers at once, try isolating this movement to the finger with the band.
Thumb Flexor Strengthening
This exercise will target the Flexor Pollicus Longus muscle of the thumb.
For this exercise secure a resistance band at the tip of your thumb. Stabilize the opposite end with your other hand, then take your thumb across your hand as if you’re making a number 4. Pull your thumb down towards your wrist then slowly release back up. This will be a very small movement. You will work the muscle on the front side of your thumb with this exercise. Don’t let your wrist rotate, specifically inward (pronation), keep your palm up towards the ceiling.
Exercises To Improve Wrist Pain Related To De Quervain’s Tenosynovitis
Exercises to improve de Quervain’s involve loading the abductor pollicis longus tendon and the extensor pollicis brevis tendon.
Thumb Abduction Strengthening
This exercise will target the Abductor Pollicus Longus muscle of the thumb.
Place a band around your thumb and pointer finger. place your pinky down onto a stable surface. Bring your thumb away from your pointer finger towards an “L” position, slowly return and repeat this movement. You will feel the muscles of the thumb work with this exercise. Avoid moving with the wrist and hand.
Thumb Extension Strengthening
This exercise will target the Extensor Pollicus Brevis muscle of the thumb.
Place a band at the end of your thumb and pointer finger with your hand down onto a stable surface. Take the end of your thumb away from the pointer finger. Move as far as you can then control this motion back to the starting position and repeat. You will feel the muscles on the back of the thumb working with this exercise.
Carpal Tunnel and DeQuervain’s are two common diagnoses that can cause pain in the wrist and hand. There are various ways that a clinician can delineate the differences between presentations of these two conditions, as well as how to rehabilitate each individual optimally. Exercising is a great way to combat symptoms for both of these conditions that are often due to overuse! Take these exercises and add them to your tool kit in regards to exercises to improve wrist pain!
About The Author
Shannon graduated with her Doctorate in Physical Therapy from the University of Kansas, then received her Specialist certification in Muscle Activation Technique. She owns a cash-pay physical therapy practice called Levo Wellness in Durham, North Carolina. She specializes in improving and resolving joint pain by identifying and correcting muscular imbalances.
Follow Shannon on Instagram @dr.shannon.dpt for more fitness, physical therapy, and yoga hacks and tips.
- Ashton-Miller, James A. “Response of muscle and tendon to injury and overuse.” National Research Council (US) Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base. 1999.
- Goel, Ritu, and Joshua M Abzug. “de Quervain’s tenosynovitis: a review of the rehabilitative options.” Hand (New York, N.Y.) vol. 10,1 (2015): 1-5. doi:10.1007/s11552-014-9649-3
- Woo, Hoi-Chi et al. “Development of Kinematic Graphs of Median Nerve during Active Finger Motion: Implications of Smartphone Use.” PloS one vol. 11,7 e0158455. 1 Jul. 2016, doi:10.1371/journal.pone.0158455
- Ali, Maryam et al. “Frequency of De Quervain’s tenosynovitis and its association with SMS texting.” Muscles, ligaments and tendons journal vol. 4,1 74-8. 8 May. 2014