Wrist and Hand Pain at Work

Wrist, Hand and Thumb Pain at Work

There are not many jobs in the modern society that do not require a high level of use and function of the hands. Whether it be highly skilled and dextrous use of fingers on fine tasks, forceful lifting / pushing / pulling moving of loads or typing at a keyboard, the hands will be exposed to various forces throughout a shift. As a consequence of these daily loads some level of discomfort is to be expected but when pain, swelling or locking occur, activity can become quite limited. 

There are many potential causes of pain in the wrist and hands that can be assessed and treated by a physiotherapist: 

1. Carpal Tunnel Syndrome 
2. De Quervain’s Synovitis – Thumb tendon pain 
3. Osteoarthritis 
4. Trigger Finger – Locking of the finger  

While wrist and hand pain is rarely anything serious you should seek urgent care, A&E, if: 

• The pain is a result of recent substantial trauma, including any major lacerations or even a fall onto an outstretched arm 
• There is any excessive redness and swelling or new deformity to the wrist and hand 
• There is any new significant onset of loss of feeling or ability to move the wrist, hand or fingers

Work Related Carpal Tunnel Syndrome?

The Carpal Tunnel is as it sounds – a tunnel bound by the carpal bones (at the wrist crease) and a tough ligament through which many tendons / nerves and blood vessels pass to the hand. Carpal Tunnel Syndrome (CTS) is a very common work-relevant condition, often seen within occupational health physiotherapy clinics as improper care can often result in lengthy sickness absence. Inflammation of the carpal tunnel area causes irritation of the structures within the carpal tunnel, in particular the median nerve, causing pain in the hands and wrists, pins and needles and numbness in the hands and weakness, particularly of the thumb and index finger. Symptoms can affect one or both hands and can be triggered by repetitive activities in the workplace. If you are suffering from work related carpal tunnel syndrome you may need to seek help and support through your line manager or occupational health service early on and consider a temporary period on alternative duties. 

What Causes Carpal Tunnel Syndrome?

CTS is multifactorial and so there are a number of factors that can influence your likelihood of developing symptoms, as well as the severity of symptoms, and symptoms usually develop due to a combination of these factors, not just one. These factors can include 

• Static or awkward postures, of the wrist, forearm and upper back (e.g. due to poor workstation set up, in particular with DSE use) 
• Repeated or excessive use of the finger flexors (e.g. prolonged or repetitive gripping due to poor manual handling techniques or work habits) 
• Individual factors – being female, increasing age and pregnancy all increase the likelihood of developing pain. 

• Physical wellbeing factors – smoking, diabetes and poor general fitness all increase the likelihood of developing pain and the length of time it takes to recover. 
• Psychological wellbeing factors – stress, depression and anxiety all increase the likelihood of developing pain and even increase the severity of pain and the length of time it takes to recover.

Work Related De Quervain’s Tenosynovitis? 

De Quervain’s Tenosynovitis (DQT) is a common work-relevant condition, often seen within occupational health physiotherapy clinics as improper care can often result in lengthy sickness absence. Inflammation of the sheath surrounding the tendons at the outer base of the thumb can result in pain and swelling and difficulty moving or using your thumb, for example when gripping or pinching. If you are suffering from work related thumb pain, you may need to help and seek support through your line manager or occupational health service early on and consider a temporary period on alternative duties. 

What Causes De Quervain’s Tenosynovitis?

DQT is multifactorial and so there are a number of factors that can influence your likelihood of developing symptoms, as well as the severity of symptoms, and symptoms usually develop due to a combination of these factors, not just one. These factors can include 

• Direct trauma to the wrist – scar tissue can restrict movement 
• Poor work habits and ergonomics- such as repeated over stretching or sustained tension through the wrist and thumb. 
• Repetitive hand or wrist movement while gripping or pinching, such as working in the garden, screwdriver use, hand-sewing or even lifting your baby, 
• Individual factors – being female, pregnancy and being between the ages of 30-50 all increase the likelihood of developing DQT. 
• Physical wellbeing factors – medical conditions in which you are prone to inflammatory conditions, such as rheumatoid arthritis, increase the likelihood of developing DQT and the length of time it takes to recover. 
• Psychological wellbeing factors – stress, depression and anxiety all increase the likelihood of developing DQT and even increase the severity of pain and the length of time it takes to recover. 

Osteoarthritis of the wrist or thumb

Just like our hair turns more grey with age, our joints may gradually become achy and stiff as osteoarthritis progresses and local tissue reacts. The wrist and thumb joints are certainly no exception to this with the amount of daily activity they accrue. 

As well as discomfort around the wrist or at the base of the thumb, you may start to notice that it is becoming difficult to bend the wrist back over with wrist changes or open your grip to grasp wide objects or open jar tops when the thumb is affected.  

Manual activities in the workplace may place strain on these joints so if you are suffering from wrist or thumb pain at work then seek help and support early on as you may need alternative duties for a temporary period. 

What causes Osteoarthritis related pain?

Osteoarthritis is a natural process of ageing increasingly seen through each decade of life with people having evidence of osteoarthritis in their joints on specialist scans despite having no pain to report. Symptoms of osteoarthritis however may be more typically experienced as people age past 45-55 years of age. Pain from Osteoarthritis, however, can occur from a seemingly random flare caused by a change of cell activity in the body or perhaps from repeated or sudden overload to the altered joint which eventually leads to an increase in local swelling / irritation. 

There is some indication however that certain factors may predispose someone to a higher risk of developing wrist or thumb osteoarthritis: 

• Secondary to past trauma to wrist or hand 
• Family history of Osteoarthritis 
• Long term repetitive overuse of the hands combined with poor ergonomics / work habits. 

Trigger Finger or Trigger thumb

Tendons run down the front and back of the wrist into the fingers and thumb to allow the incredible movement and function needed for life’s activities. These tendons run through tight pulleys at certain points to allow better efficiency of power and are protected in smooth sheaths to allow the tendons to glide with less friction. This is an incredible evolution but can be a source of pain, swelling and eventual locking of the finger or thumb when irritated as swelling prevents the tendon gliding through these tight spaces. As a result, the finger or thumb can seem stuck in a flexed position and often needs to be ‘prised’ straight again with the other hand. 

Of course, trying to keep active at work with pain and increasing locking of the thumb or fingers may be difficult. Seek support early on through your line manager or occupational health service. A temporary period of alternative duties may be useful to help your recovery. 

What causes Trigger Finger or Trigger Thumb?

Trigger finger or trigger thumb is the result of swelling and irritation between the effected tendon and the sheath surrounding it. With thickening or swelling of either tissue there becomes less space for the tendon to glide through the tight tunnel and sometimes it can get blocked or stuck either side of the narrowing.  

Sudden increase in gripping / pinching based forces or long-term gradual overload of such forces may lead to irritation, swelling and thickening of tissue and potential onset of ‘trigger-like’ symptoms. 

How can I help myself?

The majority of wrist and hand pain cases can be treated conservatively with physiotherapy treatment and advice, however, your attitude and the actions you take are the most important factors in preventing long-term problems. The most effective way to manage symptoms are to 

• Minimise aggravating activities as much as possible – such as pushing based forces with wrist pain or gripping / pinching based issues with soft tissue pain. Once symptoms have settled you can gradually increase your exposure to some of these activities, but in order to prevent recurrence of symptoms, consider changing your activities so that you minimise future exposure. 
• Discuss with your line manager if there are alternative duties that can be continued that may reduce the repeated load of certain activities that you have found difficult and painful to perform. 
• Talk to your GP or pharmacist about what pain relief or anti-inflammatory medication may be right for you. If your pain is controlled, you will be able to maintain more movement, while anti-inflammatory medication (e.g. ibuprofen) will reduce inflammation. 
• Apply an ice pack (wrapped in a towel) to reduce pain and inflammation. 
• Ensure you are following all manual handling techniques correctly at home and work – keep the load close to your waist, use your legs to lift, lower or push loads as these are the most powerful muscles in the body, and work within your capability. 
• Report any symptoms you think may be work-related. Firstly, you may have a lawful duty to report your injury. Secondly, by informing your employers they are then able to make any necessary adjustments to your workplace or working practices, either temporarily for yourself on an individual basis, or permanently to improve overall workplace wellbeing. 

How can physiotherapy help?

At Physiotherapy Matters, our physiotherapists can conduct a thorough assessment to confirm a diagnosis and work with you to help you manage work related hand and wrist pain and return to normal activity by 

• Helping you understand your condition 
• Helping identify the factors that may have caused or be aggravating your symptoms and providing advice on how to minimise these, including manual handling or safe DSE use. 
• Developing symptom management strategies so you always feel in control 
• Completing ergonomic workplace assessments to minimise any work-related risk 
• Providing an individualised exercise program to improve mobility and strength in order to address symptoms but also to prevent future episodes, including work-hardening 
• Providing additional manual therapies that may help ease symptoms, such as 
• Taping to provide postural support and reduce pressure on the carpal tunnel. 
• Soft tissue massage to reduce any muscular tension in the surrounding muscles or those of the upper back which may be causing awkward postures. 
• Mobilisation of the neck and upper back to reduce stiffness 
• Acupuncture to reduce pain 
• Referring for additional services if required including 
• Shockwave therapy treatment to improve healing 
• Corticosteroid injection to reduce pain and allow exercise