Physiotherapy wrist fracture
In case of a wrist fracture, it is important to follow the doctor’s instructions. Depending on how the fracture has been treated (conservatively or surgically), therapy is already possible after a few weeks. However, certain strains may well be prohibited for longer.
In most cases, early functional mobilization is possible after about 2-4 weeks. However, objects may only be supported and carried again once the fracture is very stable. In principle, therapy begins with active mobilizing therapy, in which the patient independently exercises the released movement directions.
The therapist can treat the operation scars to prevent restrictive scarring. The treatment of tense (hypertonic) muscles is also part of the physiotherapy in the acute phase. In this acute phase, the wrist is not yet very resilient and is very busy with wound healing, it can be painfully swollen and oedematous.
Manual lymph drainage can promote wound healing. The further the wound healing progresses, the more resilient the wrist becomes. Exercises against dosed resistance can be performed to improve the strength of the muscles.
Gripping exercises, reaction exercises can be used as coordination exercises. Fist closure is also trained. Aids such as small, soft balls, cloths or similar are available. As soon as the doctor releases the load capacity of the wrist, the support is also trained.Depending on the location of the fracture and the use of metal or wires, manual therapy techniques may also be considered, but the physician should always be consulted. The patient should also perform the exercises at home, in the case of surgical scars, it is important that regular scar mobilization also takes place at home to prevent function-limiting scarring.
Physiotherapy for carpal tunnel syndrome
Carpal tunnel syndrome is the narrowing of the median nerve within the carpal tunnel. There are several causes for this constriction. Inflammation within the carpal tunnel, which leads to swelling of the tendons/muscles, tumors, fractures with scarring, degeneration of the carpal bones.
Sometimes a carpal tunnel syndrome exists without a visible cause, this is called idiopathic carpal tunnel syndrome. The carpal tunnel syndrome often occurs in women in the menopause (menopause), so a hormonal connection is suspected. Frequently an inflammation caused by overloading of the structures running in the carpal tunnel is the cause.
In physiotherapy, attempts are made to reduce this overload. Postural correction may be necessary, as well as training of weak muscles, relief of overstrained muscles or stretching of shortened muscles. The tissue of the carpal tunnel itself can also be mobilized.
For this purpose, the arch of the hand is stretched and friction is applied. Manual mobilization of the carpal bones can be helpful. Furthermore, nerve mobilization of the median nerve can be useful in physiotherapy for carpal tunnel syndrome.
The arm is positioned so that the median nerve is brought to its full length. For this purpose, the arm is spread out at 90 degrees next to the body. The crook of the arm points to the ceiling, the fingertips point down.
It is important that the shoulder is not pulled upwards, but that there is plenty of space between the shoulder and the ear. The head can be tilted slightly to the opposite side to increase the stretch. The hand can be stretched further by standing against a wall and by applying light pressure, pressing the fingers closer to the body (more dorsal extension in the wrist).
A stretch can be felt at different points on the arm. The inclination of the head should increase the stretching sensation. There are different stretching techniques.
Either you can hold the stretching position for about 20 seconds and then return to the stretching position after a break. Or you can mobilize the nerve by alternately moving a joint out of the stretching position and back in again. The head is ideal for this.
The head can be easily straightened and slowly tilted back. Any other joint can also be used. There are other techniques that can be developed with a therapist in physiotherapy.
In carpal tunnel syndrome, it is important to relieve the compression of the nerve as quickly as possible in order not to damage the nerve permanently. Whether a conservative treatment by exercises is sufficient must be clarified by a doctor to exclude permanent damage. If necessary, an operation may be necessary to relieve the median nerve.
Afterwards, the function of the hand can be restored by mobilizing and strengthening exercises. The mobility and strengthening of the thumb should also be included in the exercise program. Just as in the post-treatment of a wrist fracture, it is important to keep the surgical scar mobile after carpal tunnel surgery.
Scar mobilization is then always part of the physiotherapy. As with any operation, it is important to follow the load and post-treatment instructions of the doctor.
