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Patient guides: Injuries/Conditions

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) occurs when the median nerve passing through the wrist is pinched or compressed, causing a progressively painful condition. The carpal tunnel is a narrow passageway linking your arm to your hand in which nine tendons and the median nerve are surrounded by an inflexible bony bracelet. The carpal tunnel is comprised of the carpal bones and the transverse carpal ligament.

Image adapted from http://www.insideradiology.com.au.

What causes carpal tunnel syndrome?

The most commonly accepted explanation is that CTS is caused by a combination of events or situations. Some people have smaller carpal tunnels and are therefore more likely to have pressure on the median nerve. Injury to the wrist from a sprain or fracture can cause swelling in the carpal tunnel, resulting in compression of the nerve. Other factors, such as arthritis, thyroid disease, diabetes, pregnancy, repeated use of vibratory tools (e.g., jackhammer or drill), or prolonged extreme bending of the wrist can all result in nerve irritation, causing CTS.

What are the symptoms of carpal tunnel syndrome?

Many people report waking up with numbness in their thumb, index, middle and part of their ring fingers on the palm side of their hand. Others report an ache or sharp pains in their hand, wrist, or forearm. Patients may feel clumsy and drop things, or have problems with fine motor tasks, such as buttoning a shirt or picking up coins. A weakened grip or pinch from prolonged CTS may cause problems when turning a key or opening a jar.

How can a hand therapist help treat carpal tunnel syndrome?

A hand therapist can help reduce the symptoms of CTS by first performing a complete evaluation to determine the main cause of the problem. He or she might recommend wearing a brace at night to keep the wrist in a safe position, or during the day for activities that might irritate the nerve. A hand therapist can provide patient education and recommendations for modifications to reduce symptoms during activities of daily living, work tasks, and recreational activities. A hand therapist may also prescribe specific exercises to help in the recovery or prevention of future CTS occurrences.

Carpal Tunnel

This image and more information about carpel tunnel syndrome/the release procedure can be found at hopkinsmedicine.org.

The Surgery

The surgeon will release the median nerve from beneath the transverse carpal ligament. This will allow the nerve to heal and will relieve your symptoms of discomfort. Full range of motion of the wrist and fingers is normally the case and you can expect this in the first four to six weeks after surgery. In six to eight weeks you will have your pinch strength back, and in twelve to twenty-four weeks your normal grip strength will return.

Image from medlineplus.gov showing an open carpel tunnel release procedure.

Image from www.hopkinsmedicine.org showing a carpal tunnel release performed endoscopically.

Possible Complications

Less than ideal results are usually related to ongoing scar sensitivity, persistent numbness and pain, loss of endurance during gripping, and weakness. Following your surgeon’s and therapist’s advice in all aspects of recovery reduces the likelihood of having a less than satisfactory outcome.

Carpal Tunnel Release FAQ

How long does the surgery take?

Release of the tissue (transverse carpal ligament) that compresses on the median nerve will take the surgeon approximately 20 minutes. You will leave the hospital with a bulky dressing on your wrist.

Will all my pain and numbness go away immediately after surgery?

It may, or it may progressively improve in the days and weeks following surgery. This depends on a number of factors, including:

  1. How long you have had symptoms before surgery.
  2. How severe you symptoms were.
  3. Your overall health and any other hand conditions (e.g., arthritis).

Do I need hand therapy after my surgery?

Your surgeon will usually recommend you attend hand therapy within 1 – 3 days of your carpal tunnel release surgery.

Your hand therapist (either occupational or physiotherapist) will guide you through the post-operative stages. This may take eight to ten weeks. The goals of therapy will include:

  • Education on Wound Care
  • Hand Use
  • Splinting
  • Scar Management
  • Strengthening
  • Returning to Work
  • Achieving the Best Possible Overall Outcome from Surgery

Will I have pain after surgery?

Your surgeon will apply a “block” to your hand so that you have prolonged pain relief for days after surgery.

Image from www.acep.org showing a block being administered to the median nerve at the wrist.

The incision is about the length of your pinky finger over your palm. This wound usually heals well with light dressings. Very infrequently, you may have excessive swelling which may open the incision and require more attention. In general, there is very little discomfort from the surgery and infection rates are low. 

When can I go back to my usual activities?

Your surgeon will have you take anywhere from six to eight weeks off from heavier types of work; light work is okay. Gradually returning to daily light activities such as eating, light lifting (up to one pound), dressing, and self-care are allowed in the first three weeks. Your hand therapist can advise you with what tasks to avoid (e.g., raking, writing, excessive typing, strenuous gripping, cold environments, etc.).

What is hand therapy?

Hand therapy is the art and science of rehabilitating the upper limb, which includes the hand, wrist, elbow, and shoulder girdle. Using specialized skills in assessment, planning, and treatment, hand therapists provide exercises, wound care and education to promote physical recovery and the return of functional ability.


For More Information Visit:


Canadian Society of Hand Therapists: http://www.csht.org.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is cubital tunnel syndrome?

This image from www.floridaortho.com shows the major nerves of the arm. The ulnar nerve is shown in green on the right.

The ulnar nerve is one of the primary nerves in the arm that travels from the neck, along the arm, through the elbow to the fingers. When this nerve is irritated or stretched at the elbow level, a condition called Cubital Tunnel Syndrome can develop. Cubital tunnel syndrome gets its name from the tunnel in which the nerve travels. When people say they hit their “funny bone,” it is actually the ulnar nerve.

Illustration from www.urmc.rochester.edu showing the ulnar nerve passing through the cubital tunnel at the elbow.

What causes cubital tunnel syndrome?

Cubital tunnel syndrome has several possible causes. The nerve can stretch when the elbow is bent for long periods of time with activities such as sleeping or holding a phone to the ear. The anatomy can be another cause, as the nerve can shift over the bony part of the inside of the elbow during motion. Direct pressure on the elbow, frequent bending, or intense physical activity of the elbow can also irritate the nerve.

Magnetic resonance neurography (MRN) image from neurography.com showing irritation in the ulnar nerve passing through the cubital tunnel.

What are the symptoms of cubital tunnel syndrome?

Pain, numbness, tingling, and weakness in the hand are all symptoms of Cubital Tunnel Syndrome. Numbness, or loss of sensation, is usually felt in the small and ring fingers. This numbness may gradually turn into pain. Putting pressure on the elbow or bumping it can cause an “electric shock” sensation to the fingers. Other symptoms can include “clumsiness” in the hand, or a claw-like deformity of the ring and small fingers.

What is the treatment for cubital tunnel syndrome?

For nonsurgical treatment, a physician will provide a referral to a hand therapist for education and intervention to help relieve the symptoms. If the symptoms do not improve, the physician my recommend a surgery. Surgery involves relieving the pressure on the nerve. Hand therapy is usually recommended following surgery.

An example of a brace used to treat cubital tunnel syndrome from opchealth.com.au.

What can a hand therapist do for me?

The hand therapist will help determine which activities aggravate the symptoms, and instruct in modifying these activities. Treatment may include exercises for the arm and hand, taping, fitting for a padded elbow sleeve, as well as a custom-made orthosis for night use. If surgery is performed, therapy will assist in restoring normal ranges of motion and function of the arm and hand.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is De Quervain’s tendinopathy?

De Quervain’s tendinopathy involves the tendons that run along the thumb-side of the wrist. Tendons anchor muscle to bone, and the tendons associated with this condition help to pull the thumb out and away from the palm. These tendons travel under a “tunnel,” known as the first dorsal compartment, as they approach the base of the thumb. The patient will notice pain in this area as wrist and thumb motions move the tendons back and forth under the tunnel.

Drawing from yourhands.co.uk showing the tendons on the thumb-side of the wrist running through the first dorsal compartment.

What are the symptoms of De Quervain’s tendinopathy?

Pain will be noted along the thumb-side of the wrist, and can extend down the thumb or up the forearm. Patients will complain of pain when reaching across the palm with the thumb, pinching, or with movements of the wrist. A twisting motion, such as wringing out a washcloth, can also create pain.

What causes De Quervain’s tendinopathy?

De Quervain’s tendinopathy, also known as De Quervain’s tendonitis or De Quervain’s tenosynovitis, is thought to be from thickening and narrowing of the first compartment tunnel, or may occur because of inflammation or degeneration of the tendons of the first compartment. This then restricts the thumb tendons from gliding freely and smoothly through the tunnel. It can be associated with overuse, or may develop for no apparent reason. New mothers can develop De Quervain’s tendinopathy, thought to be caused by swelling and hormonal changes that occur with pregnancy and delivery.

What is the treatment for De Quervain’s tendinopathy?

Treatment for De Quervain’s can be surgical or conservative (non-operative). Conservative treatments a physician might recommend include anti-inflammatory medications or a steroid injection into the painful area. A physician can also provide a referral to a qualified hand therapist for evaluation. Surgical intervention might be recommended for severe symptoms lasting six months or longer. Surgery involves an incision to open up the first compartment tunnel to restore smooth gliding of the thumb tendons. Most patients do not need surgery and can be successfully treated conservatively.

What can a hand therapist do for me?

A hand therapist can provide conservative treatment for De Quervain’s tendinopathy. The therapist can help the patient determine which activities aggravate the symptoms and help with activity modification. The therapist may recommend a custom-fabricated orthosis, for the wrist and thumb to provide rest for the injured tissues. Following surgery, hand therapy is important to restore range of motion and return the patient to full activity.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

Photo from orthoinfo.aaos.org showing Dupuytren’s contracture in a patient’s ring finger.

What is Dupuytren’s Contracture?

Dupuytren’s contracture, also known as Dupuytren’s disease, is a condition in the hand that causes the fascia, or layer of tissue beneath the skin, to tighten and draw the fingers in the palm. Dupuytren’s disease develops over time and is most common in the ring and small fingers; however, it may be found in any digit of the hand.

Illustration from physiocheck.co.uk.

What are the symptoms of Dupuytren’s Contracture?

Initially you may feel a lump or thickening of tissue in the palm; however, with time, Dupuytren’s disease can progress. Thick cords may develop in the palm and make it difficult to open the hand to hold change, or to place the hand in a pocket. The cords may also become sensitive and limit the ability to grip tools. The tightness of skin in the palm and the bent position of the fingers may take months or years to develop. Dupuytren’s disease can occur in both hands, although one hand is typically worse than the other.

What causes Dupuytren’s contracture?

The exact cause of Dupuytren’s disease is not known. Dupuytren’s disease is found most often in older males. Smoking, diabetes, and having a family member with Dupuytren’s disease are all risk factors.

What is the treatment for Dupuytren’s contracture?

Dupuytren’s disease is diagnosed by a physical exam. Your physician may monitor the nodules for change in size or thickness. For many, the nodules in the palm do not progress or become painful; however, when the fingers become stiff and limit the ability to use the hand, a referral to a hand surgeon is necessary. Surgery may be performed to remove the nodules and thick tissue in the palm. Your surgeon may also recommend a special injection and manipulation to straighten the fingers.

What can a hand therapist do for me?

A hand therapist works closely with the physician to help treat Dupuytren’s disease after surgery. Post-operative care involves fabrication of an orthosis to keep the fingers extended, a home exercise program to perform active range of motion and scar management and a strengthening program to regain functional use of the hand.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is frozen shoulder?

Frozen shoulder is the shortening, thickening, and chronic inflammation of the soft tissue surrounding the shoulder joint, which can result in pain and loss of motion. It has been called adhesive capsulitis, and more recently, frozen shoulder contracture syndrome.

What causes frozen shoulder?

Frozen shoulder may be associated with an injury, such as a broken arm, and the inactivity of the arm following the injury. At times, a frozen shoulder may develop with no known cause.

What are the symptoms of frozen shoulder?

The symptoms of frozen shoulder are pain and loss of movement in the shoulder joint. Lifting, reaching, and daily activities, such as putting on a shirt, may be difficult, and pain may be worse at night.

There are three stages of frozen shoulder. The early stage when pain is greater than stiffness is known as the “freezing” stage. The stage when stiffness is greater than pain is known as the “frozen” stage. The “thawing” stage occurs when pain has decreased and shoulder range of motion begins to improve. If left untreated, the pain and stiffness from a frozen shoulder may last several years.

“These photos taken through an arthroscope show a normal shoulder joint lining (left) and an inflamed joint lining affected by frozen shoulder.” (Photos and captions from https://orthoinfo.aaos.org/en/diseases–conditions/frozen-shoulder.

What is the treatment for frozen shoulder?

The term frozen shoulder suggests that shoulder pain and stiffness will eventually “thaw” on their own without the need for therapy; however, with treatment, shoulder motion may return much faster.

Non-surgical treatment of a frozen shoulder can include therapy to help with motion and pain, medication to reduce inflammation and control pain, or a cortisone injection. Surgical treatment is an option your physician may recommend if pain and motion do not improve.

What can a hand therapist do for me?

A hand therapist has specialized training to assist in reducing joint pain and improving shoulder motion and function. Each patient’s condition is unique, and will require a thorough evaluation to determine the best treatment approach. The physician, hand therapist, and patient work together as a team in order to achieve the best possible outcomes for an individual with a frozen shoulder.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

This image of hands affected by osteoarthritis is from handtherapy.com.au, where you can learn more about the different types of arthritis.

What is osteoarthritis of the hand?

There are many joints in the human hand. Joints in the hand are formed where two or more bones meet. In between the joints, we have a cushion called cartilage. Arthritis occurs when the cartilage between the bones becomes thin or worn out.This allows the bones to touch and not move smoothly against one another. Arthritis in the hand may lead to pain, stiffness and loss of function.

These photograph and X-ray images of a hand with osteoarthritis are from www.researchgate.net (Marshall et al. 2014).

What causes osteoarthritis in the hand?

Osteoarthritis is caused by overuse, an injury to a joint, or “wear and tear” on a joint. This may be present in all joints of the hand or only a few. Other factors that may contribute to osteoarthritis in the hand are age, gender, and family history.

Image showing the various locations osteoarthritis may affect the hands from www.health.harvard.edu.

What are the symptoms of osteoarthritis in the hand?

Stiffness, pain, and weakness are some of the symptoms of osteoarthritis in the hand. Joints in the hand may also have a deep ache, be tender or warm to the touch, develop swelling or have a change in appearance, such as a bump. Osteoarthritis in the hand may make it difficult to perform activities, such as gripping or pinching.

Image from boneandspine.com showing the different types of bumps, or nodes, forming in the hand joints.

What is the treatment for osteoarthritis in the hand?

Osteoarthritis in the hand will be diagnosed by a doctor. Often an X-ray is taken to determine if there are changes to joint surfaces. The doctor may prescribe anti-inflammatory medicine to help ease the discomfort. A referral to a hand therapist will also help to manage osteoarthritis in the hands. If pain and stiffness continue to be a problem, the doctor may recommend surgery.

X-ray image of hands affected by osteoarthritis from radiopaedia.org.

What can a hand therapist do for me?

A hand therapist is a great resource in the treatment of hand osteoarthritis. The main goal in hand therapy is to decrease pain and improve hand function. A hand therapist may suggest using heat to decrease joint stiffness and pain. An orthosis may be used to provide rest and proper positioning to painful joints. A hand therapist will provide instruction in the use of adaptive equipment and also provide a specialized home program to protect the joints, decrease joint stiffness, and improve the ability to use the hand.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is shoulder impingement?

The rotator cuff is a group of muscles and tendons in the shoulder that connect the bone in the upper arm (humerus) to the shoulder blade (scapula). The rotator cuff allows for stability and flexibility while moving the shoulder. Impingement happens when the muscles and soft tissues around the rotator cuff are pinched or squeezed. This pinching occurs between the humerus and the front of the shoulder blade called the acromion.

Excerpt from image at atlasorthopedics.com.

What causes shoulder impingement?

There are several factors that contribute to shoulder impingement. The shape of the acromion can pinch on the tissues in the shoulder causing impingement. Weakness of the shoulder muscles along with poor posture can cause impingement. Impingement may also be the result of repetitive shoulder motion, such as throwing a ball or reaching overhead.

What are the symptoms of shoulder impingement?

Shoulder impingement is one of the most common causes of pain in the shoulder. The pain usually develops after performing activities that involve reaching behind the back or above the head. Pain caused by shoulder impingement may be mild at first, and then become worse while performing activities and while sleeping.

What is the treatment for shoulder impingement?

Nonsurgical treatment includes rest, changing the ways activities are performed and a referral to therapy to instruct in exercises for posture and stretching. If the symptoms do not improve with therapy, the physician my recommend a cortisone injection or surgery. Surgery involves widening the space in the shoulder to decrease the pressure on the rotator cuff. Therapy also plays an important role in recovery after surgery.

What can a hand therapist do for me?

A hand therapist can help evaluate the cause of shoulder impingement, determine which activities aggravate the symptoms, and also provide treatment to decrease pain. After surgery, the hand therapist will provide instruction in exercises to restore flexibility and strength around the shoulder joint.

Sprains and strains are both injuries involving soft tissues, but differ in the types of tissues affected. Tears may be partial or full thickness tears, the latter meaning the tissue has torn completely through.

A sprain is a tear in a ligament, which is a tough cord of fibers that connects two bones at a joint. A common example seen at our clinic is a sprain in the ulnar collateral ligament (UCL) of the thumb, known as skier’s or gatekeeper’s thumb.

A strain is a tear in a muscle or tendon. Tendons are short, flexible bands of tissue that connect muscles to bones.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is tennis elbow?

Tennis elbow, also known as lateral epicondylosis, lateral tendinosis, or lateral epicondylitis, is a condition that involves tendons located around the outside of the elbow. These tendons, which anchor muscle to bone, work to extend the wrist or fingers. Over time these tendons degenerate, weakening the attachment site and placing a strain on the muscles.

What are the symptoms of tennis elbow?

Patients complain of pain around their elbow, usually on the bony point just above the outside of the elbow called the lateral epicondyle. The area may be tender to touch. Patients may report weakness and an inability to perform their normal activities of daily living, such as lifting a cup of coffee.

An MRI showing inflammation where the extensor carpi radialis brevis (ECRB) muscle attaches to the bone at the elbow (Image from http://www.orthobullets.com.

What causes tennis elbow?

Many patients diagnosed with tennis elbow have never played tennis at all! Any activity, such as gripping or repeated grasping, can strain the tendon attachment to the lateral epicondyle. The most common age group is between 30-60 years old, although it can occur in younger and older patients.

What is the treatment for tennis elbow?

Conservative (nonsurgical) treatment through a physician can include anti-inflammatory medications and steroid injections into the painful area. A physician can also provide a referral to a qualified hand therapist. Surgery is often only considered if the pain is severe, and/or symptoms have been present for six months or longer.

Epicondylitis brace (http://www.m-brace.com).

What can a hand therapist do for me?

A hand therapist can provide conservative management for the treatment of tennis elbow, with the goal to return the patient back to normal work, home, and sports activities. A therapist can help identify what activities might aggravate symptoms, and discuss activity modifications. A custom-fabricated brace or orthosis for the wrist might be recommended to rest the area. Various treatments can be utilized, such as heat, ice, ultrasound, massage, or electrical stimulation. The therapist will often prescribe stretching and strengthening exercises. Following any surgery for tennis elbow, therapy is important to regain motion and stretch.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is trigger finger?

Trigger finger is inflammation of one of the tendons, or cord-like structures on the palm side of the hand, that allows the fingers and thumb to bend. The tendon is surrounded by a fluid-filled tube or sheath that allows the tendon to glide more easily. When the tendon is inflamed it cannot slide easily, making it difficult to bend or straighten the finger or thumb. This is also known as tendonitis.

What are the symptoms of trigger finger?

The first sign of trigger finger may be pain and a small nodule or bump in the palm of the hand. A physician or certified hand therapist may feel for tenderness and swelling at the base of the finger or thumb. The patient will be asked to make a fist and then straighten the fingers. The affected finger or thumb may stay curled and then suddenly pop to a straight position, as if releasing the trigger of a gun. This repeated catching and releasing continues to irritate the tendon. If the condition persists for several months, the finger may become stiff.

What causes trigger finger?

Often the cause of trigger finger is unknown; however, trigger finger may occur with repeated gripping, or with the use of tools, such as a drill or wrench. It is also more common in people with diabetes, arthritis, or when there has been an injury to the palm of the hand.

What is the treatment for trigger finger?

If the symptoms are mild, the physician may prescribe anti-inflammatory medication. If the triggering is moderate to severe, the physician may recommend a cortisone injection along with a custom-made orthosis designed to rest the finger. Surgery may be recommended if resting or injections do not relieve the triggering.

Oval-8 finger splint for trigger finger (image from http://www.3pointproducts.com/oval-8-conditions.

What can a hand therapist do for me?

The physician may refer the patient to a hand therapist for non-operative and post-surgical treatment. For non-operative treatment, the certified hand therapist has specialized training to fabricate a custom orthosis to rest the finger, and to teach the patient exercises to avoid stiffness during the healing process. The certified hand therapist will also discuss ways to modify activities while the finger is healing. Hand therapy following surgery will improve range of motion, and teach the patient how to regain the function of the hand.

The following information is from the American Society of Hand Therapists and is available as a handout from their website: http://www.asht.org.

What is a sprain or injury to the ulnar collateral ligament in the thumb?

The UCL, or ulnar collateral ligament, is located in the middle thumb joint, and provides support to the thumb during grip and pinch. It is the most common ligament injury in the thumb. This injury is known as skier’s or gamekeeper’s thumb.

Image from fairview.org showing the location of the ulnar collateral ligament in the thumb.

What causes a UCL injury in the thumb?

Most often, injuries occur during sport or recreational activities such as skiing, football, biking, and soccer. Any extreme force to the thumb in the opposite direction can cause a sprain, but injuries can also occur as a result of a fall, or jamming the thumb.

Image from http://www.schreibermd.com.

What are the symptoms of a UCL injury in the thumb?

Pain and swelling in the middle joint of the thumb can occur right after injury, with possible bruising and stiffness in the joint. With this injury, activities such as holding a drinking glass or writing may be difficult. Weakness may be a symptom as well, with a decreased ability to grip or pinch any object with the thumb and hand.

What is the treatment for a UCL injury in the thumb?

The doctor will likely order an X-ray of the thumb to rule out a broken bone. The doctor will also test the stability of the thumb with gentle pressure from each side, and compare this to the other thumb. If there is a sprain to the UCL of the thumb, the physician may prescribe a custom orthosis to rest the joint and ligament for a period of time. If the ligament is torn or ruptured, the doctor may recommend surgery to repair the ligament.

What can a hand therapist do for me?

A therapist can make a custom orthosis to rest the thumb ligament as it heals. While the ligament is healing, the therapist will provide gentle exercises for the other joints of the hand. After the ligament was healed, the therapist will progress exercises to increase function and strength in the hand and thumb.