Thumb and wrist pain: Treatment of Ruby Q.

Acute pain, Arm pain, Chronic pain, Hand pain, Muscle information, Neuromuscular therapy, Repetitive strain injury (RSI), Thumb pain, Wrist pain / Thursday, June 4th, 2009

At my Neuromuscular Therapy clinic near Boston, treatment in the case of Ruby Q. addressed her chronic upper body tension but focused part of each session on the recent acute thumb and wrist pain that was making it difficult for her to work.

In the first treatment, all of the intrinsic and extrinsic muscles were treated to determine where the pain was coming from (refer back to the post on A Neuromuscular Therapy point-of-view). In her acute condition, all of the muscles were tender so treatment included “flushing” to move out the pain-causing inflammatory products. I gave her a specific Active Isolated Stretch for the inflamed tendons on the thumb side of her wrist (tenosynovitis) and instructed her to ice the tendon sheath as often as she could for two minutes at a time to reduce the swelling. Short applications of ice get the circulation going to remove the irritating inflammatory products.

In her second treatment, she said she was improving and that the sharp pain was now inconsistent. She had been instructed by her doctor to wear a wrist brace and was now able to keep it off most of the time. She had followed my stretching and icing instructions and was managing the pain. Treatment was more focused this session on the abductor and extensors in the back side of the forearm. The extensor muscles of the fingers in the same area were all very stiff with small knots like peas in a pod. The long flexors of the thumb and the fingers were also tight, especially near the elbow. All were treated with Neuromuscular Therapy techniques.

In the third through fifth treatments, the forearm was treated again, especially those muscles causing the tenosynovitis, and I began to focus more on the short muscles in the fleshy part of the thumb. They were twitching wildly under my pressure, but began to release. She was responding well to treatment and remembered two previous incidents that might have contributed to her injury. The tendon sheath was still showing signs of inflammation, so I instructed her to leave the ice on for 15 minutes instead of two and taught her self-treatment with my favorite tool called a Knobble (available in our office for $12).

After that treatment, she fell onto her hand again and reinjured it. Inflammation came back to the tendon and pain now radiated into her index finger and up into her upper arm! I found Trigger Points in the supinator and brachioradialis muscles that referred to her index finger and caused twitching there. Additionally, the subscapularis muscle in the axilla (armpit) harbored Trigger Points to her wrist and hand. The infraspinatus on the opposite side of the shoulder blade from the subscapularis had a Trigger Point to the back of her hand. Things had gotten really bad.

Continued treatments along with a consistent home program of icing, Knobbling, and stretching produced results, but because she injured it a third time, it took more than a year of ups and downs to resolve.