In most cases of pain in the wrist and hand, cervical manipulation is the treatment of choice. Patients respond rapidly to the treatment and all symptoms disappear within two or three weeks.
Pain in the wrist and hand may be due to varied factors. These may be :
A mechanical disturbance in the cervical spine.
Pressure on the median nerve as it passes in front of the wrist between the tunnel formed by the small bones of the wrist called carpal bones.
Arthritis of the wrist joint.
Post-traumatic or following the union of fractured bones of the wrist and hand.
Often pain along with a tingling sensation and numbness in the fingers may radiate from the cervical spine. When the thumb is painful, the sixth cervical may be involved. When the middle and index fingers are painful, this may be due to the involvement of the seventh cervical nerve. When the little finger is painful, this may be due to the eighth cervical nerve.
Carpal Tunnel Syndrome
The median nerve passes anteriorly in the wrist through the tunnel formed by the small bones of the wrist. It provides nerve supply to three and a half fingers of the hand (thumb, index finger, middle finger and half of the ring finger). When this nerve is compressed while passing through the tunnel – numbness, a tingling sensation, and pain are caused in these fingers. This condition is most common in women of middle age. In the early stages, it occurs for short periods but may become continuous later.
It is more severe at night and patients may wake up due to a distressing tingling in the hand, and may have to work the fingers and shake the hand to get relief. There is clumsiness in carrying out finger movements. Sewing and stitching become difficult. If the condition persists for a long time, weakness and a wasting of the small muscles of the hand which are supplied by the median nerve occurs.
A young woman had an acute pain in the neck, which subsided in course of time, but tingling, numbness and pain persisted in the thumb. Anti-inflammatory drugs decreased the pain and other symptoms. Fifteen days later she returned with the same numbness, tingling and pain in the first three and a half fingers. She also complained of pain over the wrist on exertion of pressure. She was injected with cortisone in the carpal tunnel, and felt a lot better for three weeks. Then the pain reappeared.
She came to me with the above history. I manipulated her cervical spine, articulated and mobilised her wrist and hand, and strapped her wrist to provide partial immobilisation. She felt considerable relief. This treatment was repeated once more after one week and she was completely cured after the third treatment, never again complaining of the same problem.
In my practice, I have treated quite a few cases of pain that has persisted for 5-10 years with apparent wasting of the small muscles of the hand. Inn such cases treatment was continued for 2-3 months. The results were encouraging: there was a persistent improvement in pain and decrease in muscle wasting. Arthritis and post-fracture pain in the wrist, and numbness in the fingers responded well to articulatory and manipulative treatment of the hand, followed by strapping.
Diagnosis
To differentiate between a cervical disc lesion and pressure on the median nerve in the carpal tunnel is sometimes difficult. The history of the course of the disease is informative. Carpal tunnel pain increases with the use of the hand. The pain is located at the anterior aspect of the first three and a half fingers; there is no numbness above the wrist, though it might ache.
In a cervical disc lesion, the patient feels pins and needles come and go day or night in an erratic manner, lasting not more than half an hour to one hour at a time. If the arm is elevated and held in that position for 2-3 minutes, numbness and tingling occur in 20-30 seconds. In a few cases where diagnosis is not easy, improvement following manipulation helps to make a correct diagnosis.
Wasting and weakness of the hand muscles do not usually occur in cases which are detected early. In quite a few cases where surgery is performed, the cause of the compression on the nerve is not always known, the nerve and other structures appearing to be normal.
Treatment
Articulation of the wrist and hand followed by strapping gives encouraging results. In case of a cervical involvement, the cervical spine should be manipulated.
Contraindication. Manipulation of the hand and wrist are not done in cases of rheumatoid arthritis.