Page 1
Carpal Tunnel
Syndrome,
Arthritis and
Wrist Fractures
Self
Management
Program
DeRoyal SelfCare
™
Wrist, Hand and Finger —
A Patient's Self Help
Recovery Guide
www.deroyal.com
Manufacturer
DeRoyal
200 DeBusk Lane, Powell, TN 37849 U.S.A.
888.938.7828
Authorized Representative
DeRoyal Europe, Ltd.
Virginia Road, Kells, County Meath Ireland
353.46.9280100
©2003 DeRoyal. All Rights Reserved.
Revision A • Date of Issuance: 6/03
Reprint #0-1720
Self
Management
Program
Page 2
Self
Management
Program
6. Wrist Extension Stretch
Sitting with
elbows on table
and palms
together, slowly
lower wrists to
table until a stretch is felt. Be sure to keep
palms together throughout the stretch.
Hold ___ seconds. Relax.
Repeat ___ times.
Do ___ sessions per day.
7. Wrist Flexion/Extension
Actively bend
wrist forward
then backward
as far as you
can.
Hold ___ seconds. Relax.
Repeat ___ times.
Do ___ sessions per day.
8. Active Resistive Wrist Flexion
With tubing wrapped
around fist and oppo-
site end secured under
foot, bend wrist up
(palm up) as far as
possible.
Hold ___ seconds. Lower slowly, keeping
forearm on thigh. Relax.
Repeat ___ times.
Do ___ sessions per day.
9. Active Resistive Wrist Extension
With tubing wrapped
around fist and oppo-
site end secured under
foot, bend wrist up
(palm down) as far as
possible.
Hold ___ seconds.
Lower slowly, keeping
forearm on thigh. Relax.
Repeat ___ times.
Do ___ sessions per day.
6
7
8
9
Self
Management
Program
What's Inside?
This is a self recovery guide for some very
common wrist, hand and finger injuries.
These include carpal tunnel syndrome,
arthritis and fractures of the wrist.
Carpal Tunnel Syndrome…page 2
This section of the self recovery guide focuses
on carpal tunnel syndrome. This section will
give you a better understanding of what
carpal tunnel syndrome is as well as the
causes and symptoms. Also included are the
steps to take to reduce the symptoms of
carpal tunnel syndrome.
Arthritis Recovery Guide…page 6
This section focuses on the two main types
of arthritis: Rheumatoid and Osteoarthritis.
The purpose is to provide you with a better
understanding of both types of arthritis and
the causes of each. You will also be given
steps to control the pain and reduce
inflammation resulting in a more independent
lifestyle.
1
Wrist Fractures…page 13
This section focuses on two common fractures
to the wrist area: colles' and scaphoid. This
section will give you a better understanding
of these types of fractures and explain some
common causes. You will also be given some
treatment options and learn some exercises
your doctor may recommend.
Section 3
18
Page 3
Self
Management
Program
Section 3
16
Contrast Baths
1. Prepare 2 pans: one warm water,
approximately 105-110° F and one cool
water 59-68° F.
2. Immerse your hand and wrist in the warm
water for 10 minutes.
3. Immerse your hand and wrist in the cold
water for 1 minute.
4. Immerse your hand in the warm water for
4 minutes.
5. Immerse your hand in the cold water for 1
minute.
6. Repeat steps 4 and 5 two (2) times, then
end in warm water for 4 minutes.
Elevate
Elevate hourly above the heart with active
fisting.
With any injury or medical condition, it is
advisable to consult a physician or other
medical professional before beginning any
treatment or rehabilitation program. DeRoyal
strongly recommends that you contact your
physician immediately if you experience any
of the following symptoms:
• Numbness or tingling in your wrist or hand
• Cold or discolored fingers
• An increase in swelling
• Pain that does not ease with rest
Patient Name:_________________________
Perform the following
_______ per day for ________weeks
or
until_________________________________
Further Instructions:
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is compression of the
median nerve (one of the main nerves of the
hand). Symptoms of carpal tunnel syndrome
can include numbness, pain or tingling in the
thumb, index, long and ring finger. Other
problems can also include: weakness,
clumsiness or swelling of these fingers
and thumb.
Causes?
Carpal tunnel syndrome appears to occur in
people who are prone to have swelling or
inflammation in their hands.
At the wrist, the median nerve lies in a
tunnel (the carpal tunnel), along with nine
tendons which allow the fingers to bend.
When the tendons become irritated, the
tendon lining becomes swollen. Since space
is very limited in the carpal tunnel, swollen
tendons take up room and put pressure on
the median nerve, cutting off its blood supply.
Symptoms?
In the early stages of carpal tunnel syndrome,
symptoms (including numbness, tingling,
swelling or pain) occur during sleep. During
waking hours, fluid is pumped out of the
hand and carpal tunnel by normal activity.
Bending the wrist, especially during
repetitive activities or prolonged gripping,
may also cause symptoms. In the advanced
stage, symptoms will also occur during
waking hours. Prolonged nerve irritation will
eventually cause weakness in the hand and a
loss of grip strength.
TREATMENT RECOMMENDATIONS
What should I do about mild to
moderate pain?
Your goal is to
reduce symptoms
by reducing
compression of
the median nerve.
Listed below are
several ways
you can do this
conservatively. Two out of three people who
suffer from carpal tunnel syndrome will
experience improvements using these
conservative, non-surgical treatments.
However, surgery may be recommended for
Self
Management
Program
3
Section 1
Page 4
COLLES' FRACTURE
What is a Colles’ Fracture?
One of the most common
fractures of the wrist is a
Colles’ Fracture. This is
where there is a break in
the radius bone at the end
of the forearm bone on the
thumb side of the hand.
(Distal radius fracture)
Causes?
A Colles' Fracture usually
occurs as a result of a fall
on an outstretched arm, forcing the hand
backwards and upwards. The radius bone has
a flare shape as it joins the wrist. Fractures
occur here because this is a natural weak area.
SCAPHOID FRACTURE
What is a Scaphoid Fracture?
Another common fracture
of the wrist is a scaphoid
fracture. The scaphoid
bone is one of eight small
bones in the wrist.
Causes?
A sudden force that has caused the hand to
bend backward, if strong enough, can cause a
wrist fracture. Common causes of scaphoid
fractures include falls and motor vehicle
accidents.
Scaphoid fractures can have unpre-
dictable or delayed healing. Delayed healing
can occur because the fracture can cut off the
blood supply to the bone. Healing time can
vary between 6-12 weeks.
TREATMENT OF WRIST FRACTURES
Treatment varies depending on the type of
break. Your doctor’s recommendations may
include any of the following:
• Wearing a brace or cast.
• Specific exercises for the wrist, fingers
and thumb.
• Ice.
• Elevation.
• Rest.
• Surgery to set the break. This may include
open reduction, internal fixation, which
involves pins and screws.
Braces or Cast?
The type of break will
dictate what treatment
your doctor prescribes
for you. If you have
been prescribed a brace,
your doctor will advise you of your wearing
schedule. As your fracture heals, you will be
weaned from the use of your brace.
Self
Management
Program
Section 3
145
Section 2
EXERCISES
Refer to end of booklet.
Additional Instructions:
Self
Management
Program
Page 5
Stomach Lying
1. In general, this is not the best position
because it puts too much pressure on the
neck.
2. Put 2 to 3
pillows
under hips
and lower chest.
3. Put a pillow under your feet.
4. Put a small, soft pillow under your upper
chest and the front of your neck.
EXERCISES
Refer to end of booklet.
Additional Instructions:
Self
Management
Program
12
Section 2
Self
Management
Program
7
Section 2
There are two main types of arthritis:
Rheumatoid Arthritis, which is a medical
condition whereby the immune system
attacks and causes damage not only to the
joints but also to other parts of the body,
and Osteoarthritis, which is wearing away
of the joint cartilage that covers the surface
of a joint.
WHAT IS RHEUMATOID ARTHRITIS?
Rheumatoid Arthritis is a chronic, systemic
(affecting many parts of the body),
inflammatory disorder that results in
symmetrical, progressive joint destruction and
deformity. The process appears to originate
in the synovial membrane which secretes
lubricating fluid (synovial fluid) into the joint.
The thickening of the synovial fluid erodes
articular cartilage, bone, tendons, ligaments
and the joint capsule. This in turn causes
deformity, pain and disability. Common joints
in the wrist and hand affected by Rheumatoid
Arthritis include the big knuckles of the fingers
and thumb and the wrist bone on the small
finger side.
Causes?
It is not currently known why some people
develop Rheumatoid Arthritis. However, it is
known that it is more common for women
between the ages of 25 and 35 to develop
Rheumatoid Arthritis than the general
population.
What should I do about mild to moderate pain?
• Rheumatoid Arthritis is primarily a medical
condition treated with prescription drugs.
• Wearing splints or
braces for the
hands and wrist
can help reduce
pain and increase
function.
• Modifying activities or "work simplification"
can maintain function longer and reduce
pain.
• Learn to carry out joint protection
techniques.
• Use assistive devices to help you with
everyday activities.
• Joint replacement surgery is an option
when conservative treatment no longer
provides relief.
WHAT IS OSTEOARTHRITIS?
Osteoarthritis is generally characterized by
degenerative changes in the joints. It is the
most common form of arthritis in which one
or many of the joints undergo degenerative
changes. Typically, there is loss of joint
cartilage which protects the bone surface.
This degeneration results in inflammation,
pain and a loss of joint motion. In the hand,
osteoarthritis typically affects the small joints
of the fingers and the joint at the base of the
thumb, where the thumb joins the wrist.
Page 6
Bedroom and Bathroom Ideas
• Raise your bed to avoid bending and
straining your back.
• Move bed away from the wall if it will
improve accessibility.
• Do not open sheets up in the air. Place on
the bed to unfold.
• Use fitted sheets that go on easily.
• Use grab bars, bath benches and raised
toilet seats for added safety.
• For convenience,
try bath pillows
and long-handled
sponges.
• Use mops to clean
floors and long
handled brushes to clean bathroom rather
than cleaning from a hands and knees
position.
Laundry Ideas
• Do not wring out clothes by twisting them.
Put in washer on the spin cycle to wring
out or lay flat and push down on garment
using whole hand and body weight to
push water out of the clothes.
• Utilize a dryer whenever possible.
• Use whole arm movements to smooth
sheets, fold and smooth laundry.
• Keep dirty clothes in a bag hanging on the
wall or somewhere raised to decrease bending.
• Sit to iron or fold clothes.
Ergonomic Design and Assistive Devices
Reduce the effort required in activities of daily
living by using adaptive/assistive equipment.
Equipment is a worthwhile expenditure if it
helps to protect your joints. Many devices are
suggested, not just because it makes it easier
for you, but in order to protect your joints and
maintain their function. Examples include:
• Soft built-up handle utensils
• Suction holders
• Foam padding to build up hands for grip
• Jar lid openers
• Portable electric can opener
• Apron hoop
• Long oven mitts
• Paring board with corner guard, suction
cups and two
stainless steel
"holding nails"
• Pan holder and
strainer
• Vegetable peeler with horizontal handle
• Suction brush
• Suction bottle-glass brush
• Key holders
• Door knob extensions
• Furniture extenders
• Mobile stool
• Shower chair
• Long scrub brush
• Raised toilet seat
• Extension comb and brush
Self
Management
Program
Section 2
10
paring board
Self
Management
Program
9
Section 2
• Use lightweight tools.
• Keep work heights comfortable at elbow
level.
• Correct your posture – stand tall and don't
slump.
• Always sit when possible to work or perform
daily tasks.
• Use the unaffected extremity when possible
to do a job.
• Use elevated toilet
seats and grab bars
if necessary.
• Use both hands for
difficult jobs especially when lifting items.
• Slide or wheel heavy and large objects.
• Push objects with the palm of your hand.
• Change positions frequently.
• Plan your work.
• Get a good night’s sleep.
• When dusting or wiping, wipe in the
direction of the thumb.
• Keep hands flat when dusting.
Kitchen and Meal Preparation
• Push down on dishcloth to wring out
instead of twisting it.
• Arrange your kitchen to eliminate
unnecessary steps.
• Pick up pots and pans
with two hands, using
your palms. Let your
strong wrists and
elbows do the work.
• Arrange items so they are within your
reach. Move less used items to less
accessible shelves.
• Maintain proper working heights.
• Use a lazy susan.
• Immerse dishes under water when washing
to reduce the weight of the dishes or use a
dishwasher.
• Use an electric knife if possible.
• Use an automatic chopper or food
processor for chopping.
• Baking may be the easiest way to prepare
foods.
• Install pegboards on walls next to stove
area to hold utensils. Caution: Position
carefully away from stove burners due to
flammability concerns.
• Assemble all needed supplies and utensils
before beginning to cook.
• Spread tasks over the day and do as much
as you can ahead of time.
• Open jars with flat palms.
• Slide heavy dishes and
trays of food rather than
picking them up.
• Use a cutting board with suction cups at
the bottom.
• When stirring, stir in the direction of your
thumb.
Page 7
Causes?
Several factors play a role in developing
Osteoarthritis. These factors include: the
aging process, heredity, wear and tear from
aging and trauma.
What should I do about mild to
moderate pain?
• Wearing splints or braces for the hands
and wrist can help.
• Modifying activities or "work simplification"
can maintain function longer and reduce
pain.
• Use assistive devices to help you with
everyday activities.
• Joint replacement surgery may be
recommended when conservative treatment
no longer provides relief.
• Use heat (such as a heating pad or warm
bath) in the morning to begin the day. Five
minutes should be enough.
• Use ice on swollen, tender areas. Do this
for approximately 20 minutes, 2-4 times
per day.
• Take over the counter non-steroidal anti-
inflammatory medication. These include
aspirin, ibuprofen, etc. (check with doctor
or pharmacist about drug interaction and
side effects)
• A cortisone shot into the sore area may
provide temporary relief (up to a couple of
months).
• Occupational and physical therapy may be
recommended for range of motion
strengthening.
Splints
There are many splints that are used in the
treatment of pain and discomfort caused by
both Rheumatoid and Osteoarthritis. The goal
of wearing a splint includes: decreasing or
relieving pain, preventing further deformity,
protecting the already damaged joint and
maintaining proper alignment.
WORK SIMPLIFICATION
(Modifying Activities)
The goal in modifying activities or simplifying
work is primarily to do activities in such a way
as to protect the joint from further deformity.
Here are some ideas for making your home
more manageable while protecting your joints:
General
• Avoid repetitive
activities and
strenuous work.
• Do not grip objects
too tightly and avoid
prolonged gripping.
• Use assistive devices to help you open
and turn things.
• Place palm of hand on jar lid and using
the weight of your body, turn arm at
shoulder to open jar. Use left hand to
close and right hand to open.
Self
Management
Program
Section 2
8
Self
Management
Program
11
Section 2
• Wire frame book holder
• Pen and pencil grips
• Sock and stocking aid
• Extension sock-aide
• Long-handled shoe
horn
• Elastic shoe laces
• Dressing stick
• Button hole aids
• Zipper pulls
• Utility carts
• Spray can lever
• Stabilizing mat
• Car door opener
• Grocery bag grip
• Swedish knife
(horizontal handle)
• Soft drink tab grabber
• Lamp switch extension
• Special writing devices
• Walker basket
• Pill splitter
• Oven door push/pull
• Multi-purpose turning
handle
• Box top opener
• Pill cap opener
• Portable chair cushion
• Reacher
PROTECTING JOINTS WHILE SLEEPING
Sleeping positions are very important when
you suffer from Rheumatoid Arthritis or
Osteoarthritis. You need to rest in a
comfortable position at night so that your
body can recover from the day’s activities.
Try to stay in the same position you normally
sleep in, but modify it to be more "neutral",
meaning that your body is well supported with
very little strain on one body part. The following
illustrations demonstrate a neutral position:
Side Lying
1. Sleep with
your painful
side up.
2. Put thick pillows between your legs from
groin to feet.
3. Place a pillow under your affected extremity.
4. Put a towel roll at your waist.
5. Your head pillow holds your head midline.
Back Lying
1. Put a small
pillow
comfortably
under your head, fluffy under neck.
2. Put fat pillows under your legs to position
your knees higher than your hips.
3. Put one fat pillow under the painful
extremity.
sock aid
dressing sitck
button aid
zipper pull
walker basket
reacher
Page 8
Section
2
Arthritis
Self-Recovery
Guide
Goal:
Control pain,
reduce
inflammation
and get back to
an independent
lifestyle.
Self
Management
Program
6
Section
3
Wrist Fractures
Self-Recovery
Guide
Goal:
Promote the
proper healing
environment for a
quicker recovery
13
Self
Management
Program
Page 9
travels through the carpal tunnel. It is also
important to avoid strapping the splint too
tight.
The wearing of a wrist splint is
recommended during the night to prevent the
wrist from bending. Daytime wearing is only
recommended when experiencing pain or
decreased sensation. This may only occur
during certain activities or in a variety of
activities. If you find you are wearing the
brace for extended periods during the day, it
is advisable to remove the brace one or two
times per day and perform wrist range of
motion activities to maintain flexibility of the
wrist.
REST
It may be necessary to rest the hand and
wrist if pain persists despite wearing a brace
and modifying activities. Keeping the wrist in
a neutral position, elevate the hand and wrist
such that the hand is higher than the elbow.
This can be easily achieved by placing the
hand on a pillow and allowing the elbow to
rest on a lower surface.
patients who have evidence of nerve damage.
• Wearing a splint or brace while sleeping
and while performing daily activities.
• Modifying activities using pain and
numbness as a guide.
• Taking over the counter non-steroidal
anti-inflammatory medication. These
include aspirin, ibuprofen, etc. (check
with doctor or pharmacist about drug
interaction and side effects)
• Contrast baths. (Refer to page 16.)
• Ice.
• Occupational or physical therapy.
• Studies indicate taking 100mg of vitamin
B6 daily can help. (Before taking, check
with your doctor if you are pregnant.)
• An effective non-operative treatment may
be a cortisone shot into the carpal tunnel.
Sometimes this provides long term relief.
SUPPORTING THE WRIST
Wrist splints are used as treatment for pain
and discomfort of carpal tunnel syndrome.
A wrist splint provides support, allowing
your wrist to rest in
a neutral position.
Bending your wrist
can put more
compression on the
median nerve as it
Self
Management
Program
Section 1
4
Your brace may be removed as specified
by your doctor for exercise and light activities
of daily living.
Refer to "Work Simplification (Modifying
Activities)" in the previous section.
EXERCISES
Wrist and finger stiffness is very common
following a wrist fracture. Therefore, it is
important to follow an exercise program to
help in a speedy recovery. Your doctor will
advise you if these exercises are appropriate
for your wrist fracture.
Patient Name:_________________________
Perform the following exercises
_______ per day for ________weeks
or
until_________________________________
Further Instructions:
For this section of exercises, keeping the
hand elevated above the heart helps to reduce
swelling. Exercise should be done for short
periods of time and done often. Pain is a
warning sign. Your hand may be very sore
following exercise sessions. All exercises
should be pain free.
1. Open the hand. Holding fingers straight,
bend at the first knuckle.
2. Open the hand. Reach the fingertips
toward the base of the fingers.
3. Open the hand. Reach the fingertips
toward the base of the thumb.
4. Open the hand. Reach the fingertips
toward the middle of the palm.
Ice
Cold therapy can be used in cases of wrist
fractures, typically in the form of contrast
baths. Your doctor will advise you if this is
appropriate for your type of fracture.
Self
Management
Program
15
Section 3
1
3
2
4
Page 10
Self
Management
Program
Section
1
Carpal Tunnel
Syndrome
Recovery
Guide
Goal:
Control pain,
reduce
inflammation
and swelling,
and protect the
injured wrist.
2
EXERCISES
These exercises may be prescribed by your
physician for carpal tunnel, arthritis or fractures.
1. Thumb Flexion/Extension
Actively bend
thumb across palm
as far as you can.
Hold ___ seconds.
Relax. Then pull
thumb back into
"hitch hiking"
position.
2. Thumb Abduction/Adduction
Actively bend
thumb out away
from palm as far as
you can. Hold ___
seconds. Relax.
Then pull thumb
back to touch
fingers. Try not to bend fingers toward
thumb. Repeat ___ times. Do ___
sessions per day.
3. Finger Opposition
Actively touch thumb to
finger tip. Starting with
index finger and proceed
toward little finger. Move
slowly at first, then begin
to move rapidly as your
motion and coordination improve.
Be sure to touch each finger tip.
Hold ___ seconds. Relax.
Repeat ___ times.
Do ___ sessions per day.
4. Wrist Flexor Stretch
Keeping elbow straight,
grasp involved hand and
slowly bend wrist until a
stretch is felt.
Hold ___ seconds. Relax.
Repeat ___ times.
Do ___ sessions per day.
5. Wrist Extensor Stretch
Keeping elbow straight,
grasp involved hand and
slowly bend wrist down
until a stretch is felt.
Hold ___ seconds. Relax.
Repeat ___ times.
Do ___ sessions per day.
Self
Management
Program
3
4
5
1
2
17
Section 3
Loading...