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Background & Etiology

The wrist joint contains the ends of the radius and ulna (forearm bones) and eight carpal bones (which form the floor of the carpal tunnel.) It allows the hand to move with a wide range of motion and flexibility. The wrist joint is surrounded by two burse. A burse is a fluid filled sack that serves to reduce friction between tendons, and between tendons and bone. The two major bursee of the wrist are the radial burse and the ulnar burse.

  • Radial burse: reduces friction on the tendons that run from the forearm through the wrist and into the hand, serving the thumb. This burse extends to the wrist crease.
  • Ulnar burse: reduces friction on the tendons that run from the forearm through the wrist and into the hand, serving the index, middle, and ring fingers.
  • A direct blow to the burse can produce inflammation and irritation.
  • A fall onto the wrist or burse.
  • Pressure on the burse from use of the wrist.
  • Repeated stress injury to the burse and tendon from using the hand, which can also cause tendinitis and bursitis.
  • Complications from rheumatoid arthritis, osteoarthritis or gout.
  • Infection of the burse or wrist
  • Burse can become swollen as a response to other wrist conditions.
  • Pain and tenderness over the location of the burse
  • Swelling
  • Loss of motion of the wrist
  • Pain with activities that stress the burse like typing and writing, or activities that cause stress on the tendons that are lubricated by the burse.
  • Initial treatment of bursitis includes avoiding activities that produce pain or stress of the burse and associated tendons.
  • Splinting of the involved area
  • The use of ice to reduce inflammation and pain.
  • NSAIDS (nonsteroidal anti-inflammatory drugs)
  • Hand Therapy
  • Drainage of the fluid in the burse for severe cases. Fluid can be checked for possible infection.
  • Antibiotic in the case of infections of the burse
  • Surgery may be indicated in extreme cases if the problem becomes chronic.

Hand therapists are occupational or physical therapists, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Hand therapy for a wrist bursitis must remain conservative at the onset to not aggravate the condition. Emphasis will be in rest, reducing the inflammation and increasing the blood circulation for healing. Once the initial inflammation has reduced a program of stretching and light strengthening will be initiated to restore full motion and improve strength to reduce stress on the tendons and wrist joint.

Common Hand Therapy interventions in the treatment of Wrist Bursitis include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the wrist. Use of mobilization techniques also help to modulate pain.
  • Splinting as appropriate to limit use of involved area.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the forearm to support, stabilize, and decrease the stresses place on the burse and tendons of the wrist joint.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity and improve movement techniques and mechanics of the involved upper extremity to reduce stress on burse and tendons in daily activities.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation of the involved burse.
  • Home program including strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Avoiding the activities that produce the pain or stress the involved burse is the first line of treatment.

  • RICE: (Rest, Ice, Compression, Elevation) should be used to reduce the stress on the burse.
  • Splinting of involved area as appropriate.
  • NSAIDS (non steroidal anti-inflammatory drugs) to reduce pain and inflammation.
  • Needle drainage to remove excessive fluid from the burse
  • Injection of steroids to reduce inflammation in burse
  • In the case of infection antibiotics may be prescribed,
  • In severe recurrent conditions surgery to remove the burse may be indicated.

Prognosis

In general, patients respond well to conservative treatment of wrist bursitis. It is important that once the pain and inflammation is reduced and motion and strength are restored that the patient gradually returns back to full activities. Instruction in daily activities or sport performance is helpful to reduce the chance of a reoccurrence of the bursitis. In most cases full return to activity will take from 2-6 weeks depending on the severity of the condition. As a preventive measure individuals should:

  • Make modifications in work or daily activities such and typing and writing or wearing protective equipment to avoid prolonged pressure or unexpected blows on the burse.
  • Maintain strength and flexibility to reduce stress on the burse and tendons of the wrist
  • Avoid highly repetitive activities whenever possible.

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Real People, Real Testimonials.

The Bridgewater Location is excellent! Every single staff person is on point. From day one when I called to schedule my first appointment and throughout my treatment staff were helpful, professional, and overall a caring and compassionate team. Their professionalism and caring was evident not only in my treatment, also in the treatment of other patients. Being in a room with multiple treatment stations you cannot help but notice the care received by other patients. My ankle is 100% better and if I ever need PT again I would not hesitate to return. I was always a part of the therapy process, if I had questions they were answered. If I wanted to improve my ankle health at home I was provided clear instructions for exercises. Staff were skilled and knowledgeable. I highly recommend this location to family and friends.

Constance C.

"I have had the pleasure of attending Twin Boro Physical Therapy this past year and prior to Optimum Health becoming Twin Boro, I had been a patient since 2006. The entire staff is very caring, professional, and make your PT sessions fun. There is always something to laugh about and get you through your pain! A special thanks to Keith for all he has done for me over the years!"

Donna R.

“My sincere thanks to you and your staff for a very interesting and informative presentation you conducted for the seniors of Clark. Our members were very pleased with the information, and especially the exercises which many said they would use. We would certainly be glad to have you return again and look forward to another exciting presentation.”

Senior Citizens Club of Clark

I have been a customer at Twin Boro in the Hadley Center Mall, South Plainfield off and on for over a year, in the care of Brianna Patane. I am writing to commend the staff there on their friendly and helpful customer service and professional and personal approach to physical therapy. In particular I want to let you know what an asset to Twin Boro Brianna is. She is an outstanding physical therapist who provides a great exercise program to use both onsite and at home, and also utilizes deep massage to increase blood flow to the injured area, which also helps make the injured area feel better. Her friendly and professional approach to PT made my experience there more enjoyable then I ever thought PT could be, and the results and improvement to my injury were noticeable at once and were long-lasting. Not only are her PT skills top notch, but her enjoyment of working with people made it a joy to have her as my physical therapist. She is the best! Having a 41-year career myself, I know employees like Brianna do not come along every day, and my suggestion is that Twin Boro do whatever is necessary to keep this valuable employee on your staff. She is a tremendous physical therapist.

Lisa W.

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