We use our hands, wrists and fingers more than we care to acknowledge. Often without really realising the amazing dexterity and anatomy of the palm and wrist, we continue on our merry way until – minor pain turns into major drama! It is only when an injury occurs in these small areas that we often notice how much we do use the middle finger or the hand in life and it becomes a major issue when you can’t pick up your coffee cup or use the ATM machine when you are suffering from inflammation.
Minor injury or small tears in the fibres of these muscles can and do result in inflammation of the area. Perhaps more frustratingly, inflammation can occur in this area for ‘no apparent reason’. These unexplained symptoms can often be debilitating and cause major pain and discomfort whilst rendering the simplest task unachievable. This type of pain can also be very chronic if there is not sufficient treatment or priority given to it at the onset.
Unfortunately, often these minor conditions get grouped together by medical practitioners under a singular umbrella term such as Repetitive Strain Injury (RSI). This does nothing much for the sufferer as with many such umbrella terms, there comes an umbrella approach to treatment – ‘take some anti inflammatory cream and I’ll see you in the morning’. This may well deal with the symptoms of the issue but doesn’t get to the cause or the reason behind WHY the injury or symptoms have occurred.
RSI is more than just ‘typer’s wrist’. It’s a debilitating issue that only results in carpal tunnel syndrome of tendinitis in the wrist – it can also attribute itself to swelling and oedema in the forearm, rendering movement and pressure painful and difficult to deal with. It is noted that there has been a marked increase in this type of injury with the advent of workplaces operating mainly with computers and keyboards. However this is not just a contemporary condition. Cases have been diagnosed as early as 1700 in Italy describing more than 20 varieties of RSI in industrial workers, musicians and clerks. Carpal Tunnel Syndrom was first coined in 1854 by the British surgeon James Paget and 1895 saw the Swiss surgeon Fritz de Quervain coining his syndrome that deals with inflammation of the two tendons that control movements of the thumb.
To be more specific with regards to inflammation conditions in this area, often RSI can be the term that overrides what actually is an inflammatory condition of the sheath that covers certain tendons (extensor tendon compartments of the wrist). A sheath (synovium) is the covering that contains a tendon or group of tendons, and produces a ‘synovial fluid’ that helps to keep tendons lubricated and reduces friction that is caused by movement and the tendons crossing over other tendons in small narrow areas. Injury (via overuse of the tendons) or issues that relate to the production of the synovial fluid (which can even be hormonal) can affect these sheaths and create inflammation and even fluid retention in the area. This condition is classified as tenosynovitis.
As an example, the dorsal side (or back side) of the forearm is typically involved with this type of condition as the Extensor Compartments that connect the small, thin muscles that extend each individual finger (lift them upwards) are all covered by these tendon sheaths. These ‘compartments’ are numbers according to which particular muscle they are dealing with. There are 6 compartments in all and they each conduct individual muscles. Trauma or overuse of these muscles can bring on the conditions of the swelling which creates less space for movement of the other tendons and thus illicits and general swelling and restriction of the area, rendering any movement painful. Mechanics and carpenters often develop tenosynovitis in the 1st Compartment (de Quervain’s Syndrome) due to the nature of working with tools repetitively. Weightlifters, rowers and similar athletes working with repetitive flexion/extension of the writs often suffer from injury to the 2nd Compartment (Intersection Syndrome) and racquet sports players and golfers tend to stimulate the 6th Compartment which relates the the Ext Carpi Ulnaris tendon that attaches at the ulnar (elbow). So you can see how certain activities can all relate to certain individual sheaths of this small area.
General swelling can also be experienced in this area due to other causes such as osteoarthiritis, gout, diabetes, sclerodema (skin condition) so it is always best to eliminate these presenting issues at first. But often specific treatment to the tendon sheaths can warrant great results. With any finite specific area of inflammation, needling can be a very effective way of addressing the inflammation, reducing the heat and the restriction via direct palpation to the small tendons and compartments lining the generic region. Specific Acupuncture points and stimulation along areas of the Large Intestine meridien, Spleen meridien and even the Lung and Heart meridiens can be used to effect treatment for the inflammation. Of course full diagnosis in this system will look further than the symptomatic location of the swelling.
As a soft tissue therapist it is also important to work with the fascia of these tendon sheaths. After all, removing restrictions in these fascial sheaths can be most beneficial in helping the body to eliminate and remove the inflammation. Creating space for the tendons to function. Lymphatic drainage is also most advised in this case, especially if the condition has become chronic or is believed to involve osteoarthritic or autoimmune characteristics. We have also had some marked success utilising a new treatment technique that involves electro-stimulation at certain frequencies to activate the body's own healing system. This is particularly appropriate for inflammation as it stimulates the lymphatic system and cellular movement to enable shifting excessive fluid and swelling. The SCENAR machine uses electronic pulsing at various frequencies to activate the body's own healing mechanisms and this has had success on our therapists and clients with noticeable improvement in range of motion and immediate benefit of the symptomatic responses.
So ensuring the particulars of the condition can be most beneficial in bringing about accurate treatment modalities that get to the crux of all the contributing factors. So don’t settle for the umbrella approach. Find the right approach and proactive therapy to deal with those minor issues that create major drama.