Physio Insights Case Study
Assessment of Miss E
Miss E presented to Physiotherapy following a right wrist injury 2 months previously after she fell on an outstretched hand. An Xray, ultrasound scan and a bone scan were all negative. Wearing a wrist support had eased her symptoms a little but she was still getting pain on lifting across the radial border of her wrist, along with some paraesthesia into her fingers with a variable pattern.
This paraesthesia suggests pain of a neurogenic nature. She felt overall she had lost her grip strength and was starting to notice she was dropping things.
Prior to this injury she had had another injury to the same wrist 11 months previously, knocking her wrist on a metal shelf. She also reported a repetitive strain type injury after a prolonged period of packing boxes a couple of months after this initial injury, which had not resolved fully, leaving her with ongoing pain on heavy lifting or prolonged gripping, such as holding the phone or a book.
Clinical findings
On assessment she had full wrist range of motion and no pain with wrist or thumb resisted tests. Palpation around the wrist and joint stability tests did not reproduce her pain, all helping to rule out a wrist joint or muscle dysfunction locally in the wrist.
She had a positive Finkelsteins test, however, the pain intensity was altered depending on the position of her arm and subsequent tension of the radial nerve at the wrist. Upper limb tension tests for neural mobility were also positive, reproducing her symptoms.
The likely cause for her ongoing pain following these 3 incidents was therefore hypothesised to be radial nerve sensitivity.
Intervention and restoration of function
Her physiotherapy treatment involved both neural flushing exercises and cervical mobilisations to help reduce the sensitivity of the radial nerve and improve neural mobility.
She also had some functional strengthening exercises for fine dexterity tasks that she was still having difficulty with.
Within 5 sessions over a period of 2 months, she was almost symptom free and has returned to normal function.
She had a normal Finkelsteins test, and no pain reproduced on neural mobility tests.
Preventative strategies
Miss E was to continue with posture-based neck and upper limb exercises to maintain good cervical mobility and posture and counteract the forces of repeated lifting on her neck and upper limbs during the working day.
An improved understanding of the effect of daily activities on the neuromusculoskeletal system as a whole and how these can be altered can help prevent or manage recurrences once the nervous system has been sensitised for a period of time.
