Pain in the hand: physical therapy, treatment: Focus Fizikal✓

The clinical presentation of hand problems may develop gradually or appear suddenly, and the symptoms directly depend on whether the tendons, joint cartilage, or nerve fibers are primarily affected. At the Focus Physical Therapy Center, we carefully analyze each manifestation of pain in order to apply the most effective treatment approach.

The most common symptoms include:

• Tingling and numbness in the fingers (paresthesia): A characteristic symptom affecting the thumb, index, and middle fingers, often accompanied by a sensation of electric shock and severe nighttime pain that wakes the patient from sleep, which is a classic sign of carpal tunnel syndrome.
• Sharp pain during thumb movement and gripping: Pain localized on the outer side of the wrist and the base of the thumb, which significantly worsens when bending the thumb, holding a cup, or turning a key in a lock (De Quervain’s syndrome).
• “Clicking” and finger locking (trigger finger): A sensation that the finger catches while extending the hand, followed by a sharp pain and an audible “click” as it suddenly releases, or remains temporarily locked in a flexed position.
• Joint stiffness, especially in the morning: Pronounced stiffness in the small joints of the fingers lasting for the first 30 minutes after waking, accompanied by a dull pain that gradually improves as the hand is “loosened up” through daily activity.
• Loss of strength and dropping objects: Weakening of grip strength, inability to perform fine pinching movements between the thumb and index finger (pinch grip), and involuntary dropping of light objects due to motor nerve involvement.
• Local swelling and appearance of hard nodules: Visible thickening of tissues along tendon sheaths or the presence of small, hard degenerative nodules (Heberden’s and Bouchard’s nodes) on the distal finger joints.

At the Focus Physical Therapy Center, early recognition of these signs is a key step toward successful treatment, as it allows timely intervention to prevent acute inflammation from progressing into chronic tissue damage or permanent loss of joint function.

• Carpal tunnel syndrome
• Tendinitis 
• Hand osteoarthritis
• Injuries and  

The onset of pain in the hand and wrist is most often the result of cumulative trauma and chronic, repetitive overuse of the same muscle groups. At our center, through the analysis of your professional and daily activities, we identify the primary biomechanical cause of the problem.

The main causes of hand pain are:

• Carpal tunnel syndrome: Compression of the median nerve within the osteofibrous canal of the wrist, caused by swelling of the tendons due to prolonged computer work, use of a computer mouse, or operation of vibrating tools.
• De Quervain’s tendinitis: Inflammation and narrowing of the tendon sheath of the muscles that abduct and extend the thumb, caused by repetitive wrist twisting movements (commonly seen in young mothers due to specific ways of lifting a baby, as well as in hairdressers and programmers).
• Osteoarthritis and arthritis of the hand joints (rhizarthrosis): Progressive degeneration of the cartilage at the base of the thumb or in the finger joints, as well as systemic inflammatory diseases (such as rheumatoid arthritis) that lead to deformities and painful phases.
• Trigger finger: Formation of a localized thickening (nodule) on the flexor tendon of the finger, which mechanically cannot pass through the narrow tendon sheath during finger extension.
• Previous injuries and fractures: Conditions following fractures of the radius, scaphoid bone, or metacarpal bones, where, after cast removal significant stiffness, swelling, and fibrosis of soft tissues remain.
• Ganglion cysts: Benign, fluid-filled swellings that form above joint capsules or tendon sheaths of the wrist, exerting mechanical pressure on surrounding structures.

Treatment and physical therapy of the hand require patience and a combination of different methods, as symptoms do not resolve overnight. The first step in therapy is immediate unloading of the inflamed tendons and nerves. This is achieved by the temporary use of light, purpose-designed orthoses (splints) that keep the wrist and thumb in a neutral position, especially during the night. At home, during the acute phase accompanied by swelling and burning pain, cryotherapy (short-term ice massage) of the painful area is recommended several times a day to reduce local inflammation.

At the Focus Physical Therapy Center, hand treatment is carried out through highly specialized and gentle protocols that target the recovery of sensitive soft tissues:

• Functional evaluation and testing: Assessment of sensation using monofilaments, measurement of grip strength with a dynamometer, and performance of specific provocation tests to evaluate nerve conduction before starting therapy.
• TECAR therapy for the hand: Application of radiofrequency current via special small electrodes adapted for the palm and fingers. TECAR deeply relaxes small hand muscles, significantly improves local microcirculation, and accelerates the elimination of inflammatory edema.
• HILT laser (High-Intensity Laser Therapy): Thanks to its precise beam and deep tissue penetration, HILT laser acts directly within the carpal tunnel or on inflamed tendon sheaths of the thumb. It has a strong anti-inflammatory effect and rapidly reduces neurogenic and tendon pain.
• Electrotherapy and drug electrophoresis: Application of mild electrical currents (such as galvanic or interferential) to relieve pain, while electrophoresis enables the delivery of anti-inflammatory drugs directly through the skin to the affected area.
• Manual therapy and mobilization of carpal bones: Extremely precise, specialized techniques in which the physiotherapist mobilizes the small bones of the wrist and hand, thereby manually increasing space in the carpal tunnel and releasing pressure on the compressed nerve.
• Kinesiotherapy and cryo-exercises: Carefully dosed hand exercises including neurodynamic techniques (stretching and mobilizing the nerve through surrounding tissues), exercises to maintain range of motion in the fingers, and gradual strengthening of the intrinsic hand muscles using special soft equipment.
• Kinesiology taping of the hand and fingers: Application of elastic tapes cut into thin strips that provide mechanical support to the tendons of the thumb and fingers, improve lymphatic drainage in swollen hands, and reduce load during movement.

The combination of these advanced technologies and a micro-manual approach at the Focus Physical Therapy Center successfully eliminates pain and tingling, restores full strength, dexterity, and precision of movement to the hand, and enables a safe return to work and daily activities.