Best Exercises for 3 Common Hand Therapy Diagnoses
Anyone who has experienced a hand or wrist injury knows it can be a frustrating experience. We use our upper extremities to engage with our environment far more than we realize!
Choosing the right exercises for your patients can help expedite recovery and get them back to their meaningful occupations sooner rather than later. However, when choosing appropriate exercises for your patients, it is important to keep their goals, prior functional status, pain levels, and any surgical precautions in mind.
As an occupational therapist and certified hand therapist, three of the most common diagnoses I see are:
- thumb carpometacarpal (CMC) joint osteoarthritis
- distal radius fracture
- carpal tunnel syndrome
In this article, I will cover some of my favorite home exercise recommendations for these diagnoses. You can find each of these exercises by searching for their name in the MedBridge Home Exercise Builder and use them to help get your patients back to meaningful, functional use of their injured extremity.
Thumb CMC Joint Osteoarthritis
While splinting is traditionally included in treatment planning, thumb stabilization exercises have become an increasingly popular adjunct treatment in plans of care and home exercise programs. Webspace stretching, as well as strengthening opponens pollicis and the first dorsal interosseous have been shown to promote dynamic stability of the CMC joint.1
Here are three exercises you can assign to help patients with thumb CMC joint osteoarthritis:
- Webspace (adductor pollicis muscle) stretch can be completed by using your opposite hand or another object, as demonstrated in these exercises:
- Thumb Stabilization Web Space Release: Using Other Hand
- Thumb Stabilization Web Space Release: Using Another Object
- “C” positioning of your thumb can be completed with or without use of additional objects, such as a ball. After assuming this position, adding isometric pinch strengthening will engage and assist with strengthening your opponens pollicis muscle. These exercises include:
- Thumb Stabilization: “C” Position Isometric
- Thumb Stabilization: “C” Isometric Around Ball (see video below)
- For first dorsal interosseous strengthening with isometric contractions against resistance, try these:
- First Dorsal Interosseous Isotonic Strengthening with Rubber Band Resistance
- Thumb Stabilization: Isotonic First Dorsal Interosseous, Holding a Ball
Distal Radius Fracture
For patients with a distal radius fracture, the initiation of home exercise will depend largely on intervention method (conservative vs. surgical) and precautions outlined by the orthopedist. When home exercises are indicated, here are a few I like to start with:
- Range-of-motion exercises in the dart thrower’s plane are especially beneficial, as most activities of daily living are completed while moving your wrist in the dart thrower’s plane, as shown here:
- Wrist AROM Dart Thrower’s Motion (see video below)
- Isometric wrist flexion and extension exercises assist with regaining active mobility of the wrist joint. Additionally, isometric wrist extension exercises have also been shown to help with grip strengthening.2 Try these:
- Wrist Flexion Isometric with Forearm Pronated
- Isometric Wrist Extension Pronated
Carpal Tunnel Syndrome
While a patient may suffer median nerve compression proximally, distally, or both (referred to as a “double crush”), carpal tunnel syndrome is by far the most common cause of median nerve compression. And while carpal tunnel syndrome can be quite persistent, it’s important to assist our patients in symptom management with a well-rounded home program, including (but not limited to) the following:
- Median nerve glides, in addition to splinting and client education, have demonstrated reduced likelihood of surgery for individuals experiencing carpal tunnel syndrome,3 as shown here:
- Median Nerve Gliding: Proximal (see video below)
- Median Nerve Flossing: Tray
- Carpal ligament stretching has been shown to decrease carpal tunnel symptoms.4 This can be completed by holding the affected wrist at end-range extension while simultaneously placing the first CMC joint in retroposition.
Upper extremity injuries can be frustrating and debilitating for our patients. Integrating appropriate exercises into their treatment plan helps expedite recovery and allows our patients to return to functional and recreational activities.
- McVeigh, K., Kannas, S., Ivy, C., Garner, H., Barnes, C., Heckman, M., Brushaber, D., & Murray, P. (2022). Dynamic stabilization home exercise program for treatment of thumb carpometacarpal osteoarthritis: A prospective randomized control trial. Journal of Hand Therapy, 35(3), 435-446. doi: 10.1016/j.jht.2021.06.002.
- Mitsukane, M., Sekiya, N., Himei, S., & Oyama, K. (2015). Immediate effects of repetitive wrist extension on grip strength in patients with distal radial fracture. Archives of Physical Medicine and Rehabilitation, 96(5), 862-868.
- Lewis, K.J., Coppieters, M.W., Ross, L., Hughes, I., Vicenzino, B., & Schmid, A.B. (2020). Group education, night splinting, and home exercises reduce conversion to surgery for carpal tunnel syndrome: A multicentre randomised trial. Journal of Physiotherapy, 66(2), 97-104. doi: 10.1016/j.jphys.2020.03.007.
- Kaufman-Cohen, Y., Levanon, Y., Friedman, J., Yaniv, Y., & Portnoy, S. (2021). Home exercise in the dart-throwing motion plane after distal radius fractures: A pilot randomized controlled trial. Journal of Hand Therapy, 34(4), 531-538. doi: 10.1016/j.jht.2020.03.027.
- Shem, K., Wong, J., & Kirlikov, B. (2020). Effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome: A double-blinded randomized controlled study. Journal of Hand Therapy, 33(3), 272-280. doi: 10.1016/j.jht.2019.12.002.
- Shem, K., Wong, J., & Kirlikov, B. (2020). Effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome: A double-blinded randomized controlled study. Journal of Hand Therapy, 33(3), 272-280. doi: 10.1016/j.jht.2019.12.002.
