Hand Therapy

Median Nerve Origin/Pathway

1. Arises from both the lateral and medial cords of the brachial plexus (C5–T1)

2. Travels down the midline of the arm, runs with the brachial artery, passes through the cubital fossa, down the anterior forearm between the flexor digitorum muscles, and enters the hand via the carpal tunnel.

Median Nerve Sensations

1. Palmar surface of the thumb, index finger, middle finger, and radial half of the ring finger.

2. Dorsal fingertips of the same digits (distal phalanges)

3. Three and a half fingers" on the palmar side.
   

Ulnar Nerve Origin/Pathway

1. Arises from the medial cord of the brachial plexus (C8–T1).

2. Travels down the medial arm, passes posterior to the medial epicondyle of the humerus (“funny bone”), then runs along the medial forearm

3. Enters the hand through Guyon’s canal
   

Ulnar Nerve Sensation

1. Palmar and dorsal surfaces of the little finger and the ulnar half of the ring finger.

2. Medial palm and medial dorsal hand.

3. “One and a half fingers” on both palmar & dorsal sides

Radial Nerve Origin/Pathway

1. Arises from the posterior cord of the brachial plexus (C5–T1).

2. Spirals around the posterior humerus in the radial groove, comes anterior near the lateral epicondyle, and divides into superficial (sensory) and deep (motor) branches in the forearm.

3. The superficial branch continues down to the dorsum of the hand.
   

Radial Nerve Sensations

1. Dorsal thumb, index finger, middle finger, and radial half of the ring finger up to the proximal interphalangeal joints.

2. Dorsal lateral hand (but not the fingertips—those are median nerve territory).

Median Sensory Summary

palmar thumb → radial half of ring finger + dorsal tips of those fingers

Ulnar Sensory Summary

 pinky + ulnar half of ring finger (palmar & dorsal)

Radial Sensory Summary

dorsum of thumb → radial half of ring finger (except fingertips).

De Quervain’s Syndrome

1. Definition: Painful condition that affects tendons on the thumb side of the wrist, when tendons become inflamed and trapped within their sheaths. Stenosing tenosynovitis of the 1st dorsal compartment tendons (abductor pollicis longus & extensor pollicis brevis).

2. Symptoms: Pain/swelling at radial wrist (thumb side), worse with thumb movement or gripping. A "sticking" or "stop-and-go" sensation in the thumb when moving it. Positive Finkelstein’s test.

3. Causes: Inflammatory arthritis, such as rheumatoid arthritis. Direct injury to the wrist or tendon, which may cause scar tissue that restricts movement of the tendons. Fluid retention, such as from changes in hormones during pregnancy

4. Therapy focus: Activity modification, thumb spica splinting, soft tissue mobilization, modalities, progressive strengthening.
   
   

Medial & Lateral Epicondylitis

1. Lateral epicondylitis (Tennis elbow): Overuse of wrist extensors, pain at lateral epicondyle.

2. Medial epicondylitis (Golfer’s elbow): Overuse of wrist flexors/pronators, pain at medial epicondyle.

3. Symptoms: Pain with resisted wrist motion/gripping.

4. Therapy focus: Rest, counterforce strap, stretching, eccentric strengthening, ergonomics.

Radial Tunnel Syndrome

1. Definition: Compression of the radial nerve in the proximal forearm (radial tunnel).

2. Symptoms: Aching pain in dorsoradial forearm, often mistaken for tennis elbow; minimal motor/sensory deficits (pain-dominant).

3. Therapy focus: Nerve gliding, activity modification, soft tissue release, splinting (wrist neutral).

Carpal Tunnel Syndrome

1. Definition: Compression of the median nerve under the transverse carpal ligament.

2. Symptoms: Numbness/tingling in thumb, index, middle, and radial half of ring finger; worse at night. Weak grip/pinch in advanced cases.

3. Therapy focus: Neutral wrist splint (especially at night), tendon/nerve gliding, ergonomics, activity modification.

Cubital Tunnel Syndrome

1. Definition: Compression of the ulnar nerve at the elbow (cubital tunnel)

2. Symptoms: Numbness/tingling in ring and small fingers, worse with prolonged elbow flexion; decreased pinch/grip.

3. Therapy focus: Night splinting to keep elbow extended, padding, activity modification, nerve glides.
   

Wrist Fractures

1. Common types: Distal radius fracture (Colles’ or Smith’s), scaphoid fracture.

2. Symptoms: Pain, swelling, decreased wrist/hand ROM, stiffness after immobilization.

3. Therapy focus: Edema control, gradual ROM, strengthening, scar management, functional retraining.

Hand Arthritis

1. Types: Osteoarthritis (common in DIP, PIP, 1st CMC), rheumatoid arthritis (systemic, deformity risk).

2. Symptoms: Pain, stiffness, swelling, decreased function, deformities (RA: swan neck, boutonniere, ulnar drift)

3. Therapy focus: Joint protection, splinting (thumb CMC, resting splints), activity modification, strengthening, adaptive equipment.