Joints, muscles and tendons
Wrist and hand pain
Small joints with outsized consequences for daily life. Night splinting and activity change frequently do more than clinic time here, and we will tell you when that is the case.
Four things account for most of what arrives here: carpal tunnel syndrome, thumb base arthritis, de Quervain's tenosynovitis at the thumb side of the wrist, and the stiff, weak hand that follows a period in a cast.
They have little in common clinically, and one thing in common practically: the hand is used constantly and cannot easily be rested, so the treatment has to work around a limb that is going to keep working.
Carpal tunnel
Numbness and tingling in the thumb, index and middle fingers, characteristically waking you at night and relieved by shaking the hand. Night splinting has a reasonable evidence base for mild to moderate cases and it is frequently the single most effective thing we do.
Nerve mobility work, activity modification and grip strategy make up the rest. What we watch for is wasting at the base of the thumb and persistent numbness, which suggest the nerve is under sustained compression and warrant a surgical opinion — that operation is very effective and delaying it past a certain point costs recovery.
Thumb base arthritis and de Quervain's
Thumb base arthritis is common, particularly in women over fifty, and responds well to a combination of a supportive splint, joint protection strategies and specific strengthening. It is one of the conditions where changing how you do twenty small daily tasks is worth more than any exercise.
De Quervain's is a tendon sheath problem at the thumb side of the wrist, classically provoked by lifting a baby. Relative rest of the specific movement, a thumb spica splint and graded loading. It responds well and it responds slowly.
The stiff hand after immobilisation
Six weeks in a cast costs range, strength and dexterity, and the range is the urgent part — a stiff hand becomes progressively harder to mobilise the longer it stays stiff.
This is one of the few areas where frequent early attendance genuinely matters, and where a home programme done several times a day beats a supervised session once a week.
Physical therapy is not chiropractic, massage or medicine. Physical therapy is not chiropractic, not massage therapy and not medicine. We do not adjust or manipulate the spine as a chiropractor does, we do not prescribe, we do not inject, and we do not diagnose disease. We assess how you move, we treat what movement can change, and we say plainly when your problem is not one of those. Naming the edge of a scope of practice is not modesty; it is the part of the licence that protects you.
Included as standard
How we treat this
Splinting where it is the effective treatment
For carpal tunnel and thumb base arthritis it frequently does more than anything that happens in the clinic, and we will say so.
Activity modification as real treatment
Twenty small daily tasks changed is worth more than an exercise sheet for most hand conditions.
Early range after immobilisation
A stiff hand gets harder to mobilise the longer it stays stiff. This is where frequent early work genuinely matters.
Home programme several times daily
For the hand specifically, little and often beats one supervised session a week, and we build the plan around that.
Screening for the surgical cases
Thumb-base wasting or persistent numbness in carpal tunnel warrants an opinion, and delay costs recovery.
No product to sell you
We will tell you which splint to buy and where. We do not stock them.
When to make an appointment
Signs this is worth an assessment
- Numbness or tingling in your thumb and first two fingers that wakes you at night.
- You have started dropping things, or your grip has noticeably weakened.
- Pain at the base of your thumb when you pinch, turn a key or open a jar.
- Pain on the thumb side of the wrist that started after lifting a baby.
- Your hand has come out of a cast and will not make a full fist.
- You have noticed the muscle at the base of your thumb looks flatter than the other side.
Wrist & hand — how long a course usually takes
- A typical course. Night splinting and activity modification frequently do more than clinic time here, and we will tell you when that is the case.6 – 12 visits
This is a typical number of visits for this problem, not a quote and not a promise. You get an estimate specific to you, in writing, at the first appointment, and we reassess against the same measurements at visit four rather than at visit ten — so a course that is not working gets changed or stopped instead of extended. What each visit costs is published on the pricing page: $190 for the initial evaluation and $140 for a treatment visit if you are paying yourself, or your plan's copay if you are not. We do not sell blocks of visits in advance.
Questions we are actually asked
Wrist & hand — frequently asked
Can physical therapy help carpal tunnel syndrome?
For mild to moderate cases, yes. Night splinting has a reasonable evidence base and is frequently the single most effective thing we do, alongside nerve mobility work and activity modification. What warrants a surgical opinion is wasting at the base of the thumb or persistent rather than intermittent numbness — and delaying that past a point costs recovery.
Do I need surgery for thumb arthritis?
Frequently not. A supportive splint, joint protection strategies and specific strengthening do well for a large proportion of people. Where the joint is severely degenerate and the conservative course has failed, surgery is an option worth discussing with a hand surgeon.
How long until my hand works properly after a cast?
Longer than most people expect — range comes first and strength follows, and both take months rather than weeks. Frequent early mobilisation genuinely matters here, more than in most conditions, because a stiff hand gets harder to mobilise the longer it stays stiff.
Will you make me a splint?
We will tell you exactly which one to get and where, and check that it fits and that you are using it correctly. We do not stock them — a clinic with a shelf of splints has a reason to recommend splints. Custom fabrication is a hand therapist's speciality and we will refer where that is what you need.
I lift my baby and my wrist hurts. What is that?
Classically de Quervain's tenosynovitis — a tendon sheath problem on the thumb side of the wrist, provoked almost perfectly by the scooping motion of lifting a small child. It responds well to a thumb spica splint, modification of that specific movement and graded loading, and it takes months.
Related conditions
Often seen alongside this
Elbow tendon pain
Almost nobody who has it plays either sport. It is a load problem in the forearm tendons, and rest alone reliably fails to fix it.
6 – 12 visits
Fracture rehab
Six weeks in a cast costs more muscle than most people expect, and the stiffness is usually the harder half of the problem.
8 – 16 visits
Neck pain
Desk necks, phone necks, slept-badly necks and the ones that are actually a shoulder. Telling them apart is most of the first appointment.
5 – 10 visits
Work injury
Rehabilitation aimed at the job you actually do, inside the Workers' Compensation rules that govern how many visits you get.
12 visits, then PARSixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.