Manual Physical Therapy Examination and Intervention of a Patient With Radial Wrist Pain: A Case Report

Abstract

Study Design: Clinical case report. Objectives: To describe a manual physical therapy examination and intervention approach for a patient with radial-sided wrist pain. Background: A 55-year-old woman with a 2-year history of chronic right wrist and forearm pain was referred to physical therapy with a diagnosis of de Quervain's disease. Her current symptoms were present for 6 weeks despite primary care management with wrist splinting and medications. Previous episodes were partially resolved following occupational therapy treatments. Methods and Measures: Examination of the patient's wrist and hand revealed isolated radiocarpal, intercarpal, and carpometacarpal joint dysfunctions. Evaluation of the cervical spine, shoulder, and elbow were negative. Impairment-based treatment was provided during 8 visits over a 4-week period. These treatments consisted of manual physical therapy techniques and self-mobilizations applied to the radiocarpal, intercarpal, and carpometacarpal joints. Results: The initial treatment session decreased the patient's numeric pain rating scale (NPRS) from 7/10 to 4/10 and improved her functional rating on the Patient-Specific Functional Scale (PSFS) from an average of 4/10 to 8.2/10. At treatment completion, she achieved a pain-free state (NPRS, 0/10) and nearly full function (PSFS, 9.8/10). These results were maintained at a long-term follow-up performed 10 months after treatment. Conclusion: Several diagnoses have the potential for causing or referring pain into the radial wrist and forearm region, often times mimicking de Quervain's disease. An impairment-based manual physical therapy model may be an effective approach in identifying joint dysfunctions and managing patients with radial wrist pain.