Manual physical therapy examination and intervention of a patient with radial wrist pain: a case report.

Abstract

Clinical case report. To describe a manual physical therapy examination and intervention approach for a patient with radial-sided wrist pain. 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. 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. 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. 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.