Elbow, Wrist & Hand Pain

Tennis Elbow — Lateral Epicondylitis

Tennis elbow is the most common elbow condition treated in outpatient PT — affecting up to 3% of adults per year, the majority of whom have never held a tennis racket. It produces pain and tenderness at the lateral epicondyle (outer bony prominence of the elbow), with pain reproduced by gripping, lifting, turning a doorknob, or extending the wrist against resistance. Despite the name ‘epicondylitis,’ research shows that the pathology is tendinopathic — degenerative change in the common extensor tendon — rather than inflammatory. This means anti-inflammatory treatments (ice, NSAIDs, cortisone) have limited long-term effectiveness.

At Healing Star PT, we treat lateral epicondylitis with focused shockwave therapy to stimulate tendon remodeling, progressive wrist and forearm loading exercise, IASTM for soft tissue mobilization, dry needling, and activity modification guidance. This combination produces excellent outcomes even in cases that have failed injections and other conservative measures.

Golfer’s Elbow — Medial Epicondylitis

Medial epicondylitis affects the common flexor-pronator tendon at the medial epicondyle (inner elbow) — producing pain with gripping, wrist flexion, and forearm pronation. It is common in golfers, baseball pitchers, racquet sport players, and manual laborers. Like lateral epicondylitis, it is tendinopathic rather than inflammatory, and is treated most effectively with progressive loading exercise, focused shockwave, and dry needling. The ulnar nerve runs in close proximity to the medial epicondyle — we always screen for cubital tunnel involvement (inner elbow nerve compression) in medial epicondylitis patients.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common peripheral nerve compression syndrome, affecting approximately 3–6% of the general population. The median nerve is compressed as it passes through the carpal tunnel — a narrow passageway at the base of the wrist. Symptoms include numbness, tingling, and pain in the thumb, index, middle, and half of the ring finger — classically worse at night and with sustained wrist positions (driving, holding a phone, typing). Thenar muscle weakness and atrophy indicate more severe compression.

Physical therapy manages mild to moderate CTS effectively: nerve mobilization (neural flossing), carpal bone mobilization, activity and ergonomic modification, custom splinting to maintain neutral wrist position during sleep, and postural correction of the neck and shoulder to address proximal neurodynamic tension. Our MSK diagnostic ultrasound can visualize the median nerve at the wrist, confirming the diagnosis by measuring nerve cross-sectional area without a referral for electrodiagnostic testing.

Cubital Tunnel Syndrome — Ulnar Nerve Compression at the Elbow

The ulnar nerve passes behind the medial epicondyle of the elbow through the cubital tunnel. Compression here produces numbness and tingling in the ring and little fingers, inner forearm symptoms, and — in advanced cases — intrinsic hand muscle weakness and clawing. It is aggravated by prolonged elbow flexion (sleeping with the arm bent, holding a phone). PT includes nerve mobilization, activity modification, custom elbow splinting to prevent sustained flexion, and postural retraining.

Trigger Finger — Stenosing Tenosynovitis

Trigger finger occurs when inflammation and swelling of the flexor tendon sheath creates a discrepancy between the tendon and the A1 pulley through which it runs — producing catching, clicking, or locking of the finger in flexion. It is most common in the ring and middle fingers and in diabetic and rheumatoid arthritis patients. Conservative management includes IASTM along the flexor tendon sheath, tendon gliding exercises, activity modification, and — when indicated — coordination with your physician for corticosteroid injection before considering surgical release.

De Quervain’s Tenosynovitis

De Quervain’s affects the abductor pollicis longus and extensor pollicis brevis tendons at the radial styloid (base of the thumb / outer wrist). It produces pain and swelling at the base of the thumb, reproduced with the Finkelstein test (thumb tucked, wrist ulnar deviated). It is common in new mothers from sustained infant-carrying positions and in racquet sport and golf players. Custom thumb spica splinting from our CHT, IASTM, and activity modification are the cornerstones of conservative management.

TFCC Injuries — Triangular Fibrocartilage Complex

The TFCC is a complex of cartilage and ligaments at the ulnar side of the wrist, stabilizing the distal radioulnar joint and cushioning the wrist in rotation. Tears occur from falls on an outstretched hand, forceful forearm rotation, or repetitive loading. Ulnar-sided wrist pain, weakness with grip and rotation, and clicking with forearm turning are the typical presentation. PT addresses joint stabilization, progressive grip and forearm strength, and — for post-surgical TFCC repair — a structured return to loading protocol.

Dupuytren’s Contracture

Dupuytren’s disease involves progressive fibrosis of the palmar fascia, producing nodules and cords in the palm that can eventually pull the fingers into a fixed flexion contracture. Physical therapy — stretching, soft tissue mobilization, and custom extension splinting — helps manage the early and post-interventional stages. Following needle fasciotomy or collagenase injection, hand therapy is essential to maintain correction and prevent recurrence.

Wrist Sprains and Fracture Rehabilitation

Distal radius fractures (Colles’ and Smith’s fractures) and scaphoid fractures are among the most common fractures treated. Following casting or surgical fixation, hand therapy is the primary driver of functional recovery — restoring wrist range of motion, grip strength, and fine motor function through a structured protocol of joint mobilization, scar management, progressive strengthening, and custom splinting.

Rheumatoid Arthritis — Hand and Wrist Management

RA frequently affects the small joints of the hands and wrists — producing pain, swelling, morning stiffness, and progressive deformity. Our CHT provides specialized RA hand management: joint protection education and energy conservation strategies, custom resting and functional splints to prevent deformity and manage pain during flares, scar and edema management, and progressive exercise carefully calibrated to disease activity.