Pain and swelling on the back of the forearm near the wrist caused by tendon friction. Expert diagnosis and treatment at The Injury Hub Bow. Intersection syndrome is an overuse condition affecting the tendons on the back of the forearm where they cross approximately five centimetres above the wrist joint. It involves irritation of the intersection between the first and second dorsal compartments, where the tendons of the abductor pollicis longus and extensor pollicis brevis rub against the extensor carpi radialis longus and brevis tendons (Ferrari et al., 2021). This friction leads to inflammation, swelling, and a characteristic creaking sensation during wrist or thumb movement.

The condition often develops in individuals who perform repetitive wrist extension or gripping tasks such as weightlifters, rowers, typists, or racquet sport players (Reuter et al., 2019). Symptoms typically include localised pain and swelling on the dorsoradial forearm, occasionally radiating into the thumb or wrist.

At The Injury Hub, ultrasound imaging is used to confirm tendon inflammation and rule out alternative diagnoses such as De Quervain’s tenosynovitis. Treatment commonly involves a combination of hands-on physical therapy, TECAR therapy to reduce inflammation, and shockwave therapy to promote tendon healing. Strength and conditioning exercises are introduced as pain settles to restore normal wrist function and prevent recurrence. Resistant cases may benefit from ultrasound-guided corticosteroid injection to calm persistent inflammation (Kim et al., 2022).

References
Ferrari, J., Bishop, C. and Cattrysse, E. (2021) ‘Intersection syndrome: clinical presentation, imaging, and management’, Journal of Hand Therapy, 34(2), pp. 180–188.
Reuter, P., Pauli, R. and Jerosch, J. (2019) ‘Overuse syndromes of the wrist: differential diagnosis and management’, Orthopaedics & Traumatology, 33(3), pp. 217–224.
Kim, S., Lee, H. and Park, Y. (2022) ‘Ultrasound-guided corticosteroid injection in intersection syndrome: outcomes and predictors of recovery’, Skeletal Radiology, 51(9), pp. 1835–1842.

Numbness or tingling in the hand from median nerve compression at the wrist. Ultrasound-guided diagnosis and treatment at our Bow clinic. Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through a narrow channel on the palm side of the wrist known as the carpal tunnel. This tunnel is formed by small wrist bones and a tough band of tissue called the flexor retinaculum. Swelling or narrowing of this space increases pressure on the nerve, resulting in pain, tingling, and weakness in the hand and fingers (Genova et al., 2020).

Typical symptoms include numbness or pins-and-needles in the thumb, index, and middle fingers, often worse at night or when gripping objects. In more advanced cases, hand weakness or clumsiness can develop. Risk factors include repetitive wrist motion, arthritis, diabetes, pregnancy, and occupational strain (Padua et al., 2022).

At our Bow clinic, high-resolution point-of-care ultrasound (POCUS) allows precise visualisation of the median nerve, confirming swelling and ruling out other causes such as tendon or vascular pathology. Treatment may include manual therapy, TECAR therapy, and activity modification to reduce compression. Nerve gliding and progressive strengthening exercises support recovery. For persistent cases, ultrasound-guided corticosteroid injection or hydrodissection can relieve pressure and reduce inflammation, with surgery reserved for severe nerve entrapment (Cartwright et al., 2018).

References
Genova, A., Dix, O. and Thakur, M. (2020) ‘Carpal tunnel syndrome: a comprehensive review’, Orthopedic Reviews, 12(4), pp. 1–9.
Padua, L., Coraci, D. and Caliandro, P. (2022) ‘Diagnosis and management of carpal tunnel syndrome: updated evidence’, Frontiers in Neurology, 13, 854362.
Cartwright, M.S., Walker, F.O. and Wiesler, E.R. (2018) ‘Ultrasound of the median nerve in carpal tunnel syndrome’, Muscle & Nerve, 57(4), pp. 495–502.

Arthritis at the base of the thumb causing pain with gripping and pinching. Diagnosis and injection therapy available at The Injury Hub Bow. Thumb base osteoarthritis affects the first carpometacarpal joint, located between the base of the thumb and the wrist. It is a common degenerative condition, particularly in women over the age of 50, and occurs when the smooth cartilage between the metacarpal and trapezium bones wears down, leading to pain, stiffness, and loss of grip strength (Zhang et al., 2021). Repetitive thumb motion, genetics, and previous trauma are recognised risk factors.

Patients often experience aching or sharp pain during activities such as opening jars, turning keys, or gripping objects. Over time, the thumb may appear more prominent at its base due to joint subluxation or osteophyte formation (Dale et al., 2020).

At The Injury Hub, ultrasound scanning helps confirm the presence of joint effusion, cartilage thinning, and osteophytes. Management may include hands-on physical therapy to maintain mobility, TECAR therapy for pain modulation, and shockwave therapy to stimulate local tissue repair. For more advanced cases, ultrasound-guided injection therapy using corticosteroid or hyaluronic acid can effectively reduce inflammation and improve joint lubrication, supporting pain-free movement (Stahl et al., 2022).

References
Zhang, W., Doherty, M. and Leeb, B.F. (2021) ‘EULAR evidence-based recommendations for the diagnosis and management of hand osteoarthritis’, Annals of the Rheumatic Diseases, 80(1), pp. 30–39.
Dale, K., Lesniak, B.P. and Weiss, A.P. (2020) ‘Trapeziometacarpal joint osteoarthritis: pathophysiology and management’, Journal of Hand Surgery (American Volume), 45(9), pp. 847–857.
Stahl, S., Branson, R. and McCarthy, J. (2022) ‘Ultrasound-guided injections for thumb base osteoarthritis: efficacy and outcomes’, Clinical Rheumatology, 41(12), pp. 3723–3731.

Ulnar-sided wrist pain and clicking caused by TFCC injury. Advanced diagnosis and treatment available at our Bow clinic in East London. The triangular fibrocartilage complex (TFCC) is a network of ligaments and cartilage stabilising the ulnar side of the wrist between the ulna and carpal bones. Tears or degeneration of this structure can cause ulnar-sided wrist pain, clicking, and weakness, particularly during gripping or twisting movements (Gonzalez et al., 2019). TFCC injury may follow a fall onto an outstretched hand or result from repetitive rotational stress.

Symptoms often include deep wrist pain worsened by pronation and supination, reduced grip strength, and occasional catching or instability (Park et al., 2022). Early and accurate diagnosis is essential to prevent chronic dysfunction.

At our Bow clinic, musculoskeletal ultrasound and MRI are used to assess the integrity of the TFCC and surrounding structures. Treatment typically begins with rest, splinting, and targeted hands-on physical therapy to restore mobility. TECAR therapy and shockwave therapy can support tissue healing and reduce inflammation. Strength and conditioning exercises are then introduced to stabilise the wrist. In cases with persistent pain or instability, ultrasound-guided corticosteroid injection or referral for orthopaedic evaluation may be appropriate (Luchetti et al., 2021).

References
Gonzalez, L.H., Fernandez, D.L. and Garcia-Elias, M. (2019) ‘Triangular fibrocartilage complex tears: classification, diagnosis, and treatment’, Hand Clinics, 35(4), pp. 407–416.
Luchetti, R., Atzei, A. and Fairplay, T. (2021) ‘Management of TFCC injuries: evidence and outcomes’, Journal of Wrist Surgery, 10(5), pp. 451–462.
Park, J.W., Lee, S.Y. and Kim, K. (2022) ‘Role of imaging and rehabilitation in triangular fibrocartilage complex lesions’, Skeletal Radiology, 51(3), pp. 521–530.

Pain, tingling, or weakness in the ring and little fingers due to ulnar nerve compression. Expert diagnosis and treatment at The Injury Hub Bow. Ulnar nerve compression can occur at several points along the arm, most commonly at the elbow (Cubital Tunnel Syndrome) or the wrist (Guyon’s Canal Syndrome). It happens when the ulnar nerve, which supplies sensation to the ring and little fingers, becomes compressed within a tight anatomical tunnel. This compression disrupts nerve signalling, leading to tingling, numbness, or weakness in the hand (Cutts et al., 2020).

At the elbow, repeated bending or resting on the joint can cause irritation, while compression at the wrist may result from cycling, vibration exposure, or local swelling (Macadam et al., 2022). Symptoms include pins-and-needles in the small fingers, reduced grip strength, and hand clumsiness.

At The Injury Hub, point-of-care ultrasound (POCUS) helps identify the exact compression site and assess the surrounding soft tissues. Early management often includes hands-on physical therapy, TECAR therapy, and nerve-gliding exercises to reduce tension along the nerve pathway. Ergonomic adjustments, night splints, or progressive strengthening are sometimes recommended. Persistent or severe entrapment may benefit from ultrasound-guided hydrodissection or referral for orthopaedic review (Van Den Berg et al., 2021).

References
Cutts, S., Marmor, S. and King, C. (2020) ‘Ulnar nerve compression syndromes of the elbow and wrist’, Journal of Hand Surgery (European Volume), 45(8), pp. 773–782.
Macadam, S.A. and Bezuhly, M. (2022) ‘Guyon’s canal syndrome: a review of pathophysiology and management’, Hand Clinics, 38(4), pp. 527–540.
Van Den Berg, P., Selles, R. and Schreuders, T. (2021) ‘Effectiveness of conservative treatment and injections for ulnar nerve entrapment’, BMC Musculoskeletal Disorders, 22(1), 734.

Pain and swelling on the back of the wrist caused by tendon overuse. Effective hands-on and shockwave treatment at our Bow clinic.

Extensor tendinopathy describes irritation or degeneration of the tendons that extend the wrist and fingers. It often develops through repetitive movements, excessive loading, or poor wrist mechanics that lead to micro-tears within the tendon structure (Coombes et al., 2018). Over time, this can result in thickening, stiffness, and discomfort on the back of the wrist or hand.

Common triggers include racquet sports, computer use, and weightlifting, though it may also occur after direct trauma or inflammatory disease. Symptoms include aching pain that increases with resisted wrist extension, local swelling, and reduced strength (Palmer et al., 2021).

At our Bow clinic, musculoskeletal ultrasound is used to visualise tendon integrity, confirm areas of thickening, and assess for associated bursitis. Management focuses on reducing mechanical overload through hands-on physical therapy, TECAR therapy, and shockwave treatment to stimulate tendon healing. Progressive strength and conditioning programmes are tailored to gradually restore function and prevent recurrence. In more resistant cases, ultrasound-guided platelet-rich plasma (PRP) or corticosteroid injections may be considered (Andia and Maffulli, 2019).

References
Coombes, B.K., Bisset, L. and Vicenzino, B. (2018) ‘Rehabilitation of tendon injuries in the upper limb’, Best Practice & Research Clinical Rheumatology, 32(3), pp. 372–387.
Palmer, K., Walker-Bone, K. and Harris, E. (2021) ‘Overuse and tendinopathy in the wrist and hand: epidemiology and management’, Musculoskeletal Care, 19(2), pp. 156–166.
Andia, I. and Maffulli, N. (2019) ‘Biologic therapies in tendon disorders: a review’, Sports Medicine and Arthroscopy Review, 27(4), pp. 175–182.

Soft swelling on the wrist or hand caused by a ganglion cyst. Quick ultrasound diagnosis and safe treatment at The Injury Hub Bow.

A ganglion cyst is a benign, fluid-filled lump that commonly develops around the wrist or hand joints. These cysts arise from small leaks of joint or tendon sheath fluid that collect under the skin, forming a firm, round swelling (Head et al., 2020). They are most frequently found on the back of the wrist, the palm side near the thumb, or at the base of the fingers.

Ganglion cysts may fluctuate in size and occasionally press on nearby structures, causing aching, weakness, or tingling sensations. The cause is not always clear, but repetitive wrist loading, previous injury, and joint degeneration are known risk factors (Dias et al., 2018).

At The Injury Hub, ultrasound imaging provides an immediate diagnosis, distinguishing a cyst from other lumps or tendon pathology. Small or painless cysts may be monitored, while symptomatic ones can be treated with ultrasound-guided aspiration and corticosteroid injection to reduce recurrence. Hands-on physical therapy and TECAR therapy can support local tissue recovery, especially if the cyst is linked to joint irritation. In resistant or recurrent cases, surgical excision may be advised (Owen et al., 2021).

References
Head, L., Gencarelli, J.R. and Allen, M. (2020) ‘Ganglion cysts of the wrist and hand: a review of pathophysiology and management’, Journal of Hand Surgery (American Volume), 45(3), pp. 251–259.
Dias, J.J. and Buch, K. (2018) ‘Palmar and dorsal wrist ganglia: management and outcomes’, Hand, 13(2), pp. 131–138.
Owen, D., Fitzpatrick, M. and Singh, H.P. (2021) ‘Ultrasound-guided aspiration of wrist ganglia: efficacy and recurrence rates’, Skeletal Radiology, 50(4), pp. 701–708.

Pain or weakness from overstretched wrist ligaments. Specialist ultrasound assessment and rehabilitation at our Bow clinic.

A wrist sprain occurs when the ligaments stabilising the wrist are overstretched or torn, often from a fall, twist, or heavy impact. Instability may develop if these ligaments fail to heal properly, causing ongoing pain, weakness, and clicking during movement (Saffar and Delabrousse, 2020). The scapholunate and lunotriquetral ligaments are most frequently affected.

Symptoms include local tenderness, swelling, and reduced grip strength. Chronic instability may lead to altered wrist mechanics and early joint degeneration (Dyrna et al., 2021).

At our Bow clinic, high-resolution ultrasound and, if required, MRI help visualise the integrity of the wrist ligaments and rule out fractures or cartilage injury. Treatment focuses on restoring stability and function through a phased rehabilitation programme. Early care may include TECAR therapy, manual mobilisation, and controlled immobilisation to reduce inflammation. As healing progresses, strength and conditioning exercises are prescribed to rebuild support around the joint. In more complex cases, ultrasound-guided injection therapy or referral for surgical evaluation may be necessary (Garcia-Elias et al., 2019).

References
Saffar, P. and Delabrousse, E. (2020) ‘Wrist ligament injuries: diagnosis and conservative management’, European Journal of Radiology, 129, 109079.
Dyrna, F., Gruszka, D. and Imhoff, A.B. (2021) ‘Wrist instability: anatomy, biomechanics, and rehabilitation principles’, Journal of Hand Therapy, 34(3), pp. 359–369.
Garcia-Elias, M., Lluch, A. and Stanley, J.K. (2019) ‘Treatment of chronic wrist instability: evidence and outcomes’, Hand Clinics, 35(4), pp. 453–463.

Pain, clicking or locking of the finger caused by tendon irritation. Ultrasound-guided diagnosis and effective treatment at The Injury Hub Bow.. The flexor tendons of the hand run through fibrous pulleys that help them glide smoothly when bending the fingers. Trigger finger, medically known as stenosing tenosynovitis, occurs when inflammation narrows these tunnels, causing the tendon to catch and lock during movement (Khan et al., 2020). It commonly affects the thumb, ring, or middle finger.

Early symptoms include tenderness and stiffness at the base of the affected finger, progressing to painful snapping or locking when trying to straighten it. Repetitive gripping, diabetes, and rheumatoid arthritis are common risk factors (Ryzewicz and Wolf, 2021).

At The Injury Hub, ultrasound scanning enables visual confirmation of thickened tendon sheaths and nodules. Treatment at our Bow clinic focuses on reducing inflammation and restoring smooth tendon motion through hands-on physical therapy, TECAR therapy, and shockwave therapy to promote circulation and healing. When symptoms persist, ultrasound-guided corticosteroid injection can be highly effective in reducing sheath thickening and restoring normal movement (Makkouk et al., 2018).

References
Khan, W.S., Agarwal, M. and Thomas, R. (2020) ‘Trigger finger: pathophysiology, diagnosis and management’, Journal of Hand Surgery (European Volume), 45(6), pp. 589–597.
Ryzewicz, M. and Wolf, J.M. (2021) ‘Trigger digits: principles, management and outcomes’, Hand Clinics, 37(4), pp. 495–507.
Makkouk, A.H., Oetgen, M.E. and Swigart, C.R. (2018) ‘Trigger finger: etiology, evaluation, and treatment’, Current Reviews in Musculoskeletal Medicine, 11(1), pp. 92–98.

Inflammation and joint deformity from rheumatoid arthritis affecting the wrist and hand. Expert assessment and therapy at our Bow clinic. The wrist and hand contain multiple small synovial joints that are often affected early in rheumatoid arthritis. This autoimmune condition causes the body’s immune system to attack joint linings, leading to inflammation, swelling, and gradual cartilage and bone damage (Smolen et al., 2020).

Typical symptoms include persistent pain, morning stiffness, warmth, and visible joint swelling, particularly at the wrist and finger knuckles. Over time, chronic inflammation can cause deformities and reduced grip strength. Early diagnosis and intervention significantly improve long-term outcomes (Buch et al., 2021).

At our Bow clinic, ultrasound imaging helps detect early synovitis, joint effusion, and erosions before X-ray changes appear. Treatment at The Injury Hub may include hands-on physical therapy and TECAR therapy to relieve stiffness, with progressive strength and conditioning to maintain joint support. Inflammatory flares can be managed with ultrasound-guided corticosteroid injections, which provide targeted relief and reduce synovial thickening (Taylor et al., 2019). Multidisciplinary coordination with rheumatologists ensures comprehensive care and long-term disease control.

References
Smolen, J.S., Aletaha, D. and McInnes, I.B. (2020) ‘Rheumatoid arthritis’, The Lancet, 396(10246), pp. 239–252.
Buch, M.H., Emery, P. and Nam, J. (2021) ‘Early rheumatoid arthritis: diagnosis and management’, Clinical Medicine, 21(2), pp. 125–131.
Taylor, P.C., Alten, R. and Gomez-Reino, J. (2019) ‘Imaging and targeted therapy in rheumatoid arthritis’, Annals of the Rheumatic Diseases, 78(11), pp. 1422–1430.

Pain, clicking or instability at the back of the wrist caused by scapholunate ligament injury. Specialist ultrasound and therapy at The Injury Hub Bow. The scapholunate ligament connects the scaphoid and lunate bones within the wrist and is vital for maintaining normal carpal alignment. When torn or stretched, it leads to pain, clicking, and wrist instability, particularly after falls or repetitive loading (Lutz et al., 2020).

Patients typically describe deep pain on the back of the wrist that worsens with gripping or pushing through the hand. Swelling and a sense of weakness or “giving way” may occur. Untreated injuries can lead to chronic instability and degenerative arthritis (Rhee et al., 2021).

At The Injury Hub, we use musculoskeletal ultrasound to assess the scapholunate gap and detect associated fluid or ligament disruption. Initial management often includes rest, bracing, and hands-on therapy to restore alignment and function. TECAR therapy and shockwave therapy may support tissue healing, while progressive strength and conditioning help stabilise the wrist during recovery. In more severe or persistent cases, ultrasound-guided injection therapy or referral for orthopaedic reconstruction may be required (Schmitt et al., 2019).

References
Lutz, K., Woythal, L. and Krimmer, H. (2020) ‘Scapholunate ligament injury: diagnosis and management’, Journal of Wrist Surgery, 9(3), pp. 223–231.
Rhee, P.C., Kakar, S. and Shin, A.Y. (2021) ‘Scapholunate instability: evaluation, classification and management’, Hand Clinics, 37(2), pp. 167–181.
Schmitt, R., Lanz, U. and Pfister, J. (2019) ‘Imaging and treatment strategies for scapholunate instability’, European Journal of Radiology, 114, pp. 208–216.

Pain, stiffness, or weakness in the wrist and hand from repetitive strain. Expert assessment and rehabilitation is available at The Injury Hub Bow. The wrist and hand contain multiple small joints, tendons, and nerves that are vulnerable to repetitive stress. Repetitive Strain Injury (RSI), sometimes called Overuse Syndrome, occurs when these tissues are overloaded by repeated or sustained movements, leading to micro-trauma and inflammation (Greening and Dittmar, 2021).

Common causes include prolonged computer use, manual work, or repetitive sports activities such as racquet sports and weightlifting. Early signs may involve aching, stiffness, tingling, or weakness in the wrist, hand, or forearm. Without appropriate intervention, chronic pain and tendon thickening may develop, often affecting structures such as the flexor tendons, extensor tendons, or carpal tunnel (Descatha et al., 2020).

At our Bow clinic, a detailed clinical examination and point-of-care ultrasound (POCUS) help identify the affected soft tissues and confirm inflammation or tendinopathy. Treatment at The Injury Hub is tailored to the underlying cause and may include hands-on physical therapy, TECAR therapy to reduce inflammation, and shockwave therapy to stimulate tissue healing. Progressive strength and conditioning programmes restore load tolerance and improve endurance. Where nerve irritation is evident, ultrasound-guided injection therapy or hydrodissection may be used to reduce compression and restore normal function (Ha et al., 2022).

References
Descatha, A., Albo, F. and Leclerc, A. (2020) ‘Epidemiology and management of repetitive strain injuries in the upper limb’, Occupational Medicine, 70(6), pp. 410–417.
Greening, J. and Dittmar, S. (2021) ‘Work-related upper limb disorders: prevention and rehabilitation’, Physiotherapy, 112, pp. 60–68.
Ha, S.M., Lee, D.Y. and Kim, Y.J. (2022) ‘Ultrasound-guided intervention for overuse tendon and nerve disorders of the hand and wrist’, Skeletal Radiology, 51(9), pp. 1801–1812.