What we are talking about
The hand is a dense mechanism: many tendons, many small joints, nerves passing through narrow tunnels. When something becomes inflamed or narrowed, the effects show up immediately, because there is no movement in the day that does not involve it.
The three most common pictures are these. Carpal tunnel, with night-time tingling in the first three and a half fingers, which makes you shake the hand to clear it. Thumb base arthritis, which makes every pinch grip painful: turning a key, opening a jar. De Quervain tenosynovitis, on the thumb side, typical after pregnancies and repetitive work.
Then there is the whole band of use-related pain: wrist and forearm in people who spend the day on a mouse and keyboard. Here the word «posture» is almost always less important than the word «breaks».
When it makes sense to get seen
What we hear most often:
- Tingling in the hand that wakes you at night
- Pain at the base of the thumb when you grip or turn something
- The wrist hurting after hours at the computer
- You are dropping things
- After a wrist fracture you have not regained movement and strength
- Fingers stiff in the morning that take a while to free up
What can be done remotely, and what cannot
The hand shows very well on a video call: it is close to the camera, and most of the assessment comes from how you use it.
What can be done remotely
- Working out exactly where the tingling reaches, which guides the diagnosis a great deal
- Watching you perform the grips and movements that hurt
- Setting up the exercise programme for mobility, nerve gliding and strength
- Reviewing the workstation and above all the rhythm of the breaks
- Following recovery after a fracture, in the phase that needs progression
What cannot
- Manual therapy, joint mobilisations and scar treatment
- Making custom splints and orthoses
- Nerve conduction studies and imaging
If hand strength is dropping noticeably or the muscles at the base of the thumb are wasting, you need a medical assessment without waiting.
Frequently asked questions
Does carpal tunnel always need surgery?
No. In mild and moderate forms the conservative route — night splint, nerve gliding exercises, changes to what you do during the day — gives results in a good share of cases. Surgery is considered when symptoms are severe or there is documented nerve damage.
Why does the tingling come at night?
Because in sleep the wrist tends to bend, and that increases the pressure in the tunnel the nerve passes through. It is why a night splint, which keeps the wrist straight, is often the first thing tried.
Can I still use my hand with thumb base arthritis?
Yes, and it is better to. The available evidence supports exercise, joint protection in daily tasks and sometimes a splint. Stopping using the hand weakens it without protecting it.
My wrist hurts at the computer: is it posture?
Partly, but less than people say. What usually changes things is how often you take breaks and the overall load of the day. A perfect workstation held motionless for eight hours is still a problem.
