Hand Pain: A Case Study

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Xela (Quetzaltenango), Guatemala has many Spanish language schools and has a reputation in the country as the place you go if you are serious about learning Spanish.  The cost of study is quite surprising: U$60 for one week of intensive one on one Spanish classes (4 hours/day, 5 days/week, 20 hours total).  A home stay with a local family can be arranged for an extra U$70 (7 nights accommodation, 3 meals per day).


I took classes at the Miguel de Cervantes School and was matched with my teacher, Miriam for one on one classes.  After learning that Miriam was having trouble with her hand, I offered my help over the remaining 3 days.  She accepted, and saw some dramatic improvements.

Miriam was 55 years old at the time of this article.  5 years prior, she tripped and fell in the street, landing on her right hand.  During the fall, most of the impact centred on her right carpal bones and the metacarpals heads.  She also tore her left achilles tendon which was treated during 8 months of physiotherapy.  She never received any treatment for her hand.

Before treatments started, she showed the following signs:

  • For the past 5 months she has not been able to close her right hand to make a fist.  With effort she could close her hand to roughly 25% of the way.
  • Her right third finger could not move more than 15 degrees in flexion or extension.
  • Her hand was very sore throughout the day as she did her chores.  She had trouble holding a spoon to stir for extended periods of time.
  • Her hand hurt after 5 minutes of writing.
  • She relied more and more on her left hand.
  • She could not raise her right arm more than 90 degrees (50%) in abduction.
  • Her right shoulder hurt her when she slept. She slept on her back.
  • She had been suffering from asthma for her whole life.


Upon examination of her hand, I noticed quite a build up of scar tissue around the second, third, and fourth metacarpo-phalangeal joints.  There was very little joint mobility in her carpals and between her metacarpals.


I gave her the following treatment over three days:

  • A combination of myofascial release, ART, and tuina focussed on the right metacarpophalangeal joints and tendons, as well as the LI4 acupuncture point
  • Joint mobilizations of all carpal, metacarpal and phalangeal joints of the right hand
  • Acupuncture
  • Ginger and honey tea to help with her asthma


She also did the following home care:

  • A daily 10 minute hand soak in warm water
  • Wrist flexor and extensor stretches
  • Self massage of the forearms and hands
  • Appley stretches for her rotator cuff muscles
  • Finger walks on the wall to improve glenohumeral abduction


After 3 days of daily treatments and home care, she had the following results:

  • She could close her right hand 100% into a tight fist
  • She could write for 1 hour without any pain in her right hand
  • She used her right hand for everything now
  • She could sleep on her side
  • She had less shoulder pain while sleeping
  • She could raise her hand above her head for 100% shoulder abduction
  • She was able to sleep through the night without being awoken by her breathing problems