Wrist Pain

Wrist pain can stem from various causes, including sudden injuries like sprains and fractures, as well as long-term issues like repetitive use (overuse) syndromes, arthritis, and carpal tunnel syndrome.

Diagnosing the specific cause can be challenging due to this variety, but an accurate and timely diagnosis is crucial for effective treatment and healing.

Wrist pain varies in its presentation depending on the underlying cause. For example, arthritis often results in mild, persistent pain, while carpal tunnel syndrome is characterized by numbness and tingling in the fingers. The specific location of wrist pain can be a valuable clue in determining its cause.

Damage to any of the parts of your wrist can cause pain and affect your ability to use your wrist and hand. The damage may result from:

Trauma

• Acute injuries: Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures.
• Repetitive stress and overuse syndromes (or Repetitive Strain Injuries (RSI): Any activity or profession that involves wrist motion that you do again and again can inflame the tissues around joints or cause stress fractures. Some examples include hitting a tennis ball or driving cross-country. The risk of injury is increased when you perform the movement for hours on end without a break. De Quatrain’s Tenosynovitis is a repetitive stress injury that causes pain at the base of the thumb.
• Arthritis is an inflammation of the joints that can cause swelling and stiffness in the affected body part. It has many causes, including normal wear and tear, aging, and overworking the hands. There are many forms of arthritis, but the most common types that can affect the wrist include:
• Osteoarthritis (OA) is a degenerative joint disease that’s common among older adults. It is caused by a breakdown of the cartilage that covers the joints. The protective tissue is damaged over time and through repeated motion. This increases the friction as the bones of the joint rub against each other, resulting in swelling and pain.
• Rheumatoid Arthritis (RA) is an autoimmune disease that can affect both wrists. It develops when the immune system mistakenly attacks the lining of your joints, including your wrists. This can cause painful swelling, which may eventually result in bone erosion.
• Carpal tunnel syndrome: Carpal tunnel syndrome (CTS) is caused by pressure or compression on the median nerve as it passes through the carpal tunnel in the wrist.
• Ganglion cysts: These benign, noncancerous, and usually harmless lumps occur most often in the hand, usually on the back of the wrist. In most cases, they are painless, but if they’re putting pressure on a joint or nerve, they can cause pain in the wrist area.

The initial step in diagnosing wrist pain involves a thorough clinical examination. This includes assessing the wrist for tenderness, swelling, and any visible deformities. The doctor will also check the range of motion in all directions (flexion, extension, radial and ulnar deviation) to identify any limitations or pain associated with movement.

Imaging tests may include:

• X-rays: This is the most commonly used test for wrist pain. Using a small amount of radiation, X-rays can reveal bone fractures or signs of osteoarthritis.
• CT scan: This imaging test can provide more-detailed views of the bones in the wrist. CT may spot fractures that don’t show up on X-rays.
• MRI: Itis the gold standard for evaluating soft tissue injuries like those to ligaments and tendons. It provides excellent visualization of these structures and can help diagnose sprains, tears, and other injuries that might not be apparent on X-rays or CT scans.
• This simple, noninvasive test is useful for examining tendons and surrounding soft tissues, particularly for identifying inflammation and detecting fluid-filled cysts. It’s a non-invasive and readily available option for assessing these specific issues in the wrist.

Neurological Examination

In cases of suspected carpal tunnel syndrome, an electromyogram (EMG) is used to rule out or confirm the diagnosis.

A reasonable question is, “What should I do for the pain in my wrist?” The approach to treating wrist pain is multifaceted and depends heavily on the specific characteristics of the pain, as well as the individual’s overall health and age.

The most common treatment options for wrist pain are the following:

Medication

While non-steroidal anti-inflammatory drugs (NSAIDs) and other pain relievers can effectively reduce pain and inflammation, they should always be used under the guidance of a doctor due to potential side effects and risks. A doctor can help determine the appropriate dosage and duration of treatment, monitor for adverse reactions, and consider alternative therapies if necessary.

Physical Therapy

Physical therapy, including targeted exercises and techniques, is crucial for strengthening the wrist and promoting healing, especially after injuries or surgery.

Lifestyle adjustments, such as resting the wrist, using ice packs, and modifying activities that aggravate the pain, can also be beneficial.

Splints

Splints are crucial for managing wrist pain by providing support and immobilization during healing, especially after fractures or injuries to ligaments, tendons, or soft tissues. In cases of fracture, whether treated conservatively or surgically, immobilization with a splint is essential to allow the bone to heal properly.

Similarly, splints are used for ligament injuries, inflammation, or tendon ruptures to facilitate healing by preventing movement and providing support.

Surgical Treatment

In some cases, surgery may be necessary.

Bone fractures: In some cases, you may need surgery to stabilize bone fractures and accelerate healing. A surgeon may need to connect the fragments of bone together with metal materials.

Carpal Tunnel Syndrome: When numbness and pain from carpal tunnel syndrome become severe or persistent, and conservative treatments like splinting or steroid injections are not effective, surgical decompression of the median nerve is often recommended. This procedure, typically performed through a small incision in the palm, aims to relieve pressure on the nerve and alleviate symptoms.

Tendon or Ligament Repair: In cases of tendon or ligament rupture, surgical repair such as stitching may be necessary. Specifically, De Quervain’s tenosynovitis, a condition causing wrist and thumb pain, may require tendon decompression surgery to relieve pressure on the tendons.

When should I see a doctor if I have wrist pain?

You should see a doctor for wrist pain if it doesn’t improve within a few days, worsens over time, or doesn’t respond to home treatment like rest, ice, and over-the-counter pain relievers after two weeks. Persistent or worsening pain, inability to move your wrist or fingers, tingling or numbness, and swelling or discoloration are all reasons to seek medical evaluation by a specialized orthopedic surgeon. Ignoring these symptoms could lead to chronic pain or long-term disability of the hand.

Is wrist pain related to my profession or the sport I participate in?

Yes, certain professions and sports are known to have a higher incidence of wrist pain due to the repetitive or high-impact nature of the activities involved. Occupations like computer users, seamstresses, compressor operators, and nurses, as well as sports like tennis and weightlifting, often lead to wrist pain.