1. Wrist pain
Definition
Wrist pain is a common complaint. It's often caused by sprains or
fractures from suddeninjuries. But wrist pain can also result from
long-term problems, such as repetitivestress, arthritis and carpal tunnel
syndrome.
Because so many factors can lead to wrist pain, diagnosing the exact
cause can sometimesbe difficult. But an accurate diagnosis is essential
for proper treatment.
Symptoms
Wrist pain may vary, depending on what's causing it. For example,
osteoarthritis pain isoften described as being similar to a dull toothache,
while carpal tunnel syndrome usuallycauses a pins-and-needles feeling,
especially at night. The precise location of your wristpain also can give
clues to what might be causing your symptoms.
When to see a doctor
2. Not all wrist pain requires medical care. Minor sprains and strains, for
instance, usuallyrespond to ice, rest and over-the-counter pain
medications. But if pain and swelling lastlonger than a few days or
become worse, see your doctor. Delays in diagnosis and treatmentcan
lead to poor healing, reduced range of motion and long-term disability.
Causes
Your wrist is a complex joint made up of eight small bones arranged in
two rows betweenthe bones in your forearm and the bones in your hand.
Tough bands of ligament connect yourwrist bones to each other and to
your forearm bones and hand bones. Tendons attach musclesto bones.
Damage to any of the parts of your wrist can cause pain and affect your
abilityto use your wrist and hand.
Injuries
● Sudden impacts. Wrist injuries often occur when you fall forward
onto your outstretchedhand. This can cause sprains, strains and
even fractures. A scaphoid fracture involves abone on the thumb
side of the wrist. This type of fracture may not show up on
X-raysimmediately following the injury.
● Repetitive stress. Any activity that involves repetitive wrist motion--
from hitting atennis ball or bowing a cello to driving cross-country--
can inflame the tissues aroundjoints or cause stress fractures,
especially when you perform the movement for hours onend
without a break. De Quervain's disease is a repetitive stress injury
that causes painat the base of the thumb.
Arthritis
● Osteoarthritis. This type of arthritis occurs when the cartilage that
cushions the ends ofyour bones deteriorates over time.
Osteoarthritis in the wrist is uncommon and usuallyoccurs only in
people who have injured that wrist in the past.
● Rheumatoid arthritis. A disorder in which the body's immune
system attacks its owntissues, rheumatoid arthritis commonly
3. involves the wrist. If one wrist is affected, theother one usually is,
too.
Other diseases and conditions
● Carpal tunnel syndrome. Carpal tunnel syndrome develops when
there's increased pressure onthe median nerve as it passes
through the carpal tunnel, a passageway in the palm side ofyour
wrist.
● Ganglion cysts. These soft tissue cysts occur most often on the
part of your wristopposite your palm. Smaller ganglion cysts seem
to cause more pain than larger ones do.
● Kienbock's disease. This disorder typically affects young adults
and involves theprogressive collapse of one of the small bones in
the wrist. Kienbock's disease occurswhen the blood supply to this
bone is compromised.
Risk factors
Wrist pain can happen to anyone-- whether you're very sedentary, very
active or somewherein between. But your risk may be increased by:
● Sports participation. Wrist injuries are common in many sports,
including bowling, golf,gymnastics, snowboarding and tennis.
● Repetitive work. Almost any activity that involves your hands and
wrists-- even knittingand cutting hair-- if performed forcefully
enough and often enough can lead to disablingwrist pain.
● Certain diseases or conditions. Pregnancy, diabetes, obesity,
rheumatoid arthritis andgout may increase your risk of developing
carpal tunnel syndrome.
Preparing for your appointment
Although you may initially consult your family physician, he or she may
refer you to adoctor who specializes in joint disorders (rheumatologist),
sports medicine or even anorthopedic surgeon.
4. What you can do
You may want to write a list that includes:
● Detailed descriptions of your symptoms
● Information about medical problems you've had or have
● Information about the medical problems of your parents or siblings
● All the medications and dietary supplements you take
● Questions you want to ask the doctor
What to expect from your doctor
Your doctor may ask some of the following questions:
● When did your symptoms begin?
● Do they seem to be connected to a recent injury?
● Does any particular wrist motion trigger your pain?
● Is there any numbness or tingling in your hand?
● Are you right-handed or left-handed?
● What is your occupation? Does it require a lot of wrist motion?
● Do you participate in any sports or hobbies that put stress on your
wrist?
Tests and diagnosis
During the physical exam, your doctor may:
● Check your wrist for tenderness, swelling or deformity
● Ask you to move your wrist to see if your range of motion has been
decreased
● Assess your grip strength and forearm strength
In some cases, your doctor may suggest imaging tests, arthroscopy or
nerve tests
Imaging tests.
● X-rays. This is the most commonly used test for wrist pain. Using a
small amount ofradiation, X-rays can reveal bone fractures, as well
as signs of osteoarthritis.
5. ● CT. This scan can provide more-detailed views of the bones in
your wrist and may help findfractures that don't show up on X-rays.
● MRI. This test uses radio waves and a strong magnetic field to
produce detailed images ofyour bones and soft tissues. For a wrist
MRI, you may be able to insert your arm into asmaller device
instead of whole-body MRI machine.
● Ultrasound. This simple, noninvasive test can help visualize
tendons, ligaments and cysts.
Arthroscopy
If imaging test results are inconclusive, your doctor may perform an
arthroscopy, aprocedure in which a pencil-sized instrument called an
arthroscope is inserted into yourwrist through a small incision in your
skin. The instrument contains a light and a tinycamera. Images are
projected onto a television monitor. Arthroscopy is now considered
thegold standard for evaluating long-term wrist pain. In some cases, your
doctor may repairwrist problems through the arthroscope.
Nerve tests
If your doctor thinks you have carpal tunnel syndrome, he or she might
order anelectromyogram (EMG). This test measures the tiny electrical
discharges produced in yourmuscles. A needle-thin electrode is inserted
into the muscle, and its electrical activityis recorded when the muscle is
at rest and when it's contracted. Nerve conduction studiesalso are
performed as part of an EMG to assess if the electrical impulses are
slowed inthe region of the carpal tunnel.
Treatments and drugs
Treatments for wrist problems vary greatly, depending on the type,
location and severityof the injury, as well as on your age and overall
health.
Medications
6. Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others)
andacetaminophen (Tylenol, others), may help reduce wrist pain.
Stronger pain relievers areavailable by prescription.
Therapy
A physical therapist can recommend specific treatments and exercises
for wrist injuriesand tendon problems. If you need surgery, your physical
therapist can also help withrehabilitation after the operation. You may
also benefit from having an ergonomicevaluation that addresses
workplace factors that may be injuring your wrist.
If you have a broken bone in your wrist, the pieces will need to be
aligned so that it canheal properly. A cast or splint can help hold the
bone fragments together while they heal.
If you have sprained or strained your wrist, you may need to wear a
splint to protect theinjured tendon or ligament while it heals. Splints are
particularly helpful with overuseinjuries caused by repetitive motions.
Surgery
In some cases, surgery may be necessary. Examples include:
● Severely broken bones. A surgeon may connect the fragments of
bone together with metalhardware.
● Carpal tunnel syndrome. If your symptoms are severe, you may
need to have the tunnel cutopen to relieve the pressure on the
nerve.
● Tendon or ligament repair. Surgery is sometimes necessary to
repair tendons or ligamentsthat have ruptured.
Lifestyle and home remedies
Not every cause of wrist pain requires medical treatment. For a minor
wrist injury, youmay want to try putting ice on it and wrapping your wrist
with an elastic bandage.
7. Prevention
It's impossible to prevent the unforeseen events that often cause wrist
injuries, butthese basic tips may offer some protection:
● Build bone strength. Getting adequate amounts of calcium-- at
least 1,200 milligrams a dayfor women over age 50, or 1,000
milligrams a day for most adults-- can help preventfractures.
● Prevent falls. Falling forward onto an outstretched hand is the
main cause of most wristinjuries. To help prevent falls, wear
sensible shoes. Remove home hazards. Light up yourliving space.
And install grab bars in your bathroom and handrails on your
stairways, ifnecessary.
● Use protective gear for athletic activities. Wear wrist guards for
high-risk activities,such as football, snowboarding and
rollerblading.
● Pay attention to ergonomics. If you spend long periods at a
keyboard, take regular breaks.When you type, keep your wrist in a
relaxed, neutral position. An ergonomic keyboard andfoam or gel
wrist support may help.
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