Wrist pain

 

Wrist pain

Overview

Wrist pain is often caused by sprains or fractures from sudden injuries. But wrist pain also can result from long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome.

Because so many factors can lead to wrist pain, diagnosing the exact cause can be difficult. But an accurate diagnosis is essential for proper treatment and healing.

Symptoms

Wrist pain may vary, depending on the cause. For example, osteoarthritis pain often is described as being similar to a dull toothache. Carpal tunnel syndrome usually causes a pins-and-needles feeling. This tingling sensation usually occurs in the thumb and index and middle fingers, especially at night. The precise location of wrist pain also provides clues to what's behind the symptoms.

When to see a doctor

Not all wrist pain requires medical care. Minor sprains and strains usually respond to ice, rest and pain medications you can buy without a prescription. But if pain and swelling last longer than a few days or become worse, see your health care provider. Delayed diagnosis and treatment can lead to poor healing, reduced range of motion and long-term disability.

Causes

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:

Injuries

·         Sudden impacts. Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures. A scaphoid fracture involves a bone on the thumb side of the wrist. This type of fracture may not show up on X-rays immediately after the injury.

·         Repetitive stress. Any activity 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, bowing a cello or driving cross-country. The risk of injury is increased when you perform the movement for hours on end without a break. De Quervain tenosynovitis is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

·         Osteoarthritis. This type of arthritis occurs when the cartilage that cushions the ends of the bones deteriorates over time. Osteoarthritis in the wrist is uncommon and usually occurs only in people who have injured that wrist in the past.

·         Rheumatoid arthritis. A disorder in which the body's immune system attacks its own tissues, rheumatoid arthritis commonly involves the wrist. If one wrist is affected, the other one usually is too.

Other diseases and conditions

·         Carpal tunnel syndrome. Carpal tunnel syndrome develops when there's increased pressure on the median nerve as it passes through the carpal tunnel, a passageway in the palm side of the wrist.

·         Ganglion cysts. These soft tissue cysts occur most often on the part of the wrist opposite the palm. Ganglion cysts may be painful, and pain may either worsen or improve with activity.

·         Kienbock disease. This disorder typically affects young adults and involves the progressive collapse of one of the small bones in the wrist. Kienbock disease occurs when there is not enough blood supply to this bone.

Risk factors

Wrist pain can happen to anyone — whether you're very sedentary, very active or somewhere in between. But the risk may be increased by:

·         Sports participation. Wrist injuries are common in many sports, both those that involve impact and those that involve repetitive stress on the wrist. These can include football, bowling, golf, gymnastics, snowboarding and tennis.

·         Repetitive work. Almost any activity that involves your hands and wrists, even knitting and cutting hair, if performed forcefully enough and often enough can lead to disabling wrist pain.

·         Certain diseases or conditions. Pregnancy, diabetes, obesity, rheumatoid arthritis and gout may increase the risk of developing carpal tunnel syndrome.

Prevention

It's impossible to prevent the unforeseen events that often cause wrist injuries, but these basic tips may offer some protection:

·         Build bone strength. Getting adequate amounts of calcium can help prevent fractures. For most adults, that means 1,000 to 1,200 milligrams a day.

·         Prevent falls. Falling forward onto an outstretched hand is the main cause of most wrist injuries. To help prevent falls, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and handrails on your stairways, if necessary.

·         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 wrists in a relaxed, neutral position. An ergonomic keyboard and a foam or gel wrist support may help.

Diagnosis

During the physical exam, your health care provider may:

·         Check your wrist for tenderness, swelling or deformity

·         Ask you to move your wrist to check for a decrease in your range of motion

·         Check your grip strength and forearm strength

Imaging tests

Imaging tests may include:

·         X-ray. 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. This scan can provide more-detailed views of the bones in the wrist and may spot fractures that don't show up on X-rays.

·         MRI. This test uses radio waves and a strong magnetic field to produce detailed images of the bones and soft tissues. For a wrist MRI, you may be able to insert your arm into a smaller device instead of a whole-body MRI machine.

·         Ultrasound. This simple, noninvasive test can help examine tendons, ligaments and cysts.

Arthroscopy

If imaging test results do not provide enough information, you may need an arthroscopy. This procedure uses a pencil-sized instrument called an arthroscope is inserted into the wrist through a small incision in the skin. The instrument contains a light and a tiny camera, which projects images onto a television monitor. Arthroscopy is considered the gold standard for evaluating long-term wrist pain. In some cases, your doctor may repair wrist problems through the arthroscope.

Nerve tests

Your health care provider might order an electromyogram if carpal tunnel syndrome is suspected. This test measures the tiny electrical discharges produced in the muscles. A needle-thin electrode is inserted into the muscle, and its electrical activity is recorded when the muscle is at rest and when it's contracted. Nerve conduction studies also are performed to check whether the electrical impulses are slowed in the region of the carpal tunnel.

Treatment

Treatments for wrist problems vary greatly based on the type, location and severity of the injury, as well as on your age and overall health.

Medications

Nonprescription pain relievers, such as ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others), may help reduce wrist pain. Stronger pain relievers are available by prescription. Injections of corticosteroid medication also may be considered for some conditions.

Therapy

A physical therapist can implement specific treatments and exercises for wrist injuries and tendon problems. If you need surgery, your physical therapist can help with rehabilitation after the operation. You may benefit from having an ergonomic evaluation that addresses workplace factors that may be contributing to wrist pain.

If you have a broken bone in your wrist, the pieces will need to be aligned so that the bone can heal 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 the injured tendon or ligament while it heals. Splints are particularly helpful with overuse injuries caused by repetitive motions.

Surgery

In some cases, surgery may be necessary. Examples include:

·         Bone fractures. In some cases, you may need surgery to stabilize bone fractures to permit healing. A surgeon may need to connect the fragments of bone together with metal hardware.

·         Carpal tunnel syndrome. If your symptoms are severe, you may need to have the ligament that forms the roof of the tunnel cut open to relieve the pressure on the nerve.

·         Tendon or ligament repair. Surgery is sometimes necessary to repair tendons or ligaments that have ruptured.

Lifestyle and home remedies

Wrist pain doesn't always require medical treatment. For a minor wrist injury, apply ice and wrap your wrist with an elastic bandage.

Preparing for your appointment

Although you may initially consult your family health care provider, you may receive a referral to an orthopedic surgeon, a doctor who specializes in joint disorders, called a rheumatologist, or a doctor specializing in sports medicine.

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 health care provider

What to expect from your doctor

Your health care provider may ask some of the following questions:

·         When did your symptoms begin?

·         Do your symptoms 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?