Causes and Treatment of Wrist Pain

Wrist pain is a frequent complaint, and there are many potential causes, with a wrist sprain and tendonitis being the most common ones. The reason behind your pain dictates exactly how it's experienced—sharp pain, dull ache, pins and needles, or tightness, for example. But due to the wrist's complex anatomy, determining the "why" behind your wrist pain can be a tricky process.

That is why the diagnostic process entails a detailed medical history and physical examination, followed by an imaging test. A treatment plan will follow, which usually involves medication for pain and inflammation control, and, rarely, surgery.

If you are unsure of the cause of your wrist pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Some signs that you should be seen by a doctor include:

• Inability to carry objects  or use the arm
• An injury that causes deformity of the joint
• Wrist pain that occurs at night or while resting
• Wrist pain that persists beyond a few days
• Inability to straighten or flex the joint
• Swelling or significant bruising around the joint or forearm
• Signs of an infection, including fever, redness, warmth
• Numbness and tingling of the hands and/or wrists

While the misuse and.or overuse of the wrist are the primary causes of wrist pain, there are many other causes a doctor may investigate.

Wrist Sprain

A ligament is tough, fibrous tissue that controls the motion around a joint. The ligaments around the wrist joint help to stabilize the position of the hand and allow controlled motions. When a wrist sprain injury occurs, the ligaments of the wrist are stretched beyond their normal limits. This often occurs after an injury, such as a fall onto the hand.

Besides pain with movement of the wrist, other common symptoms of a wrist sprain include swelling around the joint, bruising or discoloration, or a burning or tingling sensations known as paresthesia.

Wrist Tendonitis

There are multiple strong bands of tissue called tendons that cross over the wrist, connecting the muscles in the forearms to the hand and finger bones. Flexor tendons are located on the palm side of your hand and allow your fingers to flex for grasping and gripping objects. Extensor tendons are on the top side of your hand and help your fingers straighten and release objects.

When one or more tendons becomes inflamed, wrist tendonitis develops, which causes a dull, aching pain, along with morning stiffness and, sometimes, mild swelling or warmth. Some people report crepitus (a popping sensation) when moving their wrist.

Occupational activities that involve repetitive wrist motion, such as typing or working with machinery, and sports that place repetitive stress on the wrist (golf, tennis) are the most common causes of wrist tendonitis.

Wrist Tenosynovitis

The term "tenosynovitis" is often used interchangeably with "tendonitis." With tenosynovitis, the tendon sheath (a fluid-filled covering that your wrist tendons glide through) become inflamed, which causes the same symptoms as an inflamed tendon.

One specific type of tenosynovitis is called de Quervain's tenosynovitis, which causes wrist pain on the thumb side that may move into the arm. This condition is most common in women between the ages of 30 and 50. Often times, a woman reports a history of a repetitive hand-based activity, such as picking up a child.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition that results from dysfunction of one of the nerves in the wrist. The median nerve is compressed, or pinched off, as it passes through the wrist joint. Besides wrist discomfort that tends to be worse at night, a person with carpal tunnel syndrome may experience numbness and tingling in their palms, as well as their thumb, index, and middle finger.

Wrist Fracture

A wrist fracture is a common orthopedic injury. This may occur due to an injury and/or bone weakness, such as with osteoporosis.

One common type of wrist fracture is a scaphoid fracture, which may arise from a fall on an outstretched hand. Your scaphoid bone is a curved bone, shaped like a boat, that is located on the thumb side of your wrist. A scaphoid fracture causes swelling, pain, and tenderness in the area just below the base of the thumb (called the anatomic snuffbox). The pain may worsen when a person tries to pinch or grasp something.

Arthritis

There are a few different types of arthritis that may affect the wrist. Rheumatoid arthritis (RA) commonly affects the wrist joint, and gout (another type of inflammatory arthritis) may affect the wrist joint as well. Osteoarthritis of the wrist is less common and is most likely to occur as a result of a prior wrist injury. Septic bacterial arthritis of the wrist (when the wrist joint is infected) is possible, but rare.

Ganglion Cyst

Ganglion cysts are benign, fluid-filled capsules that cause swelling and/or wrist pain. They usually occur over the back of the hand or wrist and often feel smooth and rubbery. While they may grow, they will not spread to other parts of your body. Rarely, the cyst may compress a nerve, causing some muscle weakness and/or numbness and tingling

Cubital Tunnel Syndrome

Cubital tunnel syndrome, also known as ulnar neuropathy, results when your "funny bone nerve," called your ulnar nerve, is compressed. It may cause wrist pain, along with numbness and tingling in your fourth and fifth fingers.

Carpal Boss

A firm, immovable bump on the back of the hand/wrist, a carpal boss is created by a small area of osteoarthritis occurring at the junction of the long hand bones and the small wrist bones.

The wrist, while small, is comprised of several bones, muscles, and tissues, making it quite an intricate area of the body. Therefore, a comprehensive medical history and physical examination are needed to make the diagnosis behind your wrist pain, followed often by an imaging test, usually an X-ray to start.

Medical History

During your appointment, your doctor will ask you several questions about your wrist pain. For instance, your doctor will inquire as to whether your wrist pain came on suddenly or gradually. Your doctor will also want to know whether you experienced any sort of trauma to your wrist, like a fall on an outstretched hand.

Physical Examination

During the physical exam, your doctor will first inspect your wrist, hand, and arm for bruising, swelling, skin changes, or muscle wasting. She will then press on the bones and muscles to check for tenderness or deformities, in addition to moving your wrist around to evaluate its range of motion.

Besides a thorough musculoskeletal exam, your doctor will check the pulse in your wrist and do a quick neurological exam on your hand, wrist, and arm to check for sensory problems or muscle weakness.

Imaging Test

Imaging is commonly utilized during the diagnosis of wrist pain. The first imaging test ordered is typically an X-ray, which, for instance, can diagnose a fracture, as well as, arthritis of the wrist.

Depending on the suspected diagnosis, an x-ray may be followed by a computed tomography (CT) scan or magnetic resonance imaging (MRI), especially if a wrist fracture is suspected but the x-ray is negative. For example, sometimes, scaphoid fractures do not immediately show up on x-ray—a repeat x-ray in a few days or an MRI can usually reveal the bone break.

Special Tests and Procedures

Depending on your doctor's suspicion for a particular diagnosis, she may perform a special test. For example, the Tinel test can help diagnose carpal tunnel syndrome. Your doctor will lightly tap on your medial nerve to determine if it is inflamed. The test is positive if you feel a "pins and needles" sensation in your first three fingers.

Another test, the Finkelstein test, can help a doctor diagnose de Quervain's tenosynovitis. In this test, a person makes a fist around their thumb. The doctor then uses one hand to stabilize the forearm, while using the other hand to move the wrist towards the little finger. If this maneuver causes pain along the thumb, the test is positive.

If your doctor is worried about an infected wrist joint (called septic arthritis) or gout of the wrist, he will remove a sample of the synovial fluid within the joint. This procedure is called a joint aspiration and is most often performed in a doctor's office. With gout, the synovial fluid will reveal the presence of crystals and a moderately elevated white blood cell count. With septic arthritis, the white blood cell count will be extremely high.

Seeing your doctor for an evaluation of your wrist pain, whether it comes on suddenly or has been present for a while, is important. If the above issues have been ruled out or are not otherwise suspected as the source of your wrist pain, these diagnoses may be considered. Some are whole-body illnesses, while others are localized issues.

Rheumatoid Arthritis (RA)

With RA versus other causes of wrist pain, a person will often have a positive anti-citrullinated protein antibody (ant-CCP), as well as other physical symptoms like unusual fatigue, unexpected weight loss, and other sites of joint pain. Moreover, RA tends to affect joints symmetrically, while this would be uncommon for an isolated wrist sprain or tendonitis. All of these clues can help a doctor arrive at the correct diagnosis.

Thyroid Disease or Diabetes Mellitus

Besides RA, thyroid disease or diabetes (which can alter tendon structure) may cause or contribute to wrist pain. In order to rule out the above diagnoses, your doctor may order the following blood tests:

• Thyroid stimulating hormone (to screen for thyroid disease)
• Hemoglobin A1c (to screen for diabetes)

Cervical Radiculopathy

Another condition your doctor will consider when evaluating your wrist pain is a pinched C6 or C7 nerve root in your neck (called cervical radiculopathy). The pinching or compression of these nerve roots may occur as a result of cervical stenosis (narrowing of the spinal canal in your neck), a herniated disc in the neck, or osteoarthritis in the neck.

Like carpal tunnel syndrome, a compressed C6 or C6 nerve root causes dull pain, as well as tingling and/or numbness in the palm and first three fingers. Besides a thorough neurological exam, an electromyogrpahy (EMG) and/or an MRI of the neck can be done to help sort out one condition from the other.

Soft Tissue Tumors

Bear in mind that while a ganglion cyst is the most common cause of a "rubbery" bump on the wrist, other soft tissues masses need to be considered, such as:

• Tenosynovial giant cell tumor
• Epidermoid cyst
• Lipoma
• Tophus
• Rheumatoid nodule
• Synovial sarcoma

The good news is with a combination of transillumination (seeing if light is able to pass through the mass), ultrasound, and/or MRI, doctors can usually make a diagnosis. If there is any doubt, a surgical biopsy (a tissue sample) can be done.

Treating wrist pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program.

Self-Care Strategies

To start, a few self-care strategies may soothe your wrist pain, especially if you have been diagnosed with a sprain or tendonitis.

• Rest: The first treatment for many common conditions that cause wrist pain is to rest the joint and allow the acute inflammation to subside. It is important, however, to use caution when resting the joint because prolonged immobilization can cause joint stiffness.
• Ice Application: If you have been diagnosed with a sprain or tendonitis, it's a good idea to ice your wrist for twenty minutes every three to four hours for the first two days. While you may be tempted to extend the application time, doing so won't help heal your wrist any faster, and it could actually cause damage to the tissues.
• Compression: Your doctor may recommend wrist compression. Using an elastic bandage, wrap the wrist from the base of the fingers all the way up to the top of the forearm, overlapping the wrap by one half of its width. The wrap should be snug, but not cutting off circulation to the hand and wrist (tingling is a sign it's too tight).
• Immobilization: Support braces or splints may help people who have either experienced a recent wrist sprain injury or who have carpal tunnel syndrome or tendonitis. For people with wrist arthritis, wearing a splint during painful activities can be useful. A cast is needed in the event of a break, which—of course—would need to be applied by a medical professional.

Medications

Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with wrist pain caused by problems such as a sprain, tendonitis, and arthritis. NSAIDs are not used in the treatment of carpal tunnel syndrome.

Cortisone is a powerful medication that also treats inflammation—and inflammation is a common problem in patients with wrist pain, like those with tendonitis. Some people with arthritis of the wrist or carpal tunnel syndrome also benefit from a cortisone injection.

Surgery

Some wrist conditions require a surgical procedure for treatment, such as certain types of fractures, ganglion cysts (if removal is desired), and median or ulnar nerve decompression. If you require wrist surgery, talk with your doctor about finding a hand surgeon—an orthopedic or plastic surgeon with specialized expertise in performing operations on the hand, wrist, and forearm.

Some activities are such that participants are at significant risk for sustaining a wrist injury. Wearing protective wrist splints or guards in sports such as rollerblading, street hockey, and snowboarding can help prevent many sprained wrists. While skiing, use a pole that has a low-profile grip and do not secure the poles to your wrists with tight straps.

In addition, people who have sustained a previous wrist injury may have a higher risk of further injury, especially if they do not regain full mobility of strength of their wrist. For that reason, it is important for active individuals, especially athletes, to ensure they regain full function of their wrist before resuming competitive activities. Physical therapy, especially hand therapy, can be especially useful for strengthening the wrist joint.

Lastly, to prevent the development or worsening of carpal tunnel syndrome, avoiding repetitive motions, taking breaks, and using ergonomic devices like a wrist rest or mouse pad can be helpful.

Not every patient with wrist pain will find relief with the treatments above. However, simple steps like ice, rest, and wrist support will be effective for the vast majority of people with common wrist ailments, like a sprain or tendonitis.

If you find your symptoms persist despite appropriate treatment, you may want to discuss with your doctor what the next steps might be. While surgery may be an option, most people choose this only if they fail to find relief with the steps listed above.