Wrist Pain Causes

Wrist pain has a lot of possible causes, including a sprain, tendonitis, arthritis, and fractures. Some may heal with rest, while others may need treatment and/or be chronic issues that have the potential to cause long-term pain in the wrist.

Wrist pain may feel sharp, dull, achy, or like pins and needles. Pain may get worse when you bend your wrist forward, flex it backward, put pressure on it, or rotate it to turn a doorknob.

This article discusses possible causes of wrist pain and their symptoms, how to get an accurate diagnosis, plus how wrist pain can be treated and how prevented.

Why Does Your Wrist Hurt?

The main causes of wrist pain are misuse and overuse (spending long periods typing on a keyboard, day after day, for example). But a lot of other things can lead to wrist pain, as well.

Some conditions that specifically and directly affect the wrist include:

• Wrist sprain
• Wrist tendonitis
• Wrist tenosynovitis
• Carpal tunnel syndrome
• Wrist fracture
• Arthritis

Wrist pain also has some less-common causes.

Wrist Sprain

A sprain is a ligament injury. Ligaments are tough connective tissues that control joint movement.

The ligaments around the wrist joint help stabilize your hand position. They also allow you to make controlled motions.

A sprain happens when wrist ligaments are stretched past their limits. A common cause is falling onto your hand.

Wrist sprain symptoms include:

• Pain with movement
• Swelling around the joint
• Bruising or discoloration
• Burning or tingling sensations (called paresthesia)
  

Wrist Tendonitis

Tendons are strong bands of tissue that cross over the wrist. They connect the muscles in the forearms to the hand and finger bones.

Flexor tendons on the palm side of your hand allow your fingers to grasp and grip objects. Extensor tendons on the top side of your hand help your fingers straighten and release objects.

Wrist tendonitis occurs when one or more of these tendons become inflamed. It causes:

• Dull, aching pain
• Morning stiffness
• Sometimes, mild swelling or warmth

Some people report crepitus (popping) when moving their wrist.

The most common causes of wrist pain due to tendonitis are:

• Repetitive wrist motions (typing, working with machinery)
• Sports that place repetitive stress on the wrist (golf, tennis)

Wrist Tenosynovitis

Tenosynovitis is similar to tendonitis in that it involves damage and inflammation, but it affects the tendon sheath (a fluid-filled covering your tendons glide through.)

Tenosynovitis causes the same symptoms as tendonitis.

A specific type of of injury called de Quervain’s tenosynovitis causes wrist pain on the thumb side that may move up into the arm.

De Quervain’s is most common in women between 30 and 50. It’s often caused by a repetitive motion such as lifting a child.

Carpal Tunnel Syndrome

Carpal tunnel syndrome comes from overuse of the wrist, especially from repetitive motions. That leads to inflammation and scar tissue.

They can compress (pinch) a nerve that runs through the wrist joint. It’s called the median nerve. This condition causes pain that tends to be worse at night, plus numbness in tingling in the:

• Palms
• Thumb
• Index finger
• Middle finger

Carpal tunnel syndrome is a common workplace injury.

Wrist Fracture

A wrist fracture is a common injury. It’s more likely in people with weak bones, such as from osteoporosis.

A common type of wrist fracture is a scaphoid fracture. Your scaphoid bone is on the thumb side of your wrist. It’s often broken when you fall and catch yourself on an outstretched hand.

A scaphoid fracture causes swelling, pain, and tenderness below the base of the thumb. The pain may get worse when you try to pinch or grasp something.

Arthritis

A few different types of arthritis may affect the wrist. They include:

• Rheumatoid arthritis (RA): Inflammatory arthritis that causes joint damage and deterioration.
• Osteoarthritis: Less common. “Wear and tear” arthritis associated with age or injury.
• Gout: Sharp crystals form in the joint fluid.
  

Septic bacterial arthritis of the wrist is possible but rare. It occurs when the wrist joint is infected.

Less Common Causes

Several other conditions can cause wrist pain. They include:

• Ganglion cysts: Benign (harmless) fluid-filled capsules that cause swelling and/or wrist pain; usually located on the back of the hand or wrist
• Cubital tunnel syndrome (ulnar neuropathy): Results when your “funny bone nerve” (ulnar nerve) is compressed; causes numbness and tingling in your ring and pinky fingers
• Carpal boss: A firm, immovable bump on the back of the hand or wrist created by a small area of osteoarthritis at the junction of the long hand bones and small wrist bones
• Tenosynovial giant cell tumor: Benign tumors in the hands, arms, or legs
• Epidermoid cyst: Common skin growths that cause a round bump
• Lipoma: Benign tumors made of fatty tissues
• Tophus: Hardened deposits of gout crystals in the joint
• Rheumatoid nodule: Firm, painless lumps associated with RA
• Synovial sarcoma: A type of soft-tissue cancer

When to See a Healthcare Provider

Certain signs and symptoms can indicate a more serious cause of your wrist pain. Get medical help if you have:

• Pain that lasts more than a few days
• Inability to straighten or flex the joint
• An inability to carry objects or use the arm
• Pain at night or while resting
• A deformed joint
  
• Swelling or significant bruising around the joint or forearm
• Signs of an infection (fever, redness, warmth)
• Numbness or tingling of the hands and/or wrists

Diagnosing Wrist Pain

The wrist is small but intricate. It’s made up of several bones, muscles, and other tissues. This can make diagnosing wrist pain tricky.

To diagnose wrist pain, your healthcare provider may use:

• A comprehensive medical history
• Physical examination
• Imaging tests such as X-rays

If that doesn’t yield a diagnosis, they may move on to other tests.

Medical History

You’ll be asked several questions about your wrist pain. For instance:

• Did it come on suddenly or gradually?
• Did you fall or have some other kind of trauma?
• When is the pain worst?

This kind of information can help them narrow down the possible causes.

Physical Examination

During a physical exam, your provider will look for:

• Bruising
• Swelling
• Skin changes
• Muscle wasting

They’ll feel around to check for tenderness or deformities. They’ll also move your wrist to evaluate its range of motion.

They may do a quick neurological exam on your hand, wrist, and arm. This is to look for sensory problems (tingling, numbness) or muscle weakness.

Imaging Tests

Imaging is common with wrist pain. The first test is typically an X-ray. It can show fractures and arthritis.

If more is needed for a diagnosis, you may be sent for a computed tomography (CT) scan or magnetic resonance imaging (MRI). They can spot soft-tissue problems and fractures missed by an X-ray. That’s common with scaphoid fractures.

Special Tests and Procedures

Other tests and procedures depend on what your healthcare provider suspects.

For example, your provider may do a surgical biopsy—remove tissue for examination in the lab—if they want to diagnose a bump on the wrist and imaging is inconclusive.

They can also perform other tests that may help with the diagnosis.

Test	Checks For	What’s Involved	Positive Result
Tinel test	Carpal tunnel syndrome	Tap on median nerve in wrist	Zinging, “pins & needles” feeling
Finkelstein test	de Quervain’s tenosynovitis	Grip thumb, tilt hand toward little finger	Pain along the thumb
Joint aspiration	Gout of the wrist	Joint fluid withdrawal	Crystals, moderately high white blood cell count
Joint aspiration	Septic arthritis	Joint fluid withdrawal	Extremely high white blood cell count

Differential Diagnoses

Your healthcare provider may order tests to rule out some possible causes of wrist pain. These will likely be based on the nature of your symptoms.

Aside from the above conditions, which are localized (just in the wrist), your provider may also consider systemic (whole-body) illnesses. These may affect, but not be limited to, the wrist itself.

Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is an autoimmune disease involving damage to the joint lining (synovium). It also causes other symptoms such as:

• Unusual fatigue
• Unexpected weight loss
• Pain in other joints

RA tends to affect joints symmetrically, so it’s usually in both wrists. That’s uncommon for a wrist sprain or tendonitis.

Thyroid Disease or Diabetes Mellitus

Thyroid disease and diabetes can alter your tendon structure. That may cause or contribute to wrist pain.

Your provider may order blood tests to rule out these causes. They may include:

• Thyroid-stimulating hormone (TSH) to screen for thyroid disease
• Hemoglobin A1C (HbA1c) to screen for diabetes

Cervical Radiculopathy

Wrist pain can come from a pinched nerve root in your neck. This is called cervical radiculopathy.

The pinching may be due to:

• Cervical stenosis (narrowed spinal canal in your neck)
• A herniated disc in the neck
• Osteoarthritis in the neck

A compressed nerve root causes dull pain and tingling and/or numbness in your palm and first three fingers.

Expect a thorough neurological exam. Then you may be sent for electromyography (EMG) (to evaluate nerve function) and/or a neck MRI.

Wrist Pain Treatment

Wrist-pain treatments depend on the cause. That makes a proper diagnosis crucial.

Self-Care Strategies

Self-care strategies may soothe your wrist pain. They’re especially useful for sprains or tendonitis.

• Rest: Stop using the joint to let the inflammation go down. Don’t rest for long, though. That can lead to stiffness and slow your recovery.
• Ice: Apply an ice pack for 20 minutes every 3 to 4 hours for the first two days. Don’t use it for longer than 20 minutes or you may damage tissues.
• Compression: Wrap your wrist with an elastic bandage. Start at the base of the fingers and go up to just below the elbow. Overlap the wrap by half of its width every time around. Make it snug without cutting off circulation. If your fingers tingle, loosen it.
• Immobilization: Support braces or splints may help with an injury, carpal tunnel syndrome, or wrist arthritis. A fracture may require a cast.

Medications

Nonsteroidal anti-inflammatory pain medications (NSAIDs) and injections of cortisone (a corticosteroid) are commonly used for wrist pain from:

• Sprain
• Tendonitis
• Arthritis

NSAIDs aren’t generally used to treat carpal tunnel syndrome.

Some people with wrist arthritis or carpal tunnel syndrome may benefit from cortisone injections.

Surgery

Some wrist conditions require surgery. These include:

• Certain types of fractures
• Ganglion cysts (if removal is needed)
• Decompression of the median or ulnar nerves in the wrist

If you need surgery, your healthcare provider can help you find a hand surgeon. That’s an orthopedic or plastic surgeon with special expertise in the hand, wrist, and forearm.

Prevention

Some activities put your wrists at risk of getting hurt. A little protection can prevent a lot of injuries.

Avoid wrist sprains by wearing wrist splints or guards during sports like:

• Rollerblading
• Street hockey
• Snowboarding
• Gymnastics

If you ski, use a pole with a low-profile grip. Don’t attach them to your wrists with tight straps.

Some jobs or hobbies involve a lot of repetitive motions. That puts you at risk for carpal tunnel syndrome. Help prevent it by:

• Taking regular breaks
• Using ergonomic devices like a wrist rest or mouse pad
• Having an ergonomic workspace
• Stretching your hands and arms frequently

After Wrist Injury

If you don’t regain full strength and mobility after a wrist injury, you’re more likely to hurt it again.

Be sure you’re fully recovered before going back to sports, work, or other situations where you could re-injure your wrist.

Hand physical therapy can help you strengthen your wrist joint after an injury.

Summary

Wrist pain can come from injuries like sprains, tendonitis, and fracture. It can also come from conditions such as arthritis and carpal tunnel syndrome.

Diagnosing wrist pain may involve a physical exam, bloodwork, imaging, and special tests based on your provider’s suspicions.

Treatment may include rest, ice, anti-inflammatories, splints or casts, and surgery.