Causes and Treatment of Wrist Pain

Wrist pain has a lot of possible causes. The most common are wrist sprain and tendonitis.

The type of pain varies by cause. It may feel sharp, dull, like pins and needles, or just tightness.

Wrist anatomy is complex. So finding the "why" behind your wrist pain can be tricky. A proper diagnosis is important for choosing the right treatment.

This article looks at common symptoms of wrist pain, possible causes, how it's diagnosed, and how to treat and prevent wrist pain.

Symptoms

Minor wrist pain might go away with at-home treatments. But you should see a healthcare provider if it's more serious.

Get medical help if you have:

• An inability to carry objects or use the arm
• A deformed joint
• Pain at night or while resting
• Pain that lasts more than a few days
• Inability to straighten or flex the 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

If you have other symptoms that concern you, see your healthcare provider.

Causes

The main causes of wrist pain are misuse and overuse. But a lot of other things can lead to wrist pain, as well.

Wrist Sprain

A sprain is a ligament injury. Ligaments are tough connective tissues. They 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 the wrist ligaments are stretched past their limits. A common cause is falling onto your hand.

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 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. Your tendons are encased by a sheath. That's a fluid-filled covering that they glide through.

When it's damaged and swells up, it's called tenosynovitis. It causes the same symptoms as tendonitis.

A specific type of tenosynovitis is called de Quervain's tenosynovitis. It causes wrist pain on the thumb side that may move into the arm.

De Quervain's is most common in women between 30 and 50. Often, it's 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 that 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.
• Gout: Sharp crystals form in the joint fluid.
• Less often, osteoarthritis: "Wear and tear" arthritis associated with age or injury.

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. They're usually in the back of the hand or wrist.
• Cubital tunnel syndrome (ulnar neuropathy): Results when your "funny bone nerve" (ulnar nerve) is compressed. It causes numbness and tingling in your ring and pinky fingers.
• Carpal boss: A firm, immovable bump on the back of the hand or wrist. It's created by a small area of osteoarthritis at the junction of the long hand bones and small wrist bones.

Diagnosis

The wrist is small but intricate. It's made up of several bones, muscles, and other tissues.

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 information and more can help them narrow down the possible causes.

Physical Examination

During a physical exam, your provider will look:

• 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 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. Special tests may help with the diagnosis.

Differential Diagnoses

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

Some possible diagnoses are localized (just in the wrist). Others may be systemic (whole-body) illnesses.

Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) usually leads to a positive anti-citrullinated protein antibody (ant-CCP) test. It also causes other symptoms such as:

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

RA tends to affect joints symmetrically. 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 an electromyogrpahy (EMG) and/or a neck MRI.

Soft Tissue Tumors

A ganglion cyst is the most common cause of a "rubbery" bump on the wrist. But other soft tissues masses can cause wrist pain, too. They include:

• Tenosynovial giant cell tumor: Benign (harmless) 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.

Any of these may be diagnosed with transillumination (seeing if light can pass through it), ultrasound, or MRI.

If the diagnosis is still inconclusive, your provider may do a surgical biopsy. That means removing tissue for examination in the lab.

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 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.

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.

Prevent injuries with wrist splints or guards when playing sports or working. Proper ergonomics are also important.

A Word From Verywell

You may not realize how important your wrists are until you hurt one. A wrist injury can make it hard to use electronics, drive a car, or hold a pencil.

If you have wrist pain, talk to your healthcare provider about it. You're better off getting the right diagnosis and treatment now, before things get worse.