Overview

Wrist pain is a common condition with various causes. The wrist joint plays a role in basic movements, from texting to writing. When pain occurs, it can interfere with day-to-day activities and even impact a person’s quality of life.

The wrist is not one joint. Instead, it’s made up of several small joints where the bones of the hand and forearm meet. Wrist pain is often caused by sprains or fractures from sudden injuries. But wrist pain can also result from long-term problems, such as repetitive stress, arthritis and carpal tunnel syndrome.

Sign and Symptoms

• Achy, dull or sharp wrist pain. The location of the pain can vary.
• Wrist sprain can include swelling and bruising.

• Numbness, tingling, burning, and pain—primarily in the thumb and index, middle, and ring fingers
• Occasional shock-like sensations that radiate to the thumb and index, middle, and ring fingers
• Weakness and clumsiness in the hand—this may make it difficult to perform fine movements such as buttoning your clothes
• Dropping things—due to weakness, numbness, or a loss of proprioception (awareness of where your hand is in space)

Causes

Carpal tunnel syndrome: It is a common cause of wrist pain. You may feel aching, burning, numbness, or tingling in your palm, wrist, thumb, or fingers. The thumb muscle can become weak, making it difficult to grasp things. Pain may go up to your elbow.

Carpal tunnel syndrome occurs when the median nerve gets compressed at the wrist because of swelling. This is the nerve in the wrist that allows feeling and movement to parts of the hand. Swelling can occur if you:

• Do repetitive movements with your wrist, such as typing on a computer keyboard, using a computer mouse, playing racquetball or handball, sewing, painting, writing, or using a vibrating tool
• Are pregnant, menopausal, or overweight
• Have diabetes, premenstrual syndrome, an underactive thyroid, or rheumatoid arthritis

Injury: Wrist pain with bruising and swelling is often a sign of an injury. Signs of a possible broken bone include deformed joints and inability to move the wrist, hand, or a finger. There can also be cartilage injuries in the wrist. Other common injuries include sprain, strain, tendinitis, and bursitis.

Repetitive stress. Any activity that involves repetitive wrist motion — from hitting a tennis ball or bowing a cello to driving cross-country — can inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours on end without a break. De Quervain’s disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis: Arthritis is another common cause of wrist pain, swelling, and stiffness. There are many types of arthritis:

• Osteoarthritis occurs with age and overuse.
• Rheumatoid arthritis generally affects both wrists.
• Psoriatic arthritis accompanies psoriasis.
• Infectious arthritis is a medical emergency. Signs of an infection include redness and warmth of the wrist, fever above 100°F (37.7°C), and recent illness.

Other Causes

• Gout: This occurs when your body produces too much uric acid, a waste product. The uric acid forms crystals in the joints, rather than being excreted in the urine.
• Pseudogout: This occurs when calcium deposits in the joints, causing pain, redness, and swelling. The wrists and knees are most often affected.

Diagnosis

Physical Examination

During your evaluation, your doctor will talk to you about your general health and medical history and will ask about your symptoms. He or she will carefully examine your hand and wrist and perform a number of physical tests.

Tests

Electrophysiological tests. These tests will help your doctor measure how well your median nerve is working and help determine whether there is too much pressure on the nerve. The tests will also help your doctor determine whether you have another nerve condition, such as neuropathy, or other sites of nerve compression that might be contributing to your symptoms.

• Nerve conduction studies. These tests measure the signals travelling in the nerves of your hand and arm and can detect when a nerve is not conducting its signal effectively. Nerve conduction studies can help your doctor determine how severe your problem is and help to guide treatment.
• Electromyogram (EMG). An EMG measures the electrical activity in muscles. EMG results can show whether you have any nerve or muscle damage.

Ultrasound. An ultrasound uses high-frequency sound waves to help create pictures of bone and tissue. Your doctor may recommend an ultrasound of your wrist to evaluate the median nerve for signs of compression.

X-rays. X-rays provide images of dense structures, such as bone. If you have limited wrist motion or wrist pain, your doctor may order x-rays to exclude other causes for your symptoms, such as arthritis, ligament injury, or a fracture.

Magnetic resonance imaging (MRI) scans. These studies provide better images of the body’s soft tissues. Your doctor may order an MRI to help determine other causes for your symptoms or to look for abnormal tissues that could be impacting the median nerve. An MRI can also help your doctor determine if there are problems with the nerve itself—such as scarring from an injury or tumor.

Arthroscopy

If imaging test results are inconclusive, your doctor may perform an arthroscopy, a procedure in which a pencil-sized instrument called an arthroscope is inserted into your wrist through a small incision in your 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.

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

Over-the-counter 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.

Therapy

A physical therapist can implement specific treatments and exercises for wrist injuries and tendon problems. If you need surgery, your physical therapist can also help with rehabilitation after the operation. You may also 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, surgery may be necessary 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.

Prevention and Self care

• Build bone strength. Getting adequate amounts of calcium – 1,000 milligrams a day for most adults and at least 1,200 milligrams a day for women over age 50 can help prevent fractures.
• 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 wrist in a relaxed, neutral position. An ergonomic keyboard and foam or gel wrist support may help.
• You can help prevent wrist pain due to carpal tunnel syndrome by using an ergonomic keyboard to keep your wrists from bending upward. Resting your hands often while typing or doing similar activities
• To help prevent future episodes of gout, consider: drinking more water and less alcohol, avoiding eating liver, anchovies, and smoked or pickled fish, eating only moderate amounts of protein.
• Wear a splint to support your wrist and ease pain, especially at night – you can get these at most pharmacies and supermarkets

References :

https://my.clevelandclinic.org/health/symptoms/17667-wrist-pain

https://www.medicalnewstoday.com/articles/312070#treatment_and_prevention

https://www.mayoclinic.org/diseases-conditions/wrist-pain/symptoms-causes/syc-20366213

https://www.healthline.com/health/wrist-pain#exercises

https://www.webmd.com/pain-management/guide/hand-pain-causes#1

https://www.versusarthritis.org/about-arthritis/conditions/hand-and-wrist-pain/

https://medlineplus.gov/ency/article/003175.htm

https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/