Wrist pain

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.

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 is often described as being similar to a dull toothache, while carpal tunnel syndrome usually causes a pins-and-needles feeling or a tingling sensation, especially at night. The precise location of your wrist pain also provides clues to what's behind your symptoms.

When to see a doctor

Not all wrist pain requires medical care. Minor sprains and strains usually respond to ice, rest and over-the-counter pain medications. But if pain and swelling last longer than a few days or become worse, see your doctor. 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.

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 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

• Osteoarthritis. This type of arthritis occurs when the cartilage that cushions the ends of your 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 your wrist.
• Ganglion cysts. These soft tissue cysts occur most often on the part of your wrist opposite your palm. Ganglion cysts may be painful, and pain may either worsen or improve with activity.
• Kienbock's disease. This disorder typically affects young adults and involves the progressive collapse of one of the small bones in the wrist. Kienbock's disease occurs when the blood supply to this bone is compromised.

Risk factors

Wrist pain can happen to anyone — whether you're very sedentary, very active or somewhere in between. But your 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 your 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 — 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.

Diagnosis

During the physical exam, your doctor 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
• Assess your grip strength and forearm strength

In some cases, your doctor may suggest imaging tests, arthroscopy or nerve tests.

Imaging tests

• X-rays. 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 your 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 your 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 visualize tendons, ligaments and cysts.

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.

Nerve tests

Your doctor might order an electromyogram (EMG) if carpal tunnel syndrome is suspected. This test measures the tiny electrical discharges produced in your 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 as part of an EMG to assess if 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

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.

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 an appointment

Although you may initially consult your family physician, he or she may refer you to a doctor who specializes in joint disorders (rheumatologist), sports medicine or even an orthopedic surgeon.

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 doctor

What to expect from your doctor

Your doctor may ask some of the following questions:

• When did your symptoms begin?
• Do they 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?

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