Even the slightest wrist pain is noticeable and could impair our activities. The use of computers has made wrist pain a very common complaint.
Causes of Wrist Pain
Wrist pain is commonly caused due to three main factors- mechanical or local, nerve related or systemic disease.
Mechanical Causes: Wrist pain commonly occurs due to trauma to the wrist. Mechanical causes of wrist pain include:
• Bone Fracture: A common type of fall that causes wrist fracture is a fall on an outstretched hand. This causes a fracture called Colles’ fracture in elderly patients with osteoporosis. In children, the bone may be incompletely fractured, resulting in a greenstick fracture. The patient complains of severe pain and swelling following the fall. It can be diagnosed through radiological tests like x-ray, CT scan and MRI.
Some fractures of the small bones of the wrist may not be obvious immediately, and may produce symptoms of wrist pain much later. This pain could be due to nonunion of the fracture or the presence of dead bone fragments in the joint. These fragments may cause inflammation and arthritis in the joint many years after the initial injury. It may be possible to localize the fractured bone during examination or using imaging tests.
• Ligament Tear: A tear of a ligament of the wrist joint may also result due to trauma to the wrist. It is also common in sports persons involved in sports like tennis and hockey. It results in a painful and unstable joint. The pain is usually out of proportion to the injury. The joint moves at a wider range than normal. A clicking or popping sound may be present. The bones may appear misaligned on x-ray. MRI can be used to diagnose the condition.
• Tendon Tears: Damage to the tendons or tears that cross the wrist joint can occur due to trauma, resulting in wrist pain. It may also accompany fractures and ligament tears. It can be diagnosed with MRI or ultrasonography.
• De Quervain’s Tenosynovitis: This condition results from inflammation of the sheath surrounding two tendons at the wrist. The inflammation is a result of chronic repetitive use of the wrist. It may also be a consequence of injury or other inflammatory conditions like rheumatoid arthritis. The patient complains of pain and swelling at the base of the thumb. The pain worsens with activities like turning the wrist, grasping or making a fist. The condition is usually diagnosed on examination.
• Ganglion Cysts: Ganglion cysts are fluid-filled round or oval lumps that are found at joints including the wrist joint. They may cause pain if they press upon a nerve. They often disappear on their own. If they cause symptoms, they may be aspirated or surgically removed.
• Cancer: Cancer of the wrist bones results in the formation of a swelling at the wrist, which is firm in consistency. The wrist is tender to touch.
• Neurological Causes: Injury to any of the nerves crossing the wrist can result in wrist pain. These include the ulnar nerve, radial nerve and the median nerve. The carpal tunnel syndrome is a common cause of wrist pain due to a neurological cause.
• Carpal Tunnel Syndrome: The carpal tunnel is a small passage at the wrist through which tendons and a nerve called the median nerve pass into the hand. Carpal tunnel syndrome occurs when the median nerve gets compressed in this tunnel. The patient complains of tingling and numbness in all fingers except the little finger. The wrist pain may extend up to the shoulder. There may be some weakness of the hand muscles. Patients with diabetes, hypothyroidism or pregnant women are predisposed to developing this condition. The condition is diagnosed based on physical examination, nerve conduction studies and electromyographic studies. Radiological tests may be performed to rule out other conditions.
Systemic Causes of wrist pain include:
• Arthritis and other Rheumatological Diseases: Conditions like rheumatoid arthritis commonly affect the wrist joint. Both wrists are usually involved. The inflammation weakens the tendons and ligaments resulting in laxity at the wrist and deformity in the later stages. Septic arthritis results in severe, deep and unrelenting joint pain making it very difficult to move the wrist. The patient may also give a recent history if infection.
• Gout and other Metabolic Disorders: Metabolic disorders like gout and pseudogout can cause wrist pain along with redness and swelling. However, in gout, the big toe is more commonly affected. Other hormonal conditions like acromegaly, hyperparathyroidism, hypothyroidism and Paget’s disease may also cause wrist pain and should be excluded.
• Blood Cancers: Blood cancers like leukemia and multiple myeloma cause bony pain due to excessive production of blood cells from the bone marrow. Wrist pain may be present in some cases. A blood profile helps to diagnose these conditions.
Frequently Asked Questions (FAQs)
1. Which doctor should I visit in case I suffer from wrist pain?
You should visit an orthopedics specialist in case you suffer from wrist pain.
2. How is a wrist fracture treated?
Wrist fracture is treated by aligning the broken ends of the bone and splinting the wrist, thereby immobilizing it till it heals. In some cases, open surgery may be needed.