ORTHOPEDICS/HAND & WRIST
Wrist pain is a common illness, sprain and tendonitis being the most frequent causes experienced by a sharp pain, dull ache, pins and needles, or tightness; therefore, because of the wrist’s complex anatomy, defining the cause behind a wrist pain can be a complicated procedure.
That is the reason; the diagnostic practice involves a detailed medical history and physical examination, followed by an imaging test.
A therapy plan will follow, and commonly entails medicine for pain and inflammation regulator (with infrequently, a surgery).
Indications and Signs
A medical attention is required when a person is not sure of the pain cause, or if he do not know the precise therapy for a situation.
Here are some indications of a wrist pain that a surgeon should see:
- Failure to carrying objects
- Damage that causes joint abnormality
- Wrist pain occurring at relaxation
- Wrist pain lasting more than a few days
- Inability to flatten or activating the joint
- Inflammation around the joint (Signs of an inflammation include fever, redness, warmth)
- Coldness and burning of the hand and/or wrist
Emergency Care
When a person face a severe damage at the wrist level causing serious pain, abnormality, coldness with redness in the hand or fingers, he should pass go to the nearest emergency or urgent care clinic.
Reasons
The wrist misuse and/or overuse are the main reasons of wrist pain, there are many other reasons that may be considered.
Wrist Sprain
This frequently happens after a damage, such as a fall onto the hand. The tendons around the wrist joint that stabilize the hand position and allow controlling the movements are stretched outside their normal parameters.
Wrist Tendonitis
Many tendons cross over the wrist, joining the muscles in the forearms to the hand and finger bones. When one or more of these ligaments becomes inflamed, wrist tendonitis develops, and that causes a dull, or an aching pain, or even inflammation.
The most frequent reasons of wrist tendonitis come usually from occupational activities that involve continuous wrist movement, such as typing or working with machinery, and sports that require stress on the wrist (golf, tennis).
Wrist Tenosynovitis
“Tenosynovitis” is often confused with “tendonitis.”
With tenosynovitis, the ligament cover become inflamed and causes the same signs as an inflamed ligament.
Tenosynovitis is a wrist pain that may move into the arm. This disorder is most frequent with women between the ages of 30 and 50.
Carpal Tunnel Disorder
Carpal tunnel syndrome is a disorder generating from a dysfunction of one of the nerves in the wrist. The wrist discomfort tends to worsen at night.
A person with carpal tunnel syndrome experiences coldness and tingling in the palms, as well as in the thumb, index, and the middle finger.
Wrist Crack
A wrist crack is a frequent orthopedic damage.
Wrist crack may arise due to a bone weakness, such as with osteoporosis.
One wrist crack frequent kind is a scaphoid crack, that may occur from a fall on an outstretched hand and the scaphoid bone that is located on the thumb side of your wrist is a curved bone.
A scaphoid crack causes inflammation and pain just under the thumb.
Arthritis
Different kinds of arthritis may affect the wrist.
- Rheumatoid arthritis (RA) usually touches the wrist joint.
- Osteoarthritis of the wrist is less common.
- Septic bacterial arthritis of the wrist (when the wrist joint is inflamed) is probable, but infrequent.
Ganglion Tumor
Ganglion tumors are fluid-filled capsules that cause inflammation and/or wrist pain. They are benign. Rarely, the tumor may compress a nerve, causing some muscle weakness.
Diagnosis
The wrist includes numerous bones, muscles, and tissues, making it quite a complicated zone of the body.
Therefore, when a wrist pain occurs, a complete medical history with a physical examination are required, and frequently followed by an imaging test and an X-ray.
Imaging Test
Imaging is frequently used during the diagnosis of a wrist pain
X-ray being typically the first imaging test ordered, which, instantly, can diagnose a crack or a wrist arthritis.
When X-Ray result is negative, an MRI can generally reveal the cracked bone.
Particular Tests and Measures
Your doctor will carelessly tap on your medial nerve to define if it is inflamed. If he doubt the diagnosis, the Tinel test can help diagnose carpal tunnel disorder.
the Finkelstein test is another test that can help a clinician diagnose de Quervain’s tenosynovitis. In this test, a person makes a fist around their thumb. The doctor then uses one hand to stabilize the forearm, while using the other hand to move the wrist towards the little finger. If this maneuver causes pain along the thumb, the test is positive.
Differential Diagnoses
If the above topics are not suspected as the source of a wrist pain, below, are diagnoses that may be considered. (Some are whole-body sicknesses, while others are localized topics).
Rheumatoid Arthritis (RA)
RA is a different reason of a wrist pain, a person will often have an unusual fatigue, or an unexpected weight loss, or another sort of joint pain.
Furthermore, RA tends to affect joints equally.
All of these signs can help a doctor reaching the accurate diagnosis.
Thyroid Syndrome or Diabetes Mellitus
Thyroid syndrome or diabetes (which can modify the ligament structure) may cause or subsidize to wrist pain.
In order to define the above diagnoses, the clinician may order the following blood tests:
Thyroid stimulating hormone (to screen for thyroid disease)
Hemoglobin A1c (to screen for diabetes)
Cervical Radiculopathy
Soft Tissue Lumps
While a ganglion tumor is the most frequent reason of a “rubbery” collision on the wrist level, other soft tissues masses necessitate to be considered as well, such as:
Tenosynovial massive cell swelling
Epidermoid tumor
Lipoma
Tophus
Rheumatoid nodule
Synovial sarcoma
Note that with a mixture of a transillumination (seeing if light is able to pass through the mass), ultrasound, and/or MRI, specialists can frequently make a correct diagnosis. Consequently if there is any doubt, a surgical biopsy (a tissue sample) is done.
Therapy
it is important to know the reason of the problem before embarking on a therapy program.
Self-Care Plans
A few self-care plans may calm a wrist pain, particularly if diagnosed with a sprain or tendonitis.
Relaxation: The first therapy a wrist pain is to rest the joint and allow the severe inflammation to diminish.
Ice Application: it is a good idea to ice the wrist for twenty minutes every three to four hours for the first two days. (Ice application may calm pain and avoid inflammation)
Firmness: Your surgeon may endorse wrist firmness. The procedure is using an elastic bandage, wrapping the wrist from the base of the fingers all the way up to the top of the forearm, overlapping the wrap by one half of its width.
Immobilization: Support braces or splints may help people who have either experienced a recent wrist sprain damage or who have carpal tunnel syndrome or tendonitis.
Medicines
Nonsteroidal anti-inflammatory pain medicines are frequently prescribed medicines, expressly for patients with wrist pain caused by difficulties such as a sprain, tendonitis, and arthritis. Note that NSAIDs are not used in the therapy of a carpal tunnel disorder.
Cortisone is a commanding medicine also used to treat inflammation which is frequent in patients with wrist pain.
Surgery
Some wrist situations necessitate a surgical process, such as few kinds of cracks, ganglion tumors and median or ulnar nerve decompression.
Wrist Surgery Possibilities
Anticipation
Wearing defensive wrist splints or guards in sports such as rollerblading, street hockey, and snowboarding can help anticipate numerous sprained wrists.
it is important for active persons, especially sportspersons, to ensure full function of their wrist before resuming competitive actions. Physical therapy, specifically hand therapy, can be convenient for strengthening the wrist joint.
A final word
Wrist pain is not entirely relieved with above therapy. However, simple steps like ice, relaxation, and wrist support will be operative with common wrist disorders such as a sprain or tendonitis.
If signs and pain persist despite suitable therapy, a surgery may be an option to find relief.