The wrist is a rather complex upper limb joint, consisting of a bony component (hence the carpal bones), which connects to the bones of the forearm (radius and ulna) by means of tendons, ligaments, muscles, nerves and blood vessels, allowing the execution of movements such as rotation, flexion, extension, abduction and adduction as a whole.
The set of these movements allows you to complete all daily activities, both simple and complex, which concern the work, sports or personal sphere.
Having made these premises, it is clear how much the wrist is a joint subject to continuous stress and workloads, and how much a pain in the wristmay limit and condition the regular performance of daily activities.
In most cases, pain in both the right and left wrist is due to phenomena of little clinical significance, due to slight traumas, small bruises, fatigue due to the act of lifting weights, and especially to the execution of repeated movements (write to computer, use the mouse), which in the long term can have major repercussions.
Sometimes wrist pain is a result of traumaof greater impact, but generally the painful and functional symptoms leave no doubt on the fact of promptly seeking medical attention. In a smaller number of cases, however, the pain in the wrist is connected to chronic phenomena of inflammation or degeneration . Therefore, in summary, wrist pain can be mainly linked to three types of causes: trauma, inflammation and degenerative diseases.
What symptoms are associated with wrist pain
Pain may occur in one or both wrists, may be localized or extend to the hand or arm, and may be associated with swelling, edema, limitations or inability to move, joint stiffness, tingling and numbness of the skin, deformity, decreased of strength, skin lesions and redness.
Provided the main notions on the structure of the wrist, on its functions, on the modalities of onset of pain and on the accompanying symptoms, we can deepen the discussion by illustrating the main causes that trigger the disorder.
What are the most common causes of wrist pain
Incorrect and / or repeated movements
It can be said that they are among the most common causes of wrist pain, together with those small everyday traumas due to a slight contusion with a hard surface, the execution of sudden movements or due to excessive effort (such as lifting rather heavy weights).
Typing on the computer keyboard or handling the mouse is an action common to all, therefore the possible negative implications are underestimated. In fact, if these movements are repeated and performed for many hours a day they can result in fatigue, therefore in chronic pain and predisposition for more important pathologies such as carpal tunnel syndrome.
Carpal tunnel syndrome
Rather widespread condition and which mainly involves women in adulthood and advanced age. The mechanism underlying the problem is linked to compression and entrapment phenomena of the median nerve (which originates from the brachial plexus).
The symptom most felt is pain, intense and acute, which typically occurs at night , which is associated with the sensation of tingling in the hands and numbness . The possible causes of carpal tunnel are many, from performing repeated movements (using the computer keyboard or mouse for many hours a day), to taking medications such as some antibiotics and anesthetics.
Inflammation process following a trauma, an autoimmune disease or an infection. On the other hand, rheumatoid arthritis is an autoimmune disease that affects all joints and is very much felt in the wrist and hands, locations where very intense pains, reduction in strength, limitations in movement and bone deformities occur.
Chronic and degenerative pathology in which there is a progressive thinning of the articular cartilages and therefore subsequent joint stiffness and limitation of movements.
Fractures are part of the possible consequences of trauma, and constitute a great chapter in the development of very acute pain in the wrist.. There are mainly two types of fractures, namely that of Colles and the fracture of the scaphoid. Let’s see them in detail:
- Colles fracture: it is a displaced fracture of the distal region of the radius bone of the arm, which causes a characteristic deformity of the wrist that takes on the appearance of a “fork back”. It is a phenomenon that mostly affects elderly subjects and is consequent to rather typical traumatic events, that is to a fall forward in which one tries to cushion the blow by unloading all the weight on the hands. The energy of the fall is discharged on the wrist causing it to fracture and the consequent deformity. Before proceeding with the cast, a reduction maneuver must be performedof the fracture, and this is done by means of traction systems using weights calibrated on the patient, keeping the arm flexed at an angle of 90 °. Once the fracture has been reduced, plaster is applied for about 4-5 weeks;
- Fracture of the scaphoid: the modalities with which the fracture is established are completely similar to those of the Colles fracture, therefore a forward fall in which all the energy is discharged on the wrist, without however causing the deformity. The lack of visible signs leads in many cases the patient to underestimate the trauma, which can also have repercussions on the vascularization of the scaphoid, and therefore not to adequately treat the fracture with negative results in the long term.
The fracture of the scaphoid causes severe pain in the wrist which is exacerbated by exerting pressure on the anatomical snuffbox , ie in the dimple located between the root of the thumb and the wrist.
Often, in the emergency room, one of the maneuvers performed by the doctor is precisely that of exerting a force on this area as a preliminary sign to guide the investigations. The pain then causes difficulty or inability to perform movements that involve grasping and squeezing objects. The treatment involves immobilization of the wrist for a period of 6-8 weeks, using a cast involving the wrist and thumb, and then the use of a brace after the removal of the cast.
Condition in which damage occurs to the soft tissues of the wrist , therefore ligaments, tendons, nerves and muscles, following a minor trauma. The main symptom is the pain, very acute, to the point of being exaggerated compared to the extent of the trauma suffered (for example a small bump), due to the excessive stimulation of the peripheral nerve endings.
In addition to intense wrist pain , joint stiffness, limitation of movement, edema and swelling, skin sensitivity and bone demineralization (osteoporosis) due to prolonged immobility of the wrist occur.
This is more rare event, but wrist painit can also manifest itself in relation to this neurological pathology. It is a neurodegenerative disease that leads to the destruction of the myelin sheath that covers the nerves, a sheath that allows the correct transmission of the nerve impulse to the muscles. The result is a progressive limitation of movement until disability, and sensory disturbances including pain, tingling and numbness.
Diagnosis and treatments: what to do in case of wrist pain
Basically the attitude to adopt changes according to the complexity of the problem.
Pain not intense
Until now we have seen how in most cases the pain in the wristis a temporary phenomenon of short duration, resulting from a small bruise or fatigue, perhaps after lifting weights or doing heavy work.
In these cases there is no reason to worry, generally to give relief in a short time it is sufficient to rest the hand, wrist and arm for a few days, applying ice packs.
Intense and long-lasting pain
When the pain in the wrist is very intense, it limits the ability to make movements, it extends over time, and tingling or edema occurs, it is necessary to refer the problem to your doctor who, after evaluating the conditions, may request tests more in-depth and the need to consult a specialist in orthopedics, or as the case may be, to a neurologist.
In general, the visit takes place in two stages, an anamnesis phase, i.e. information gathering and an inspection phase. The anamnesis provides for the administration of questions aimed at understanding all the symptoms felt by the patient and their modalities of onset. While, during the inspection, the doctor examines the wrist, evaluating its skin integrity, the ability to perform all movements, strength, signs of edema and swelling , and if there are points of pain if stimulated by a slight pressure.
On the basis of the data collected, the orthopedist assesses the need to prescribe further investigations in order to confirm the diagnostic hypotheses. In the case of wrist painthe most used investigations involve imaging diagnostics, then x-rays to view the integrity of the bone structures, magnetic resonance imaging (MRI) to assess the state of the soft tissues of the joint, CT scan and electromyography to check the state of the wrist muscles.
The therapies for treating wrist pain depend on the triggering cause of the problem, therefore each treatment must be indicated exclusively by a specialist doctor, the only one who has the necessary knowledge to assess the real needs on which to intervene.
In any case, he is wary of following the instructions found on the internet or taking any initiative based on his own beliefs, because the repercussions could be irreversible, negatively compromising the functionality of the wrist. The therapies are
usually pharmacological in nature and include the use of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and pain relievers.
When instead the pain in the wristand consequent to a fall or direct blow trauma, and is associated with limitations or inability to perform movements, bone deformities, swelling and redness, it is necessary to go to the emergency room as soon as possible and undergo the indicated treatments which may include a cast, corrective maneuvers or surgery, in addition to the administration of painkillers and anti-inflammatories.