Wrist pain is a common complaint that can interfere with day-to-day activities. It can develop due to a sudden injury or chronic disorders. Because so many factors can culminate in wrist pain, diagnosing the exact cause can be challenging.
The wrist plays a vital role in basic hand movements, from texting to writing. It comprises of several smaller joints where the bones of the hand and forearm meet. If any parts of the wrist become injured, you can feel pain in the wrist.
The carpal tunnel is a narrow passageway in the wrist at the base of the hand. The floor and sides of the carpal tunnel and comprised of eight small wrist bones called the carpal bones that connect the hand to the forearm. The roof of the carpal tunnel is a rigid band of connective tissue called the transverse carpal ligament. Because these boundaries are very rigid, the carpal tunnel has limited capacity to “stretch” or increase in diameter.
Triangular fibrocartilage complex (TFCC)
Triangular fibrocartilage complex (TFCC) is the area between your ulna and radius, the two main bones that make up your forearm on the pinky side of the wrist. It connects the bones in the hand to the bones in the forearm to form the wrist.
It is made of a network of ligaments, tendons, and cartilage that helps your wrist move and stabilizes your forearm bones, particularly when you grasp something with your hand or rotate your forearm. It also acts as a cushion for the small joints.
The median nerve runs down the length of the arm and forearm, passes through the carpal tunnel at the wrists, and goes into the hand. It controls sensations and muscle impulses in the fingers (except for the pinkie finger and half of the ring finger that’s closest to the pinkie finger).
The wrist tendons are divided into two groups: those on the back of the wrist (the extensors) and those on the front of the wrist (flexors). They bend the fingers and thumb and also travel through the carpal tunnel. Together, these tendons are responsible for subtle and complex movements in the wrists, fingers, and hands.
The tendon sheaths allow the tendons to glide smoothly as the wrist bends back and forth in a low-friction manner. The fluid within the tendon sheath surrounding the flexor tendon is called synovial fluid. Usually, the synovium lubricates the tendons, making it easier to move your fingers.
Bursa is a fluid-filled sac that cushions the joints. There are two major bursae of the wrist: radial bursa and ulnar bursa.
Wrist pain can be caused by injury or disease affecting any part of the wrist joint, including ligaments, bones, and connective tissues surrounding the area. The most common causes of wrist pain include the following:
Carpal tunnel syndrome
Carpal tunnel syndrome is caused by compression of the median nerve in the carpal tunnel. It occurs when the ligament thickens or when the tunnel becomes narrow, exerting pressure on the nerve. The nerve is squeezed, which causes pain, paresthesia (tingling pins and needles sensation), weakness, and numbness on the side of your hand near the thumb. You may feel it in your thumb and any of your fingers, except the pinkie finger. The strange sensation may also radiate up your forearm, making it hard to grip objects.
Common symptoms of carpal tunnel syndrome include:
Pain, tingling or numbness
Tingling, numbness, and pain in your fingers or hand. Usually, the thumb and index, ring or middle fingers are affected, but not your pinkie finger. Sometimes there is a shock-like sensation in these fingers that may radiate from your wrist up to your arm. These symptoms often occur while holding a newspaper, hone, or steering wheel.
You may experience weakness or loss of proprioception in your thumb’s pinching fingers, causing you to drop objects clumsily. It may be difficult to perform fine movements, such as buttoning your clothes.
Fingers “fall asleep.”
You may first notice that your fingers “fall asleep” and become numb at night. That usually happens in the evening because of the relaxed or bent position of your hand while sleeping. In the morning, you may wake up with numbness in your hands that may run to your shoulder and feel like you need to “shake out” your hands to try to relieve your symptoms.
As the condition deteriorates, you may experience symptoms during the day, as well. It may happen when you’re doing something where your wrist is bent or a long time, like holding your phone, driving a car, or reading a newspaper.
Wrist injuries may occur when you fall forward onto your outstretched arms. This can cause sprains, strains, and even fracture in the wrist.
A wrist sprain is commonly caused by falling and bending on the wrist backward when the hand hits the ground, overstretching the wrist ligament. On the other hand, a wrist strain results from injury to the wrist tendon.
A wrist fracture, otherwise known as a broken wrist, happens when there is a break in any of the wrist bones. The most common bone to break is the radius (distal radius fracture).
Wrist tendonitis can occur when the tendons around the wrist joint develop microtears or become irritated or inflamed. The condition usually occurs due to repetitive movements involving the wrist. It may be triggered by everyday activities such as playing sports, using a computer, writing, and physical work. Often, it happens at points where the tendons intersect each other or pass over a bony prominence, causing discomfort when moving the wrist joint.
Common symptoms of wrist tendonitis include:
- Dull, passive pain in the wrist, especially after you wake up in the morning
- Swelling around the wrist joint
- Warmth and redness of the wrist tendons
- Soreness and tenderness when you put pressure on your wrist
- Grinding sensations (crepitus) with the movement of the wrist tendons
Wrist tendonitis can also decrease the range of motion in your hand. You may experience weakness when performing routine motions, such as gripping, pinching, throwing, typing, and using a computer mouse.
Repetitive motion syndrome
As the name suggests, repetitive motion syndrome is triggered by repetitive tasks, such as knitting or typing. Overworking the wrist joint can cause it to swell, exerting pressure on the surrounding nerves. It can cause pain in the wrist and hand.
When the bursa in the wrist is inflamed, it is referred to as wrist bursitis. Symptoms of wrist bursitis include tenderness over the bursa of the wrist, redness in the area, and swelling.
Triangular fibrocartilage complex tear
Sustaining an injury or tear to the triangular fibrocartilage complex (TFCC) can cause pain along the outside of the wrist.
Symptoms of TFCC tear include:
- Pain along the outside of the wrist
- Pain when touching or moving the wrist
- Stiffness or weakness in the wrist
- A limited range of motion in hand or wrist
- Wrist swelling
- A popping or clicking sound as you move the wrist
Ganglion cyst occurs when fluid-filled cysts develop on the part of the wrist opposite the palm (on the back of the hand). It may also develop on the palmar aspect of the wrist (on the palm side of the hand).
Most ganglion cysts form a visible lump. However, smaller ganglions may remain hidden under the skin (occult ganglions). When formed on the back of the wrist, they become more prominent when the wrist is flexed forward.
Ganglion cysts typically produce no symptoms. Nevertheless, if it presses on the adjacent nerves that pass through the joint, it can cause pain, tingling, and muscle weakness. Their location can sometimes also interfere with wrist movement.
De Quervain’s disease
De Quervain’s disease is the inflammation of the tendons that begins in the thumb and extend to the wrist. It causes pain on the thumb side of the wrist and may radiate up to the forearm. You may also experience a grating feeling inside the wrist as well as swelling and weakness.
If you have de Quervain’s tendinitis, it can be painful when you:
- Make a fist
- Grasp or hold objects
- Turn your wrist
Kienbock’s disease occurs when the lunate bone in young adults becomes damaged due to restricted blood supply. It is otherwise known as avascular necrosis of the lunate or osteonecrosis of the lunate.
In the early stage, Kienbock’s disease causes pain in the wrist. As the disease progresses, the bone tissue may die and cause other symptoms, including:
- Wrist immobility, swelling, stiffness
- Tenderness over the lunate bone
- Weak grip strength
- Difficulty turning the hand upward
- Clicking or clunking sound when your wrist moves
Rheumatoid arthritis is an autoimmune disorder whereby the body’s immune system attacks healthy tissues, including those in the wrist. If the wrist joints are affected, you may feel pain in both wrists. Eventually, it can lead to damage in the wrist cartilage, allowing the wrist bones to rub together, resulting in permanent damage. Aside from pain, you may also notice joint stiffness around the wrist, which can limit your range of motion.
Osteoarthritis in the wrist is uncommon. It usually occurs only in people who have injured the wrist in the past.
When to see a doctor
See a doctor if:
- Wrist pain is interfering with everyday activities
- Simple hand movements are no longer possible
- Tingling or numbness is becoming worse, and there is little or no sensation in the fingers or hands
- Weakness and decreased ability to grip objects
Delayed diagnosis and treatment can impede healing and reduce the range of motion in your wrist.
During the physical exam, your doctor may:
- Check your wrist for swelling, tenderness, or deformity
- Assess your grip strength and forearm strength
- Request you to move your wrist to check for any decrease in your range of motion
Imaging tests, such as X-ray, CT scan, MRI, and ultrasound, may be ordered to reveal and structural damages or abnormalities in the wrist.
Arthroscopy is the gold standard for evaluating chronic wrist pain. It involves making a small incision on the wrist to insert a tiny camera, which can take pictures of the wrist structure for evaluation.
Your doctor may order an electromyogram if carpal tunnel syndrome is suspected. This test measures the electrical discharges produced in the muscles to identify any muscle damage and rule out other conditions.
Nerve conduction studies
A shock wave is passed through the median nerve to check if electrical impulses are obstructed in the carpal tunnel. It measures how fast nerve impulses travel through the carpal tunnel region of the wrist.
Treatment for wrist pain depends on the underlying cause and severity.
Over-the-counter pain relievers, including ibuprofen (Motrin IB, Advil, etc.) and acetaminophen (Tylenol, etc.), may help reduce wrist pain and inflammation. Stronger pain relievers are available via prescription.
In some cases, wearing a wrist splint or brace at night can help prevent wrist pain by keeping you from bending your wrist while you sleep. It can also reduce the squeezing of the median nerve. You should also wear it during the day while doing activities that aggravate your wrist pain.
A physical therapist can implement specific hand therapy and exercises to strengthen the wrist. You could also benefit from having an ergonomic evaluation that addresses workplace factors that may be contributing to wrist pain.
Hand therapy is a specialized treatment that is focused on the complex function and structure of the hand. It involves many modalities, from stretching and strengthening to electrical stimulation and ultrasound.
If your job or activities aggravate your wrist pain, changing or modifying these activities can help slow or stop the disease progression. In some cases, this may involve making ergonomic changes to your workstation.
Ice and heat
Cortisone injections can reduce pain and inflammation when delivered directly into the affected site. While cortisone injections are safe, you should limit your doses because they can weaken tendons over time.
Surgery is only considered if non-invasive treatments have not relieved your symptoms. The type of surgery depends on the cause and severity of wrist pain.
It’s impossible to prevent wrist injuries, but these essential tips may help minimize stress on your wrist:
Reduce your force and relax your grip
If your work involves a keyboard or cash register, for instance, hit the keys gently. Consider an ergonomic keyboard if you spend long hours at the keyboard. For prolonged writing, use a pen with a soft grip adapter and free-flowing ink.
Take frequent breaks
Gently stretch and bend your wrist periodically. Alternate tasks when possible, primarily if you use equipment that vibrates or that requires you to exert a significant amount of force on your wrist. You should also take regular breaks from using a keyboard.
Watch your form
Avoid bending your wrist up or down when you type on your keyboard. A relaxed neutral position is best.
Pay attention to ergonomics
Use protective gear for athletic activities
Wear wrist guards for high-risk contact sports, such as football, skateboarding, snowboarding, and rollerblading.