The wrist and hand is very intricate and a detailed assessment can determine the source of the pain. Be warned that an injury to these areas can cause long standing problems if not addressed correctly. If you struggle with activities like gripping, lifting, writing, gardening, typing or knitting it can be an indication that your injury is worse than you thought. All of these tasks are low load activities meaning that it does not take a lot of effort to perform them.
It is extremely important to determine the source of the pain as injuries to the wrist can cause long term problems if not treated correctly. Carpal Tunnel Syndrome is one of the most common causes of wrist pain.
Force of impact like Racket sports, heavy landings/falls or the wrist bending backwards by a fall are common causes of wrist pain. All of these can cause significant pain and discomfort in the wrist making it difficult or even impossible to do anything. The small bones in the wrist doesn’t need much to crack, dislocate, or break.
Technically there are no muscles in the wrist itself, there are merely tendons that crosses the wrist, and their muscle bellies are located in the forearm.
Tendons on the Palm side of your wrist
On the palm side of the hand there are a group of tendons that bend the wrist forward, then there are a group of tendons that run across the wrist further up to the fingers. The tendons that mainly bend the wrist are the Flexor Carpi Ulnaris and Flexor Carpi Radialis, these anchor directly onto the small carpal bones. One tendon assists with bending the wrist called the Flexor Palmaris longus.
Tendons moving the wrist
Flexor Carpi Ulnaris & Radialis, are two tendons that anchor directly onto the wrist, with your palms facing upward, Ulnaris on the inside and Radialis on the outside, separately each one can pull the wrist more inwards (Ulnaris) or outwards using (Radialis). When they contract together their combined force bends the wrist forward.
Cut to these tendons may leave you unable to bend your wrist. If it happens in isolation, Ulnaris will have loss of movement inward, similarly when Radialis is cut you will lose the ability to move your hand outwards. Other pain in the wrist tendons may be caused by irritations to these tendons namely Flexor Carpi Ulnaris & Radialis Tendinitis.
Tendons running across the wrist to the fingers on the palm side
The tendons that run to the fingers are a collection of ropes that forms 3 group.
- The first 4 tendons run at the top (called Superficialis) to the middle part of the finger. Flexor Digitorum Superficialis. You will be unable to bend the middle joints of your fingers when these tendons are cut.
- Deep to this group is another group of 4 tendons that run to the tips of your fingers, Flexor DIgitorum Profundus. You will be unable to bend the top joints of your fingers (tips) when these tendons are cut.
- Flexor Pollicis Longus runs to the thumb. You will be unable to bend the tip of your thumb when this tendon is cut.
Tendons running across the wrist to the fingers on the top side
The tendons that run to the fingers on the top side of the hand are called the Extensor Digitorum Communis tendons. Each finger has one tendon that runs across the wrist to straighten the finger. The index finger has an extra tendon called the Extensor indicis and the little finger (pinkie) has an extra tendon called the Digiti Minimi.
Carpal Tunnel syndrome is the most common nerve problem encountered in the wrist. This involves narrowing of the space inside your wrist that directly puts pressure on the Median nerve that supplies your thumb, index finger & middle finger.
Carpal tunnel syndrome is widely misunderstood and thousands of treatments and gadgets that claim to relieve the pain. Understanding what causes the pain will make you think for yourself. The carpal tunnel is an arch formed by the small bones in the wrist. Inside this tunnel, runs the tendons form the forearm to the hand as well as a nerve. When constant pressure is applied on the tendons and the nerve, they become irritated and swollen. The swelling in this confined space will lead to more compression and the pain doesn’t relieve.
The Ulnar nerve runs through its own tunnel called the guyon’s canal. Ulnar nerve damage & injury causes nerve pain radiating towards the little and ring finger.
Radial nerve runs over the thumb side of the wrist and mainly supplies the top part of the thumb, top of the whole hand up until the middle joint of the fingers. A drop wrist is the most common injury to the Radial nerve leaving you unable to lift your wrist & finger up.
There are 8 small Carpal bones tightly arranged next to each other in two rows in the wrist, the Lunate bone connects to the Ulna and the Scaphoid connects to the Radius.
The most commons condition that affects these contact-points between the bones are joint degeneration or arthritis. Arthritis of the wrist joints are a combination of wear & tear and destruction of the cartilage (cushioning) where the bones meet. Different types of arthritis can also be a main cause of wrist pain which will appear to be worse in the mornings and improve as the day goes on. Stiffness can occurs after a period of rest (after a nights sleep). Burning and warm feeling over the joint is usually a very good indicator of arthritic pain.
Osteoarthritis is progressive wasting away of the bone, like the tires on your car that’s thread gets driven through. Rheumatoid arthritis is a autoimmune, inflammatory disease where your own immune system destroys the inner cushioning between the contact surfaces of the bone.
Then the normal alignment of the carpal bones are disrupted you may have dislocated your wrist. The Scaphoid and Lunate regularly dislocate, and is always accompanied by ligament strains or tears.
Ligaments in your wrist must keep the bones in position and keep the joint stable. The ligaments that must keep the carpal bones stable are very tight & stiff. A very small amount of force is needed to tear these ligaments, due to this inability to have some leeway or ‘give. Thus it’s highly likely to tear these ligaments when the carpal bones are dislocated.
Fractures bring its own complications due to the ligaments that attach onto certain parts of the bone, segments of the bone that breaks away and leaves the rest of the bone vulnerable. These separated fragments will increase its likelihood to dislocate.
Due to the small size of the carpal bones they are prone to fracture quite easily and any disruption or excessive force can crack and injure these vulnerable bones.
The Radius is more common to fracture first because it’s attachment to the wrist is bigger as compared to the Ulna. Pain on the side of the thumb is more prominent. The most clear sign of this type of wrist fracture is that you will have difficulty to lift the thumb up (like showing the OK or “sharp” sign)
An Ulna fracture is on the side of the pinky. Almost all of the fractures to the Ulna break off the Ulnar Styloid process. The Ulna Styloid process is a prominent knob that can be seen on the outside and top of your wrist. If you suspect a fracture, pressing on this knob may be extremely painful and our patients even report not being unable see the knob after it is broken.
Wrist fractures and dislocation almost always happen together.
Symptoms of Wrist pain
How you can ease wrist pain yourself
There are many causes of wrist pain. Here are some tips what you can do and should’t do if you’re experiencing wrist pain.
Come see us if:
Your wrist pain is severe or stopping you form doing your normal activities
Its getting worse or keeps coming back
Unable to work
you need an accurate diagnosis
The wrist pain has not improved after resting it for 7 days
You feel any tingling, pins and needles, numbness or any loss of sensation in your hand, wrist or fingers
You are Diabetic – hand problems can be more serious if you have diabetes
Urgent medical treatment is necessary if:
you have severe pain
feel faint, dizzy or sick from the pain
heard a snap, grinding or popping noise at the time of the injury
you are not able to move your wrist
hold or grip objects
have a wrist that’s changed shape or colour, such as blue or white
swelling that gets worse
you’re unable to sleep from the wrist pain
your pain regresses to tingling, pins and needles or numbness – could indicate nerve damage
|Pain, swelling and bruising, difficult to move wrist or grip anything||Ligament||Sprained Wrist|
|Pain, swelling and stiffness at the base of the finger that lasts a long time, may be hard to move fingers and thumb, may have a lump||Tendon||Tendonitis – de Quervain’s tenosynovitis|
|Aching pain that’s worse at night, numbness or pins and needles, a weak thumb or difficulty gripping||Nerve||Carpal Tunnel Syndrome|
|Smooth lump near a joint or tendon, may be painful||Joint Capsule||Ganglion cyst|
|Sudden, sharp pain, swelling, a popping or snapping sound during the injury||Bone||Carpal bone fracture|
|Dull ache, worse after using it, difficult to turn the hand||Muscle||Muscle strain|
|Thick feeling around wrist that gets worse after being active, and stiff in the mornings||Joint||Arthritis|
Our professional experience with wrist pain
In our experience, one ofthe most common problems we encounter are wrist bone fractures. It doesn’t take much to fracture these bones. Many patients come in with pain that has been troubling them for more than a few weeks. When we take X-rays we usually find an old fracture still trying to heal. Then it’s too late to make changes if the bones has dislocated or started healing in the wrong position.
Taking too long to seek medical help or delayed treatment can significantly change the time it takes to heal your wrist pain.
Most common wrist injuries we treat:
Extensor digitorum tendinitis
Flexor digitorum tendinitis
Carpal (wrist) bone fractures
What needs to be tested to determine the source of your hand pain
Range of Movement
Nerve tension test
Tendon gliding test
A good diagnosis.
A poor diagnosis is the reason for inadequate management of your wrist pain. A medical practitioner can shrug it off and say you merely have a wrist sprain (torn ligaments in the wrist – which needs to keep the joints stable). Thus if the ligaments aren’t able to stabilize the bones in the wrist, that’s a big problem considering it should be able to handle a compression force of up to 80kg. So you’re told to put it in a cast or splint for a few days, then it’ll be fine…
Poor diagnosis is the biggest cause of problems later on. The best wrist pain treatment is to know exactly what you’re dealing with. It must be determined if the ligaments are able to re-attach, how many of the ligaments are torn and to what extent. The healing must be monitored by a skillful eye, to ensure it’s healing as expected or take action if something goes wrong.
It depends on the tissue that’s injured in your wrist. Nerves can take up to two years, where minor ligament sprains only takes 2 – 3 days. Muscle tends to heal faster, if its looked after – but re-injury of vulnerable tissue can keep you in a cycle of breakdown and repair for months or even years. All people don’t heal at the same pace, but we can tailor a program specific for your needs. Your wrist injury can heal faster by the help of an expert Hand therapist. We’ll tell you exactly what you need to do, to ensure your wrist injury heals as soon as possible.
If you’re only getting the pain as you bend your wrist, and not while it’s at rest is a very good sign. This means that you can eliminate your wrist from bending by keeping it in a soft brace or splint. We’ll fit your wrist with a custom splint that’s molded to the contours of your hand to ensure your wrist moves as little as possible. This will help you avoid bending your wrist and causing more pain.
If your goal is to get a hand full of pills, you can visit your local doctor, but I’d recommend you find a medical practitioner that has exceptional skills and knowledge about hands and the intricate structures. Hand therapists are able to test and treat wrist pain – but more importantly get an accurate diagnosis of your problem. If you’re wondering if you need to see a professional, maybe you should. Rather safe than sorry.
- P – Protect your wrist in a splint or cast.
- R – Rest your wrist for at least 48 hours.
- I – Ice your wrist to reduce pain and swelling. Do it for 20-30 minutes every three to four hours for two to three days
- C – Compress your wrist with a compression bandage (Not too tight or you’ll slow down healing)
- E – Elevate your wrist above your heart, on a pillow or the back of a chair, as often as you can.
- Take pain medication like (Panado).
- Use a cast or splint to keep your wrist immobile. This should only be for a short time.
- Stretching and strengthening exercises can be progressed under the supervision of our hand therapist.
- We will guide you through a program specific to your condition.