What is causing my wrist pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Wrist pain may be caused by a number of conditions such as carpal tunnel syndrome, sprain or strain, repetitive use, tendonitis or arthritis.
The wrist is a complicated joint. At the base of the hand are two rows of bones, with four bones in each row. These are called the carpals. The long thin bones of the hand radiate out from one row of carpals toward the fingers and thumb. The two bones of the lower arm (radius and ulna) form a joint with the other row of carpals.The bone ends are covered with cartilage, which enables the bones to move smoothly against each other. However, if the cartilage is worn away or damaged by injury, infection or disease, the result is pain.
Carpal tunnel syndrome occurs when pressure is exerted on the median nerve as it travels through the carpal tunnel. The carpal tunnel is formed by the wrist bones on the floor and the transverse ligament on the "roof." Simple devices such as wrist splints can be very helpful. By restricting motion in the wrist, inflammation in the carpal tunnel lessens and symptoms improve as a result. Often the splints are worn at night only. In severe cases, daytime use may be required.
Strains or sprains also respond to rest. Repetitive use injury is a form of soft tissue strain that again responds to rest therapy.
Tears of ligaments inside the wrist can also cause pain. Tearing of the triangular fibrocartilage complex (TFCC) causes severe pain along the outside (ulnar side) of the wrist.
Ganglion cysts are small fluid-filled swollen areas that tend to form on the volar (palmar) side of the wrist. Unless they are causing symptoms, it is best to leave them alone.
Avascular necrosis – dying of the bone- may affect bones in the wrist and cause pain.
Arthritis, particularly inflammatory forms of arthritis such as rheumatoid disease, crystal-induced arthritis, psoriatic arthritis, osteoarthritis, and so forth can affect the wrist.
One of the most common causes of wrist pain is tendonitis. Numerous tendons connect forearm muscle to the fingers. All of these tendons run through sheaths lined with synovial tissue which can be inflamed as a result of trauma or strain.
Most forms of arthritis or tendonitis in the wrist are treated with a combination of injection with glucocorticoids and splinting.
In addition to medication, injections, and physical therapy modalities, patients with a wide variety of wrist problems will benefit from the use of braces and supports.
Aggressive medical therapy is required for patients who have wrist pain due to arthritis.
Some patients require surgery and this may be a very complicated procedure.
Wrist surgery can involve either fusion or replacement. The typical candidate for wrist replacement surgery has severe arthritis but does not need to use the wrist to meet heavy demands in daily use. The primary reasons for wrist replacement surgery are to relieve pain and to maintain function in the wrist and hand.
Wrist replacement surgery may enable a person to retain or recover wrist movements and improve the ability to perform daily living activities, especially they also have arthritis in the elbow and shoulder.
This is a complicated surgery that only a few hand specialists have the expertise to perform.
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