Wrist pain

Did You Know?

• After applying hot or cold pads, if there is no inflammation, a leather or neoprene wrist brace is recommended to rest the wrist.
• Rupture of multiple wrist ligaments in a severe event may require surgical repair.
• A ganglion cyst is associated with minimal and specific pain, such as with forceful hyperextension or a dorsal wrist ganglion.

Structure and etiology

The wrist has 20 ligaments that connect eight carpal bones to the forearm’s radius and ulna and the hand’s metacarpals. A ligament’s risk of injury depends on its location and how it moves. The triangular fibrocartilage complex and scapholunate ligament are especially vulnerable. Sprains happen when a ligament is torn, cut, stretched, or twisted, often from sudden weight or rotation like landing on an outstretched hand after a fall. Osteoarthritis in older adults and rheumatoid arthritis also frequently cause wrist pain.

Types

Wrist pain can arise from injuries and non-injury conditions. Examples include De Quervain tenosynovitis, wrist osteoarthritis, scapholunate advanced collapse, osteoarthritis at the base of the thumb, carpal tunnel syndrome, ganglion cyst, extensor carpi ulnaris tendinopathy, Kienbock's disease, tendinopathy, inflammatory arthritis, rheumatoid arthritis, scaphoid fracture, scapholunate ligament injury, distal radioulnar joint instability, triangular fibrocartilage complex injury and degeneration, and distal radius fracture. Carpal tunnel syndrome's hallmark is tingling, not typically pain. Ulnar nerve entrapment at Guyon's canal causes weakness but is not typically painful.

Evaluation

During a physical exam, a doctor might find tenderness when pressing on the scapholunate ligament at the back of the wrist, just below the radius. Swelling and misshapen joints point to arthritis. The wrist is examined by bending it slightly forward while the doctor feels the back with a thumb. Motion is checked for bending forward, backward, and side to side, and standard X-rays can reveal bone problems.