Dr Mel: Common wrist problems
You need to find the cause in order to find relief...
Our wrist joints allow our hands to be flexible, strong and reach almost any angle, thanks to a network of eight carpal bones and tiny joints that link forearm bones (radius and ulna) to the metacarpal bones at the bases of our thumbs and fingers. They’re surrounded by a sleeve of gristle (the carpal tunnel) which also contains arteries, and nerves carrying movement/sensation signals to and from our hands. Muscles and tendons run across the front and back, connecting our elbows to our fingers, so we can bend, stretch, grip and twist.
Sprains, strains and overuse
Sudden forceful movement or overstretching can tweak or tear wrist muscles, tendons or ligaments, causing pain, tenderness, and perhaps swelling or bruising. If you heard a crack or notice numbness, cold and/or blue discoloration seek medical advice. See your doctor if it doesn’t settle quickly.
Tenosynovitis (inflamed muscle tendon and its tissue sheath) can follow a sprain or awkward/ excessive use. PRICE (see box, below) will help acute symptoms but you need to find and adjust the cause – perhaps your work or a hobby? Physiotherapy, a supportive splint, a steroid injection or even shockwave therapy may cure it.
Fractures
Usually caused by a fall on an outstretched hand, the radius and/or ulna can snap, producing a deformed, painful swollen wrist. You’ll need an X-ray and perhaps an anaesthetic so your wrist can be realigned, as well as painkillers, several weeks in a plaster cast, and possibly physiotherapy afterwards. Wrist fractures are more common in postmenopausal women and people with osteoporosis and increase your risk of later hip fractures. Your doctor will carry out a risk assessment and possibly a bone density scan, and suggest calcium and vitamin D supplements, and/or bone-building bisphosphonate drugs.
Arthritis
The joints between the various wrist bones may suffer wear and tear (osteoarthritis – OA), particularly at the base of the thumb, causing pain. You may have knobbly finger joints and OA elsewhere in the body, too. Use aids, such as jar openers, to reduce stress on
the joints, apply heat or a nonsteroidal anti-inflammatory gel, and/or take painkillers as needed. The wrist can also be affected by inflammatory arthritis such as gout and rheumatoid arthritis, which causes red, hot painful swelling and prolonged morning stiffness – seek medical help quickly. You’ll need blood tests, and perhaps disease-modifying antirheumatic drugs, steroid injections, physiotherapy and advice on coping with daily activities. Individual wrist joints can also be replaced with artificial joints if severely damaged by OA or inflammatory arthritis.