Definition & Overview
The wrist is a complex structure made up of multiple joints that allow the hands to move in a variety of directions. Like any other complex structures in the body, the wrist is also prone to a wide assortment of problems ranging from trauma to diseases that affect the bones, ligaments, tendons, and muscles.
Wrist problems can occur suddenly (examples are problems caused by injuries) or develop gradually. A good example of the latter is rheumatoid arthritis, which is a common wrist problem that does not produce symptoms until the condition has progressed.
Wrist problems are often accompanied by pain, which often results in decreased mobility of the wrist. It’s imperative that all problems associated with the wrists be treated before the condition cause permanent damage.
Cause of Condition
Wrist injuries, which are classified as either acute (traumatic) or chronic (overuse), are commonly caused by:
An injury or a disease. Most injuries are sudden and cause immediate damage to the bone, such as a fracture. However, some injuries do not display immediate results.
Participating in active sports like wrestling, boxing, or martial arts.
Accidents. Acute wrist injuries can also occur if you slip on a wet floor and use the hands and wrists to support your weight.
Lifting heavy objects at home or at work.
Performing a certain motion repeatedly over an extended period. For example, swinging a baseball bat, a golf club, a tennis racquet, a sledgehammer, or an axe repeatedly for years can result in chronic injuries that may only become evident after some time.
Stress. Chronic injuries are often caused by stress. They may begin with a simple sprain or strain that displays temporary symptoms, which may come back on their own at a later time or be triggered by another event.
Diseases. Diseases such as arthritis can also be the cause of wrist problems. There are hundreds of different forms of arthritis, but the two that commonly affect the wrists are rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis is an autoimmune disease that often attacks the smaller joints first. Most of these types of joints are found in the hands and wrists. One distinguishing factor of this disease is that it attacks the same type of joints simultaneously, which means that it can attack the wrists on both arms and not just one. Osteoarthritis, on the other hand, damages the articular cartilage that covers the ends of the bones, causing the bones to rub together, preventing the wrists to move smoothly in a variety of directions. This condition is not only painful, but it makes the wrists stiff and weak as well.
Neurologic conditions. Neurologic conditions, which are caused by damage to the radial, median, and ulnar nerves, can also be the primary cause of a wrist problem. Some examples of this condition are carpal tunnel syndrome, Guyon’s canal, and thoracic outlet compression syndrome.
Fracture. Many wrist problems are caused by a fracture. Wrist fractures are mostly evident at the onset, but there are fractures that may be so small that the person won’t even know they are present. In fact, these types of fractures may not be evident in a simple x-ray. Some of the most common wrist fractures are distal radius, Scaphoid, and Chauffeur’s fracture.
The symptoms of wrist problems differ depending on the exact cause. One of the most common symptoms is pain, which can be mild, moderate, or severe and can last a few minutes to several hours. Pain is often accompanied by swelling, especially if it’s a direct result of an acute injury. In chronic wrist injuries, swelling may only be temporary, lasting for a few hours or days. However, most wrist problems result in reduced mobility due to pain or swelling in a certain area or the entire wrist.
Who to See & Types of Treatment Available
If you have an evident problem with your wrists, or you believe that you may have a problem because of certain symptoms, it’s best to consult your primary care physician. Primary care doctors can treat most wrist problems after diagnosing the condition. However, some conditions will need to be referred to a specialist for further diagnosis and treatment.
To make a diagnosis, a physical exam will be performed and this typically involves examining the wrist for signs of swelling and tenderness. The range of motion and the strength of your forearm and grip will also be assessed during the exam.
The doctor may also request imaging tests, such as an x-ray, CT-scan, MRI, or ultrasound to examine the condition of the bones. Most fractures are visible in an x-ray but some may only be seen in a CT-scan. Meanwhile, an MRI and ultrasound are used to examine the tissue, ligaments, and tendons.
The majority of wrist problems will be evident after one or more imaging tests. However, if the doctor is still unable to determine the exact cause of the problem, a minimally invasive diagnostic procedure called arthroscopy will be performed. This procedure involves inserting an instrument called an arthroscope into your wrist to capture images of the structure that are then sent to a video monitor.
If the doctor believes that a wrist problem may be caused by nerve damage, an electromygram (EMG) test will be ordered. This test involves evaluating the electrical activity of the muscles when they are contracted and when at rest.
Following a diagnosis is the formulation of an individualized treatment plan, which can include the use of medications, therapy, surgery, or a combination of these. Most medications are non-steroidal anti-inflammatory drugs (NSAIDs). If you have problems with any of these types of medications, make sure that you inform your doctor. Patients who require therapy to restore their wrists’ mobility will be referred to a physical therapist.
Some wrist problems are treated through surgery, which is often performed on broken bones, torn ligaments and tendons, or on severely damaged nerves. This procedure is often followed by physical therapy.
- American Academy of Family Physicians
- American Academy of Orthopaedic Surgeons