Wrist
The wrist is one of the more complex parts of the human antomy. Due to this there are various conditions that can cause pain or weakness of this important area.
The wrist joints lie between the many different bones in the wrist and forearm. Many wrist injuries (such as fractures, also known as a broken bone) involve the joint surface. There are three joints in the wrist:
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Radiocarpal joint: This joint is where the radius, one of the forearm bones, joins with the first row of wrist bones (scaphoid, lunate, and triquetrum).
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Ulnocarpal joint: This joint is where the ulna, one of the forearm bones, joins with the lunate and triquetrum wrist bones. This joint is commonly injured when you sprain your wrist. Some people are born with (or develop) an ulna that is longer than the radius, which can cause stress and pain on the joint, known as ulnocarpal abutment (impaction) syndrome.
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Distal radioulnar joint: This joint is where the two forearm bones connect. Pain with this joint can sometimes be a challenging problem to treat.
We have extensive experience in the treatment, rehabilitation and preventative management for wrist pain and injuries.
Below provides a list of the most common wrist conditions. Each patient requires an individual assessment to determine the exact type of injury, the causes and any rehabilitation program required. During an appointment with either a Sports Doctor or a Physiotherapist you can expect the following assessment questions:
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History of the pain, including location, severity, referred pain, things that make the pain worse or better.
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Previous related injuries
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Occupational or Sporting activities
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Previous treatments
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Physical inspection of the wrist.
We recommend a booking with a Physiotherapist or Sports Doctor as a first assessment. Our physios will refer you to a Sports Physician if required.
Disclaimer
The common conditions below and the associated information have been produced as a guide only. They do not replace the judgement of a clinician. The below information should never be relied on as a substitute for proper assessment with respect to the particular circumstances of each patient. Patients should consult with an appropriate clinician as soon as practicable post injury to avoid complications.
Common Conditions
Description
Carpal tunnel syndrome is a condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow passageway on the palm side of your wrist.
The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.
Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.
Carpal tunnel syndrome symptoms usually start gradually. The first symptoms often include numbness or tingling in your thumb, index and middle fingers that comes and goes.
Carpal tunnel syndrome may also cause discomfort in your wrist and the palm of your hand. Common carpal tunnel syndrome symptoms include:
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Tingling or numbness. You may experience tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. Sometimes there is a sensation like an electric shock in these fingers.
The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep.
Many people "shake out" their hands to try to relieve their symptoms. The numb feeling may become constant over time.
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Weakness. You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are also controlled by the median nerve.
Treatments
Treat carpal tunnel syndrome as early as possible after symptoms start.
Take more frequent breaks to rest your hands. Avoiding activities that worsen symptoms and applying cold packs to reduce swelling also may help. A physiotherapist will help you diagnose the syndrome and give you exercises and advice to avoid further aggravation.
Physiotherapy
If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome, including:
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Wrist splinting. A splint that holds your wrist still while you sleep can help relieve night-time symptoms of tingling and numbness. Night-time splinting may be a good option if you're pregnant. Territory Sportsmedicine stocks a number of different wrist braces that will provide the required support.
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Education - Your physio will give you techniques to avoid long term strain on the area.
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Physical exercises and stretches - theses will help reduce pain and avoid recurrence in the future
Surgery
Surgery may be appropriate if your symptoms are severe or don't respond to other treatments.
The goal of carpal tunnel surgery is to relieve pressure by cutting the ligament pressing on the median nerve.
The surgery may be performed with two different techniques:
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Endoscopic surgery. Your surgeon uses a telescope-like device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts the ligament through one or two small incisions in your hand or wrist.
Endoscopic surgery may result in less pain than does open surgery in the first few days or weeks after surgery.
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Open surgery. Your surgeon makes an incision in the palm of your hand over the carpal tunnel and cuts through the ligament to free the nerve.
Description
A wrist sprain occurs when the strong ligaments that support the wrist stretch beyond their limits or tear. This occurs when the wrist is bent or twisted forcefully, such as caused by a fall onto an outstretched hand. Wrist sprains are common injuries. They can range from mild to severe, depending on how much damage there is to the ligaments.
Ligaments support the wrist by linking the bones that make up the joint.
Ligaments are strong, fibrous tissues that connect bones to other bones. The ligaments in the wrist help to keep the bones in proper position and stabilize the joint.
Sprains can range from a stretch or tiny tear in the fibers that make up the ligament to a complete tear through the ligament or through its attachment to the bone.
Grades of Wrist Sprains
Sprains are graded, depending on the degree of injury to the ligaments:
- Grade 1 sprain (mild). The ligaments are stretched, but not torn.
- Grade 2 sprain (moderate). The ligaments are partially torn. This type of injury may involve some loss of function.
- Grade 3 sprain (severe). The ligament is completely torn or the ligament is pulled off of its attachment to bone. These are significant injuries that require medical or surgical care. If the ligament tears away from the bone, it may take a small chip of bone with it. This is called an avulsion fracture.
Cause
Wrist sprains are caused most often by a fall onto an outstretched hand. This might happen during everyday activities, but frequently occurs during sports and outdoor recreation.
You may sprain your wrist if you fall onto an outstretched hand.
Symptoms
A sprained wrist is painful. Other symptoms may include:
- Swelling
- Bruising
- Tenderness to touch
- A feeling of popping or tearing inside the wrist
- A feeling of warmth around the wrist
Even a wrist injury that seems mild with minimal swelling could still involve a torn ligament and require surgery to avoid long-term problems.
Similarly, an unrecognized (occult) fracture can be mistaken for a mild or moderate sprain. If left untreated, the fracture may not heal properly and the patient could require a surgery that might have been avoided with early, appropriate treatment. The most common example of this is an occult fracture of the scaphoid, one of the small bones in the wrist.
It is important for your doctor to evaluate even a mild wrist injury if it does not improve quickly. This is especially important if the injury causes persistent wrist pain. Proper diagnosis and treatment of wrist injuries is necessary to avoid long-term problems, including chronic pain, stiffness, and arthritis.
Treatment
Treatment for a wrist sprain depends upon the severity of the injury.
Mild wrist sprains will usually improve with home treatment that includes the RICE protocol:
- Rest. Try not use your wrist for at least 48 hours.
- Ice. Apply ice immediately after the injury to keep the swelling down. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on the skin.
- Compression. Wear an elastic compression bandage to reduce swelling.
- Elevation. As often as possible, rest with your wrist raised up higher than your heart.
Nonsurgical Treatment
Moderate sprains may need to be immobilized with a wrist splint for one week or more. Because immobilization may cause some stiffness in your wrist, your Physiotherapist may recommend some stretching exercises to help you regain full mobility.
