Wrist Pain

Wrist pain is an extremely common condition. The wrists are used in a variety of different sports such as badminton, tennis, boxing and are also extensively used when we type and in certain occupations. This repetitive motion of certain activities makes some people more susceptible to wrist pain.


Anatomy of the Wrist


There are 15 bones that form connections from the end of the forearm to the hand. The wrist itself contains eight small bones, called carpal bones. These bones are grouped in two rows across the wrist. The proximal row is where the wrist creases when you bend it. Beginning with the thumb-side of the wrist, the proximal row of carpal bones is made up of the scaphoid, lunate, and triquetrum. The second row of carpal bones, called the distal row, meets the proximal row a little further toward the fingers. The distal row is made up of the trapezium, trapezoid, capitate, hamate, and pisiform bones.


The proximal row of carpal bones connects the two bones of the forearm, the radius and the ulna, to the bones of the hand. The bones of the hand are called the metacarpal bones. These are the long bones that lie within the palm of the hand. The metacarpals attach to the phalanges, which are the bones in the fingers and thumb.


All of the nerves that travel to the hand cross the wrist. Three main nerves begin together at the shoulder: the radial nerve, the median nerve, and the ulnar nerve. These nerves carry signals from the brain to the muscles that move the arm, hand, fingers, and thumb.


Two important ligaments support the sides of the wrist. These are the collateral ligaments. There are two collateral ligaments that connect the forearm to the wrist, one on each side of the wrist.


Causes of Wrist Pain


There are two principle reasons for wrist pain. A sudden event or an acute injury can break a bone or tear a ligament. Less apparent, but more slowly developing insidious causes of wrist pain are repeated patterns of activity (repetitive strain injuries or RSI), which over time may cause undue strain on the wrist. Other potential causes of wrist pain include diabetes, thyroid disease, arthritis, and pregnancy (which can cause severe swelling and other wrist problems).


The healing process which results from the traumatic stress of a sudden injury often causes arthritis. An accident occurs, and the bone or the connecting ligaments are broken or torn. After the broken bone


fragments are realigned, even if the realignment appears to be perfect, there will still be some distortion. Over time, the broken bones will settle, increasing the distortion, and the surfaces of the bones will tend to rub and wear out.


Risk Factors of Wrist Pain


Wrist pain can happen to anyone whether you’re very sedentary, very active or somewhere in between. But your risk may be increased by:


  • Sports participation. Wrist injuries are common in many sports, including bowling, golf, gymnastics, snowboarding and tennis.
  • Repetitive work. Almost any activity that involves your hands and wrists if performed forcefully enough and often enough can lead to disabling wrist pain.
  • Diseases and conditions. Your risk of developing wrist pain is increased if you have diabetes, leukemia, scleroderma, lupus or an underactive thyroid gland.


Symptoms of Wrist Pain


Wrist pain may vary, depending on what’s causing it. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing type of pain. The precise location of your wrist pain also can give clues to what might be causing your symptoms.


Investigations in Wrist Pain


Imaging tests


X-rays can reveal bone fractures, as well as evidence of osteoarthritis.

Computerized tomography (CT) scan. CT scans can provide more-detailed views of the bones in your wrist. A CT scan takes X-rays from several directions and then combines them to make a two-dimensional image.

Bone scan. In a bone scan, a small amount of radioactive material is injected into your bloodstream. This makes injured parts of your bones brighter on the resulting scan images.

Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of your bones and soft tissues. For a wrist MRI, you may be able to insert your arm into a smaller device rather than have your entire body slide into a full-size MRI machine.


Nerve tests


If your chiropractor thinks you have carpal tunnel syndrome, he or she might order an electromyogram (EMG). This test measures the tiny electrical discharges produced in your muscles. A needle-thin electrode is inserted into the muscle, and its electrical activity is recorded when the muscle is at rest and when it’s contracted. Nerve conduction tests also are performed as part of an EMG to assess if the electrical impulses are slowed in the region of the carpal tunnel.