Wrist pain

Pain in or around the wrist commonly occurs due to one of the following:

  • fractures
  • tendonitis
  • sprained ligaments
  • compression of nerves
  • arthritis

Fractures

Any fracture involving the forearm, wrist or hand will require a period in plaster. This may be as little as 2-3 weeks, but more commonly will be 4-6 weeks, and for some particularly nasty fractures may be in excess of 8.

The amount of physiotherapy that will be needed is directly proportional to the length of time the wrist is immobilised .When a bone is broken there is bleeding into the adjacent soft tissues, often ligaments are strained or torn, then everything is kept immobile for several weeks, so the muscles, being unable to be used, weaken.

Physiotherapy is essential to get the joints moving normally again as quickly as possible. You will be shown specific exercises to both strengthen muscles and to increase all ranges of movement. After coming out of plaster it is very tempting to be content with just those few movements that are pain free. Down this path lies a perpetually stiff and sore wrist. It is not always necessary to see the physio very often. You can be given a regime of exercises and then be seen 2-4 weeks later to check all is well.

Tendonitis

It is possible to inflame any of the many tendons that cross the wrist, but the most common, by a long way, are two of the tendons that insert into the base of the thumb. They are usually most tender about 2-3cm above the line of the wrist. Often one can feel creaking in the tendons when they are moved and they can be exquisitely painful both to touch and move.

Treatment consists of complete rest, sometimes this has to be achieved by firm and specific strapping so that the thumb is immobilised, but if you're lucky an off the peg thumb brace may do. This can also be further helped by use of ultrasound and if that still doesn't settle it, a steroid injection would be offered.

Tendonitis is caused by overuse or unaccustomed use and in the thumb example above, such things as carrying bricks/books/files or suddenly beginning activities such as tapestry/knitting or overuse of the key board may all be causative agents.

Sprained ligaments

Ligaments are short fibrous bands that exist at joints to hold the joint together and to prevent movement beyond a certain point. They have some degree of elasticity, in that they should be able to stretch and recoil. When a ligament is sprained a varying proportion of the fibres are torn. To effect a rapid repair a good blood supply is required, further strain on the ligament needs to be initially avoided and then a graduated regime of exercises followed until the ligament can be stretched without pain.

The ligaments in the wrist are at either side of the joint and injury to them commonly occurs as a result of falling awkwardly, mistiming a shot in any of the racquet sports, or unskilled use of heavy tools (e.g. sledge hammer, chain saws etc).

Treatment initially should consist of some form of support, ice and rest for 48 hours. After that, gentle pain free movement can begin. If it is not too severe no further treatment may be needed, but if there is a lot of swelling and pain, physiotherapy will help, with the use of ultrasound and other electrotherapy, to speed up the repair process that otherwise would be quite slow. Even so a moderate to severe ligament sprain will take at least 6 weeks to heal.

Compression of nerves

At the wrist this is commonly known as carpal tunnel syndrome. The carpal bones are the bones of the wrist and together they form a tunnel through which the tendons, blood vessels and nerves of the wrist pass. Anything that causes the diameter of the tunnel to diminish may cause compression on these structures. The typical symptoms are numbness and/or tingling in the fingers and hand, which is commonly worse at night.

Loss of diameter of the carpal tunnel can occur after fracture at the wrist, as a result of arthritis, because of hormonal changes, because of repetitive finger and wrist movements giving tendon thickening. Symptoms can be compounded if a neck problem coexists with any of the above.

Treatment varies but will probably involve the use of wrist splints to keep the wrist in an extended position when the width of the tunnel is naturally larger. Nerve conduction studies may be done and physiotherapy may be required to both mobilise the neck, as well as to advise on better working positions and posture. There are also some specific exercises that help to loosen nerves whose movement may be impeded by changes both in the wrist and in the neck.

Arthritis

The commonest form of arthritis is osteoarthritis which is sometimes also referred to as "wear and tear". Naturally it tends to occur more often in the dominant wrist. It involves a thinning of the protective cartilage layer that lies over the bone, subjecting the latter to increasing stress. This responds by thickening and becomes less "plastic" in nature. It is this thickening of the bone that may contribute to the development of carpal tunnel syndrome(see above). The capsules and ligaments that surround and support the joint also become thickened and because the joint gets stiffer these structures lose some of their tensile strength, leaving the joint more vulnerable just at the wrong time! To add insult to injury the associated muscles also begin to weaken partly as a reflex reaction and partly because the stiffness in the joint means the muscles are not used as much.

Treatment will often include some use of anti inflammatory drugs together with some analgesics if required. Wrist splints are often helpful in that they do give some support to the wrists but simultaneously allow functional use of the hands. If the wrists have become or are beginning to get stiff a physiotherapist should be able to show some useful exercises to minimise this and to improve muscle strength.

The nature of the condition is that it tends to have periods of activity and then remains quiescent for some time. During acute attacks some forms of electrotherapy (ultrasound, interferential) may be helpful in reducing swelling and pain.

Read about more common conditions, or contact us to find out how we can help.