Wrist Pain, Wrist Joint Pain

Anatomy of Wrist Joint:

Wrist joint includes bones, cartilages, ligaments, tendon, synovial membrane and connective tissue. Wrist joint is the link between radius and ulna with carpal bones.

What is Wrist Joint Pain?

Wrist joint pain is caused by inflammation, infection, ischemia or injury of bones, cartilages, ligaments, tendon, synovial membrane and connective tissue included in wrist joint.

What is Wrist Pain?

Wrist Pain, Wrist Joint Pain

 

 

Wrist pain is spread beyond wrist joint. Wrist pain is caused by wrist joint diseases, nerve injuries, neuritis and referred pain. Wrist pain is in wrist joint and around the wrist joint. Wrist pain is known as acute pain if pain last less than 3 months and pain is known as chronic pain if pain continues beyond 3 to 6 months.

What Are The Causes Of Wrist Joint Pain?

Following Diseases and Injuries Can Cause Wrist Joint Pain:

  • Inflammation- Inflammatory Wrist Joint Pain.
  • Trauma- Traumatic Wrist Joint Pain.
  • Ischemic Injury- Ischemic fracture or injuries to cartilage and ligaments.
  • Infection- Wrist Joint Pain Caused Due to Septic Arthritis.
  • Peripheral Neuropathy

Inflammatory Diseases That Can Cause Wrist Joint Pain

Following Are the Inflammatory Diseases That Can Cause Wrist Joint Pain:

Wrist Joint Pain Caused Due to Arthritis:

  • Osteoarthritis- Pain is secondary to inflammation of joint cartilages.
  • Rheumatoid Arthritis- Pain is caused by inflammation of synovial membrane
  • Psoriatic Arthritis- Pain is secondary to inflammation of cartilage and ligaments of wrist joint.
  • Gout– Pain is caused by uric acid crystal deposit in the joint. In gout, body over produces uric acid resulting in higher blood concentration.
  • Pseudogout- Pain is secondary to calcium pyrophosphate dihydrate (CPPD) deposits within the joint. Joint is swollen and inflamed resulting in pain.

Wrist Joint Pain Caused Due to Wrist Joint Tendonitis:

Inflammation of flexor or extensor tendon is known as wrist joint tendonitis. Tendonitis is an inflammation of tendons and can cause severe wrist joint pain. Laceration or tear of the wrist joint tendon often results in inflammation of tendon resulting in tendonitis. DeQuervain's disease is example of wrist joint tendonitis. DeQuervain's disease is a disease caused by wrist joint tendonitis involving tendon located at lateral side of wrist joint.

Wrist Joint Sprain

Inflammation of ligaments supporting wrist joint is known as wrist joint sprain and is one of the common cause of wrist joint pain. Wrist joint sprain is caused by inflammation of ligaments supporting wrist joint. Inflammation of soft tissue around wrist joint following injuries or spread of cellulitis causes inflammation of ligaments supporting wrist joint.

Inflammation of Ganglion Cyst

Inflammation of ganglion cyst causes severe pain in wrist joint. Wrist joint ganglion is a soft cyst located between tendon and ligament. Presence of Ganglion lubricates and prevents laceration of tendon or ligaments when tendon or ligaments rest against the bone.

Wrist Joint Ganglion Cystitis. Inflammation of Ganglion cyst is known as ganglion cystitis. Ganglion around wrist joint often gets inflamed following manual work involving wrist joint or repeated wrist joint movements while using computer keyboard or typing. This is also one of the causes of pain in the wrist joint.

Traumatic Causes of Wrist Joint Pain

Following Injuries Can Cause Traumatic Wrist Joint Pain

Wrist Joint Pain Can Be Caused Due to Dislocation of Following Wrist Bones

  • Dislocation of Radius
  • Dislocation of Ulna
  • Dislocation of Carpal Bones

Fracture Carpal Bones

Wrist Joint Pain Can Be Caused Due to Fracture of Following Wrist Joint Bones

  • Fracture of Radius
  • Fracture of Ulna
  • Fracture of Radius and Ulna
  • Fracture of Carpal Bones

Wrist Joint Tendon Rupture

  • Fracture of Flexor Tendons- Wrist joint pain is localized on anterior side of wrist and palm.
  • Fracture of Extensor Tendons- Wrist joint pain is localized over extensor surface of wrist joint and back of hand.

Wrist Joint Ligamental Tear

Joint ligament injury such as laceration or tear causes sprain of the wrist joint.

The causes of traumatic wrist joint injuries are as follows-

  • Direct Impact- Direct impact by heavy or accelerating object to the wrist joint causing intense wrist joint pain is mostly seen following auto or work accident.
  • Exaggerated Twist and Turn- Exaggerated twist and turn of wrist during fall off the slippery surface or ice causes fracture of the wrist joint.
  • Sports Injury- Twists and turns of the wrist joint during contact sport causes wrist joint injury.
  • Repetitive Motion Injury- Repetitive motion injuries can cause ligament and tendon injuries.

Ischemic Wrist Joint Bone Necrosis Resulting in Wrist Joint Pain

Avascular necrosis of wrist joint bone is one of the rare causes of the wrist joint pain. Progressive ischemia or collapsing of the peripheral blood vessels to carpal bone in young patient causes necrosis of small carpal bone. Condition is known as Kienbock's disease.

What is Septic Necrosis?

Infection of wrist joint following trauma or local spread of cellulitis causes infection of wrist joint known as septic necrosis.

Wrist Joint Pain Caused Due to Peripheral Neuropathy

Peripheral neuropathy is a systemic disease of peripheral nerve caused by irritation of the nerve or nerve damage. Peripheral neuropathy causes symptoms in multiple areas of the body.

What Are The Causes Of Peripheral Neuropathy?

Causes of Peripheral Neuropathy Are As Follows:

  • Degenerative Disease of Peripheral Nerve.
  • Irritation of Peripheral Nerve.
  • Laceration or Tear of Peripheral Nerve.

What Are The Symptoms Of Peripheral Neuropathy?

Peripheral Neuropathy Can Cause The Following Symptoms:

  • Wrist Joint Pain.
  • Tingling.
  • Numbness.
  • Weakness of Wrist Joint.

Which Illnesses or Medical Conditions Can Cause Peripheral Neuropathy Resulting In Wrist Pain Or Wrist Joint Pain?

Following Illnesses Cause Peripheral Neuropathy:

What Are The Causes Of Peripheral Nerve Injury That Results in Wrist Joint Pain?

Peripheral nerve is the bundle of sensory and motor nerves outside spinal cord that communicates with peripheral organ. Causes of injury to the peripheral nerve that can cause wrist pain are:

  • Direct injury like laceration or deep cut of the nerve proximal or distal to wrist joint.
  • Nerve injury following wrist joint dislocation.
  • Nerve injury following wrist joint fracture.
  • Pinch or compression of peripheral nerve as in carpal tunnel syndrome.

What Are The Risk Factors For Wrist Joint Pain?

Risk Factors for Wrist Joint Pain are as follows:

  • Repetitive Use of Wrist Joint- Recurrent use of wrist joint in activities like typing, drawing, writing, or sewing can cause inflammation and tear of ligaments of the wrist causing wrist joint pain.
  • Overweight- Obesity is associated with osteoarthritis2 and carpal tunnel syndrome resulting in severe wrist joint pain
  • Pregnancy- During pregnancy, endocrine gland secretes abundant quantity of relaxing hormone, which causes joint laxity and pain.
  • Post Menopausal Joint Pain- Multiple joint pain including wrist joint pain is caused by hormonal changes and arthralgia following menopause.1
  • Diabetes- Joint pain is often seen in patient suffering with diabetes secondary to diabetic neuropathy, vasculitis and obesity.
  • Hypothyroidism- Hypothyroidism causes hypertrophy of the ligament of the wrist joint resulting in nerve compression such as carpal tunnel syndrome and restricted painful joint movements.3 Hypothyroidism also causes tendonitis.4
  • Alcohol- Regular consumption of alcohol causes inflammatory tendonitis and neuropathy resulting in wrist joint pain.

Wrist and Finger Joint Bones

What are the Symptoms of Wrist Joint Pain?

Wrist Joint Pain Symptom Are-

  • Intensity of Pain- Wrist Joint Pain intensity can be mild, moderate or severe.
  • Occurrence of Pain- Wrist Joint Pain can be either sudden or gradual in occurrence.
  • Frequency of Pain- Frequency of occurrence of wrist joint pain is either constant or intermittent.
  • Daily Incidence of Pain- Wrist Joint Pain is worse in the morning or at night.
  • Character of Wrist Joint Pain- Pain is sharp, throbbing, or burning.

Describe The Other Symptoms Associated With Wrist Joint Pain?

  • Sensory Nerve Neuropathy- Tingling and numbness in wrist joint and hand.
  • Motor Nerve Neuropathy- Weakness of wrist joint and hand.

Describe Abnormal Signs Associated With Wrist Joint Pain?

  • Bruises- Wrist joint bruise may be associated with hematoma or blood clot.
  • Weakness- Trouble making a fist or gripping the objects.

Swollen Wrist Joint- Seen in following cases

  • Bleeding – Subcutaneous or intra-articular (within the joint).
  • Wrist Joint Dislocation.
  • Wrist Joint Fracture.
  • Wrist Joint Arthritis.
  • Wrist Joint Sprain.

Warmth and Redness of Wrist Joint May Indicate:

  • Septic arthritis.
  • Wrist Joint Abscess.

Fever:

  • Septic Arthritis.
  • Infected Tendinitis.
  • Infected Ligaments- Sprained ligament.

How is Wrist Joint Pain Diagnosed?

Electromyography (EMG) of Upper Extremity:

  • EMG is done to evaluate sensory and motor nerve damage that could be causing wrist joint pain.
  • It helps to evaluate prognosis and improvement of nerve damage.

X-Ray of Wrist Joint:

  • X-ray are done to evaluate fracture of wrist joint pain.
  • Evaluate Wrist Joint Dislocation.

MRI of Wrist Joint:

  • MRI helps evaluate fracture which could be the cause of wrist joint pain.
  • Helps Evaluate Wrist Joint Dislocation.
  • Evaluate Bleeding and Hematoma (Blood Clot).
  • Evaluate Nerve Laceration Or Tear.
  • CAT Scan of Wrist Joint
  • CAT Scan helps evaluate fracture.
  • Helps Evaluate Wrist Joint Dislocation.
  • Evaluate Bleeding and Hematoma (Blood Clot).
  • Ultrasound of Wrist Joint
  • Evaluate Fracture.
  • Evaluate Wrist Joint Dislocation.
  • Evaluate Bleeding and Hematoma (Blood Clot).
  • Evaluate Abscess Or Infected Arthritis.

Blood Examination:

  • White Blood Cell Count (WBC) - Increase in infection.
  • Erythrocyte Sedimentation Rate (ESR) - Increase in infection.

What is the Treatment for Wrist Joint Pain?

The Following Are the Treatment Choices for Wrist Joint Pain -

  • Conservative Treatment.
  • Medications.
  • Physical Therapy.
  • Interventional Pain Therapy.
  • Surgery.

Conservative Treatment for Wrist Joint Pain

Conservative Treatment for Wrist Joint Pain Is As Follows-

  • Wrist Brace or Splint Helps to Reduce Swelling and Ease Wrist Joint Pain.
  • Hot or Cold Compresses are an effective treatment to soothe wrist joint pain.
  • Weight Loss: It is important to try to lose weight if you are obese.
  • Exercise or Yoga Therapy for Upper Extremity can help deal with wrist joint pain.

Medications Prescribed To Treat Wrist Joint Pain

Wrist joint pain is treated with following medication-

NSAID:

Most used Non-Steroidal Anti-inflammatory Medications (NSAIDs) are Motrin, Naproxen and Celebrex.

Opioids:

Opioids are prescribed for severe intractable wrist joint pain pain not responding to NSAIDs and NSAIDs are contraindicated because of severe side effects.

Which Opioids Are Prescribed For Wrist Joint Pain?

Acute wrist joint pain of less than 3 months duration is treated with short acting opioid medication and pain lasting more than 3 months is treated with long acting opioids. Breakthrough wrist joint pain is treated with short acting opioids.

What is Breakthrough Wrist Joint Pain?

The pain is known as breakthrough pain when wrist joint pain is induced by activities despite patient being treated with long acting opioids. You may suffer with severe sudden intractable pain while chronic wrist joint pain is treated with long acting opioids.

Which Are The Most Commonly Used Long Acting Opioids?

Long Acting Opioids That Are Most Commonly Used in the treatment for Chronic Wrist Joint Pain Are As Follows-

  • Morphine- MS Contin.
  • Oxycodone- Oxycontin.
  • Fentanyl Patch.
  • Methadone.
Which Are The Most Commonly Used Short Acting Opioids?

Most common short acting opioids used in the treatment of wrist joint pain are as follows-

  • Hydrocodone- Vicodin, Lortab and Norco.
  • Oxycodone- Percocet.
  • Morphine- Morphine ER.

Antidepressant Analgesics and Antiepileptic Analgesics

Antidepressant or antiepileptic analgesics for Wrist Joint Pain are used for following reason-

  • Chronic Wrist Joint Pain Not Responding To Opioid or NSAIDs.
  • Neuropathic Pain.
  • Alternative Pain Medication If Patient Is Addicted To Opioids.

Anti-epileptics Used As Anti-Neuropathic Analgesics (Pain Meds) in the Treatment of Wrist Joint Pain Are As Follows-

  • Neurontin.
  • Lyrica.

Anti-depressants used as Anti- Neuropathic Analgesics (pain meds) in the Treatment of Wrist Joint Pain are as Follows-

  • Cymbalta.
  • Elavil.

Anti-Rheumatoid Arthritis Medication

Medications Used For Advanced Treatment of Wrist Joint Pain Caused By Rheumatoid Arthritis Are As Follows-

  • Methotrexate (Trexall).
  • Leflunomide (Arava).
  • Hydroxychloroquine (Plaquenil).
  • Sulfasalazine (Azulfidine).

Immunosuppressant

Immunosuppressant That Are Prescribed To Treat Wrist Joint Pain Caused By Rheumatoid or Psoriatic Arthritis Are As Follows-

  • Azathioprine (Imuran, Azasan).
  • Cyclosporine (Neoral, Sandimmune, Gengraf).
  • Certolizumab (Cimzia).

Muscle Relaxants

Muscle Pain or Muscle Spasm Causing Wrist Joint Pain Are Treated With Following Medications-

  • Baclofen
  • Flexeril
  • Skelaxin
  • Robaxin

What Are The Indications For Physical Therapy for Wrist Joint Pain?

  • Wrist Joint Pain caused due to tendonitis, sprained wrist joint and post surgical pain.
  • Muscle Spasm- Associated with tendonitis, sprained wrist joint, or after surgery.
  • Wrist Joint Stiffness- Associated with tendonitis, sprained wrist joint, or after surgery
  • Wrist Joint Instability- After surgery or closed reduction.

Is Physical Therapy Useful Before Reduction Of Fracture Or Dislocation Of Wrist Joint?

No, physical therapy is not useful before fracture or dislocation is corrected and treated with close or open reduction.

Is Interventional Pain Therapy Useful To Treat Wrist Joint Pain?

Yes, interventional pain therapy using corticosteroid injection is useful to treat wrist joint pain caused by tendonitis, sprained wrist joint and postoperative chronic pain.

Is There Alternative Interventional Pain Treatment If Pain Is Not Responding To Corticosteroid Injection?

Chronic Pain Can Be Treated In Selective Patient By Following Advanced Therapy:

  • Stimulation of wrist joint by using Spinal Cord Stimulator, which is placed in epidural space in the neck.
  • Intrathecal morphine injection delivered through morphine pump. Morphine pump is placed under abdominal wall. Pain meds such as morphine is delivered through catheter into cerebrospinal fluid.

Which Are The Surgical Treatment Options For Wrist Joint Pain?

Surgical Treatment Options for Wrist Joint Pain Are As Follows:

  • Open Reduction of Wrist Joint Dislocation.
  • Open Reduction of Wrist Joint Fracture.
  • Surgical Repair of Tendon Tear or Laceration.
  • Surgical Repair of Ligament Tear.

What Can Be Done To Prevent Wrist Joint Pain?

Following Precautions Can Be Taken To Prevent Wrist Joint Injury-

  • Avoid Repetitive Injury- Adjust your keyboard typing machine or any equipment so wrist movement are performed with least stress on tendon and ligaments.
  • Take Frequent Breaks From Activities That Require Continuous Wrist Movement.
  • Avoid Alcohol.
  • Lose Weight If You Are Obese.
  • Drink Plenty Of Water If You Have any Symptoms Of Joint Pain, Gout Or Pseudogout.
  • Prevent Frequent High Blood Sugar By Taking Regular Anti-Diabetic Medication.
  • Get Treated As Soon As Possible For Hypothyroidism Or Amyloidosis.

When Should You Contact a Doctor?

If you experience any of following symptoms you should consult doctor-

  • Wrist joint pain not responding to anti-inflammatory medications or lasting more than a week.
  • Tingling or numbness in the wrist or hand.
  • Weakness or inability to move wrist and hand.
  • Wrist joint bruises or bleeding.
  • Wrist joint swelling and fever over 100°F.
  • Wrist joint swelling, redness and pain.

Also Read:

References

  1. Menopausal arthralgia: Fact or fiction.

    Magliano M.

    Maturitas. 2010 Sep;67(1):29-33. doi: 10.1016/j.maturitas.2010.04.009.Stoke Mandeville Hospital, Aylesbury, HP21 8AL, UK. This email address is being protected from spambots. You need JavaScript enabled to view it.

  2. The association of obesity with joint pain and osteoarthritis in the HANES data.

    J Chronic Dis. 1986;39(4):311-9.

    Hartz AJ, Fischer ME, Bril G, Kelber S, Rupley D Jr, Oken B, Rimm AA.

  3. Clinical manifestations and outcome of polyarthralgia associated with chronic lymphocytic thyroiditis.

    Punzi L, Sfriso P, Pianon M, Schiavon F, Ramonda R, Cozzi F, Todesco S.

    Semin Arthritis Rheum. 2002 Aug;32(1):51-5.Division of Rheumatology, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy. This email address is being protected from spambots. You need JavaScript enabled to view it.

  4. Hypothyroidism presenting as tendinitis.

    Phys Sportsmed. 1997 Jan;25(1):47-55. doi: 10.3810/psm.1997.01.1094.Knopp WD, Bohm ME, McCoy JC.

    MacNeal Hospital, Berwyn, IL, 60402, USA.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: June 5, 2017

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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