Humans have always relied on strong wrists and hands to perform daily tasks like gardening, needlecraft, woodworking, building and just about any craft or trade you can think of. In modern times, technology has impacted the way in which most of us use our wrists and hands, and we often spend long hours typing on a computer keyboard or texting with our thumbs. In athletics, the wrists may be used to provide support, break a fall or stabilize the hand.
In any case, ongoing repetitive use of the wrists and hands can lead to painful conditions of the wrists that require treatment.
We commonly think of the wrist as a single joint, but it is actually a complex structure made up of multiple small joints that connect the carpal bones of the hand to the radius (on the thumb side) and the ulna (on the pinky side) of the forearm. While the structure of the wrist bears some similarity to the ankle, its bones are smaller and more fragile, with less cartilage and thinner ligaments.
The wrist is made up of eight carpal bones arranged in two rows of four. The ulna does not connect directly to the carpals, but its confluence is facilitated by a disc called the Triangular Fibrocartilage Complex (or TFCC) that serves as a sort of meniscus in the wrist. The TFCC can be easily injured during weight bearing activities. The TFCC also attaches to the radius though ligaments and fascia, so an injury can have a broad effect on wrist function.
Every small bone in the wrist forms a joint with adjacent small bones, creating dozens of joints that allow for a diverse range of movement and dexterity of the wrist and hand. Multiple ligaments throughout the wrist provide support to the wrist joints.
The muscles that provide wrist and hand movement are primarily located in the forearms, with long tendons that reach into the wrist and hand. Two thick ligamentous bands at the wrist anchor the tendons in place. The anterior, or palmar band, called the transverse carpal ligament, forms a tunnel with the carpals through which passes the median nerve that runs the length of the arm, into the hand.
Because of its complexity, there are many things that can cause wrist pain and reduced mobility. Some common conditions include:
Carpal tunnel syndrome: This condition occurs when the median nerve becomes compressed within the carpal tunnel, often due to swelling or hypertrophy of the tendons that pass through the tunnel from the forearm. Pain may also arise from restricted gliding of the nerve anywhere along its pathway down the arm.
Ganglion cysts: A ganglion cyst is a fluid-filled lump that appears near the joints or tendons, often at the top or on the palm side of the wrist. Their cause is unknown, and they are sometimes but not always painful.
Osteoarthritis: Arthritis is caused by deterioration of the joint cartilage, marked by pain, stiffness and swelling. It has been linked to chronic systemic inflammation and metabolic disorders.
Thumb sprain: A sprain is injury to a ligament, most often the ulnar collateral ligament that connects the thumb to the hand. A thumb sprain is a common sports injury, and may also occur from a fall.
Trigger finger: Medically called stenosing tenosynovitis, trigger finger is often seen in patients with rheumatoid arthritis, gout and diabetes. It arises from a thickening of tissue that inhibits smooth gliding of tendons.
Wrist fractures: The wrist is made up of the eight carpals, along with the radius and ulna. Any of these bones can sustain a fracture, but the radius is the most common site of wrist fracture. Falls are the most common cause of wrist fractures. A fall may also do damage to ligaments, tendons, muscles and nerves.
During diagnosis, your provider will get a medical history and ask questions about the onset of your condition. A physical exam will be conducted, and imaging via X-ray, MRI or ultrasound will be used to gain a clearer picture of the nature and extent of your condition.
Treatment of your wrist pain will vary, depending on the source and nature of your condition. In most cases, conservative treatment with physical therapy and other non-invasive methods is sufficient to resolve pain and restore function.
The wrist pain specialists at NYDNR take a multi-modal and holistic approach to treating your wrist pain. We use dynamic real-time diagnostic ultrasound to view your wrists structures and identify the source of pain. Treatment may include physical therapy, extracorporeal shock wave therapy (ESWT), manual therapy, acupuncture, nerve mobilization, and other innovative treatment methods geared to restoring pain-free function.