Pain in the wrist

Synonyms

Radiocarpalgelenk

English: wrist pain

introduction

A variety of chronic and acute illnesses can lead to wrist pain. Depending on the cause, the pain given by the affected person can assume different qualities.
From short-lasting, stabbing to long-lasting painful phenomena everything is possible in the area of ​​the wrist. When looking for causes, the exact pain quality and localization is an important clue. In addition, possible radiations, loss of sensibility and the stress-dependent occurrence of the sensations can provide a first indication of the underlying disease.

Localization of the complaints

Pain outside

Pain on the outside of the wrist can have various causes. Ganglia, which can develop as a result of overloading and cause pain and restricted mobility, must be considered. Osteoarthritis, which is the result of joint wear, is a possible diagnosis and is common in old age. Also infections, eg after an open wound, into which exciters arrived, are possible. If a collision or fall occurred previously, there could also be a broken bone behind, which can be excluded by X-ray.

Pain inside

Pain on the inside of the wrist (towards the palm) may come from a carpal tunnel syndrome. This is a syndrome in which a nerve is trapped in the so-called carpal tunnel. This nerve (median nerve) provides the palms and especially the thumb, index and middle finger with feeling and supplies the muscles. If the carpal tunnel becomes too narrow as the ligament structure thickens, the symptoms appear. The carpal tunnel syndrome often affects older and especially female persons. Concerned persons complain that the hand falls asleep and becomes numb. Also tingling and pain, as well as loss of motion can occur. Often this occurs at night and is so uncomfortable that patients need to wake up and move their hands. Temporarily, this can also occur during pregnancy, but usually forms back.
Saddle joint osteoarthritis (rizarthrosis) on the thumb joint can also project pain to the palm of the hand. Rarely, a ganglion can also form on the inside of the hand and cause pain there. Rarely, it comes to death (necrosis) of the metacarpal bone, as to the lunate malacia, which also causes pain.

Causes of pain in the wrist

The causes of the occurrence of pain in the wrist can be diverse. In most cases, excessive or incorrect loading during writing or working will result in painful symptoms. Basically, the causes that lead to wrist pain can be divided into several groups.
Possible diseases

  • the bony structures
  • the bands
  • the tendons
  • the tendon sheaths
  • and the muscles
  • Bruise wrist
  • Ganglion on the finger
  • Ganglion on the wrist

Which diseases can be the cause?

Pain in the wrist

The most common disease of the wrist is carpal tunnel syndrome. This causes pressure damage to the median nerve in the carpal tunnel (see above). Causes of a CTS ( carpal tunnel syndrome ) can not be detected in the majority of the disease. Possible causes are wrinkles close to the wrist or diseases of the rheumatic type.

Accompanying symptoms of carpal tunnel syndrome are sensory deficits in the area of ​​the thumb, the index and the middle finger on the palm of the hand. On the back of the hand, these sensations usually occur only on the finger end members.
The frequent nocturnal occurrence of these complaints is considered a classic indication of carpal tunnel syndrome.

In addition to the discomfort provoked by the presence of a carpal tunnel syndrome, pain in the wrist is often triggered by inflammatory processes in the tendon sheath area.
The patient affected by tendonitis usually reports severe, pulling pain on the affected tendon.
Further indications of inflammatory processes are

  • redness
  • Überwärmungen
  • swelling
  • and loss of mobility of the affected wrist.

The so-called "Tendovaginitis stenosans de Quervain" (synonym: Hausfrauendaumen) represents a special form of tendonitis. In this disease, the pain on the thumb-side wrist are localized. Not infrequently, the sensations radiate into the forearm and can be amplified by stress.

The most common accidental pain of the wrist is the wrist fracture ( distal radius fracture ). The spoke breaks in most cases a few inches above the wrist. In a multi-fragment fracture may also be involved directly the articular surface.

Rarer and occasionally unrecognized are pain from a scaphoid fracture.

Pain-related arthritis of the wrist is relatively rare. The reason for this is the fact that the Hangelenk must carry no body load.
Risk factors for a wrist arthrosis ( radiocarpal arthrosis ) are pre-existing fractures of the wrist, especially in the case of direct joint involvement or in rheumatic disorders.

Pain is often caused by the thumb saddle joint arthrosis, a painful signs of wear during movements and strain on the thumb.

Enchondroma (a bone cyst), which consists of cartilaginous accumulations in the bone, is another cause of pain in the wrist. The transformation from bone to cartilage tissue causes a painful increase in size over the long term, which results in break-in or fracture of the affected bone can.
In early stages, the patient suffers from complaints that occur mainly under heavy load and quickly relieve under restraint. With the progression of cartilage formation pain occurs already at rest.

In addition, frequent discomfort in the wrist can often be attributed to anatomical malformations.
For example, too short an ulna-minus (ulna-minus) may cause a pronounced pressure on the spinal portion of the wrist, causing pain in the wrist.

On the other hand, an ulna that is too long (ulna plus variant) causes an increased pressure load on the ellen side of the wrist with corresponding pain symptoms on the little finger side. As a rule, malformation-related pain in the wrist can only be remedied long-term by surgical correction.

rheumatism

The term rheumatism combines various diseases of the whole body. These diseases have in common that their own immune system is directed against normal body components and destroys them in the long term. As rheumatism on the wrist is in most cases colloquially meant a "rheumatoid arthritis", which can affect the wrist in addition to numerous small joints in the body. This causes inflammation, pain, restricted mobility and stiffness of the joint. In the long term, this can also lead to painful cartilage wear that irreversibly damages the joint.

Other causes

Although pain in the wrist is often caused by injuries or diseases of the bone or tendon system, in the majority of those affected misperceptions are due to simple over- or Fehlbelastung.
Chronic overload of the wrist is one of the main causes of pain. Above all, athletes and members of special occupational groups (office workers, construction workers, etc.) are often affected.
In these cases, repetitive irritation of the joint or surrounding structures causes the least damage (micro-injury) in the tissue. The result is pain that increases steadily under stress and often stops in peace.
In the treatment of this type of wrist pain, muscular stabilization and the avoidance of heavy stress play a major role. Rare reasons for the emergence of wrist pain are

  • the gout (synonym: hyperuricemia )
  • and the pseudogout (synonym: chondrocalcinosis ).

In the case of gout, it causes uric acid deposits in the wrist area. The primary metatarsophalangeal joint, the metacarpophalangeal joint, the hocks and the knee are primarily affected.
The development of gout in the wrist is rare.
Also, a pseudogout with deposition of calcium crystals occurs more on the knee than on the wrist. In addition, various diseases whose cause is currently unclear can lead to wrist pain. These diseases include:

  • lunatomalacia

  • Kahnbeinnekrose

Pain in the wrist during exercise

Heavy loads can lead to pain in the wrist.

The wrist is often affected by pain overload. Different structures can form or change, which can be the expression of a faulty or overloading. For example, an overbone (ganglion) can arise, which usually forms on the back of the hand at the transition from forearm to wrist. A ganglion is a sock of a joint membrane or tendon sheath that surrounds the tendons to allow it to glide well. If this sacculation thickens or stores water in it, it can come to a palpable knot on the wrist, which hinders the movement. Patients report wrist pain, especially when they are under stress, such as push-ups.
Tenosynovitis can also lead to pain on exertion. In most cases, it arises as a result of many writing, typing or other activities by hand. Here, the tendon sheath surrounding the tendon thickens and is inflammatory changed. Often the tendonitis is associated with redness, swelling and pain in the wrist.
Other diseases can affect the wrist and especially noticeable under load. These include primarily diseases from the rheumatic type. Psoriasis can also be associated with joint problems (psoriatic arthritis) and should be clarified.
Wrist arthrosis (radiocarpal arthrosis) must also be considered. This is a wear on the wrist cartilage and can arise in several ways. Sometimes the cause is unknown, but often secondary to another disease or fracture.

Pain during rotation

The most common cause of wrist pain during twists is tendonitis (tendovaginitis). Here, the tendon sheath, which surrounds a tendon, thickens. Often this occurs after a period of frequently repeated movements. The tendon of the muscle, which is particularly stressed during this movement, rubs it in her tendon sheath back and forth and inflamed. This can be triggered when screwing in screws with a screwdriver, or by much writing and typing. Sufferers often describe drawing pains that radiate to the forearm. In addition, a crack in the rotational movement can be heard. The tendonitis is usually treated by immobilization and relief, if necessary by cortisone syringes to the tendon or rarely by surgery with splitting of the tendon sheath.

Pain after a fall

After a fall on the wrist, it may be bruised or broken. Since both can be associated with severe swelling, the distinction by means of clinical tests is often insufficient. To find out for sure, an X-ray of the wrist is often necessary. If there is a bruise or distortion, no bone fracture can be detected in the X-ray image. In this case, especially the ligaments and tendons have been strained by the fall, but heal usually after a few weeks without consequences again.

Breakage can affect different bones. Often, the radius (the radius), that is, the forearm bone, breaks on the side of the thumb and forms the wrist with the wrist bones. This so-called distal radius fracture is one of the most common fractures ever. Also in this fracture women are often affected, suffering from a bone softening (osteoporosis). The diagnosis is likely when a wrist deformity is visible or a level in the bone is palpable. Also, a strong swelling and severe pain indicate this diagnosis. Rarely is the ulna (Ulna) broken, ie the forearm bone, which pulls on the side of the little finger to the wrist and forms with the wrist bone the wrist on this side. The metacarpals can also break. Sometimes, the scaphoid (Os scaphoideum) breaks in a fall, it is particularly important to rest the arm for a long time, so that the navicular bone heals completely again.

Pain when supporting

A pain in the wrist, which is strengthened during support, is very typical for irritation in the joint, as well as for injuries of the bone, ligament and cartilage structures in the wrist. Numerous movements, injuries, sports and anatomical features can cause damage and pain to the wrist over time. Very often the cartilage between the ulna and the carpal bones are involved, which is called "Discus triangularis". This area of ​​the joint can be damaged by long-term wear as well as by acute events. When supporting this cartilage is particularly heavily loaded.

Supports, as well as vibrations in the sport or support of the hands during falls, can cause damage to the wrist cartilage and worsen it. A fall that is caught with the hands can often lead to cartilage damage and even fractures of the forearm and carpal bones. The support of the hands therefore provokes pre-existing pain by the increased pressure on bony and cartilaginous joint components.

Pain without swelling

Swelling refers to an increased fluid accumulation in the tissue. Swelling on the wrist can be purulent, bloody or clear. In most cases there is an acute injury of cartilage, bone or ligaments, inflammation of joint structures or a chronic irritation of the tendons and mucous membranes.

However, any acute or chronic changes in the wrist may be without swelling. The swelling is just an accompanying symptom, which can occur in response to diseases of the joint. But even without swelling, there may be a tear of ligaments and cartilage or a fracture of the bones following an acute event. The absence of a strong swelling even allows a faster healing in chronic irritations, strains, inflammation and injuries.

The swelling itself causes additional pain. With a suitable acute therapy, swelling after injury can even be reduced and prevented. For this purpose, the joint should be cooled, compressed, protected and stored high.

On the thumb

The pain can also occur on the thumb after injuries and degeneration of the cartilage and bone. The most common cause of wrist pain in the thumb is tendonitis in this area. This occurs without causative pathogens as a result of a permanent state of irritation. The thumb is particularly often affected by tendonitis. Due to its exposed anatomical position and its significant function when gripping the thumb is particularly exposed to stress. The tendonitis often begins at the level of the wrist and continues on the extensor side of the thumb and forearm.

  • Tendinitis on the wrist
  • Tendinitis in the thumb

Pain on the wrist with numb fingers

Wrist pain associated with numb fingers is an important indication of a "carpal tunnel syndrome". In the middle area of ​​the wrist, important tendons and muscles, along with the median nerve, pass through the carpal tunnel from the forearm into the hand. The carpal tunnel is an anatomically very narrow space. Even slight pressure on the inside of the wrist can lead to pinching of the nerve and thus to tingling, numbness, muscle weakness and paralysis in the fingers. If this anatomical tightness increases, permanent pain and numbness can occur. In many cases, the carpal tunnel syndrome must be treated surgically, so that the pain sustains no lasting damage.

Figure pain in the wrist

Therapy of pain in the wrist

Simple remedy: cool the wrist

The treatment of pain in the wrist depends primarily on the causative disorder. As a rule, the occurring pain phenomena, no matter what the cause is, can be treated quite well.

In general, pain in the wrist, whether caused by overwork or a fall, should be treated by immobilization and cooling. Since the wrist is much used in everyday life, it is advisable to create a bandage or a splint to really protect it from stress. You can also tapes certain movements and prevent others. Rarely, a plaster splint is applied to keep the wrist really quiet. To alleviate the pain, analgesics can be taken, which also have a decongestant effect. This also reduces the inflammatory reaction in the wrist. This can be done with tablets (such as ibuprofen), or locally, for example, with a diclofenac (Voltaren) ointment dressing.
When swelling, the wrist should be held up, so that the blood can drain better. Here you can store the affected hand on some pillows higher than the rest of the body while sleeping.
If the cause is known, specific therapeutic measures can still be used. Thus, in a Ganglion help to drain the collected fluid in Ganglionsack by means of puncture. It may also be considered an operative removal.
In a tendonitis, the hand should be particularly quiet and the triggering movement to a minimum. If this is not enough, a cortisone injection can also improve. Rarely, an operation with splitting of the tendon sheath is necessary.
In case of bone fractures, operative therapy is often necessary so that the fracture heals completely again. Failure to do so can result in malpositioning and long-term pain. With well-standing, smooth fractures can also be sufficient immobilization by means of plaster.
In rheumatic disorders, experienced rheumatologists must weigh the treatment options. Often, medical measures are required here.
In infected wounds, antibiotics may be necessary to prevent the spread of the infection.

In summary, regular application of anti-inflammatory ointments is sufficient in most cases to achieve effective pain relief.
In addition, the consistent wearing of a support bandage can relieve the pain in the wrist.
For severe underlying diseases, various medications can be used.
The treating physician will inform the affected patients about the necessary / possible treatment measures after diagnosis.

taping

An alternative to bandage, splint and plaster is the so-called taping / taping. This can also be used for stabilization in the wrist and promises a better wearing comfort. It can continue to allow and support certain movements by guiding the bands, while other movements are selectively braked. This allows the hand to move and use even better. In addition, it is much lighter than a plaster cast. But also prophylactic tapes can be used. So they use many professional athletes to prevent injuries and to support heavily loaded tendons, joints and muscles. Even boxers and other martial artists taped their wrists to keep them stable in the action of force. Tapes should be worn by experienced therapists to achieve sufficient stability in the joint. However, consideration should be given to which measure is more suitable for immobilization, since a tape can not of course be as stable as a plaster rail. Depending on the objective, it is a good alternative.
Another type of taping is the so-called kinesio tape. This is different from the classic taping, as the tapes are elastic and less contribute to stability and leadership (these tapes are usually recognized by their bright colors). The effect of these tapes is controversial.

Anatomy on the topic

X-ray picture wrist

  1. Scaphoid (Os scaphoideum)
  2. Moonbeam (Os lunatum)
  3. Pea leg (Os pisiforme)
  4. Dreickbein (Os triquetum)
  5. Hook leg (Os hamatum)
  6. Head bone (Os capitatum)
  7. small polygon (Os trapezoidum)
  8. large polygonal bone (Os trapezium)

Figure wrist

Figure right hand seen from the palm side (palmar): A - outline (joint lines green) and B - right hand bone

Outline of the hand
(Joint lines green)
I - Upper (proximal) wrist
II - Lower (distal) wrist
III - carpal middlehand
joints
IV - Finger joint
V - finger center joint
(missing with thumb)
VI - wrist joint
VII - thumb end joint

  1. Finger tip -
    Phalanx distalis
  2. Finger middle link -
    Phalanx media
  3. Finger base -
    Phalanx proximalis
  4. Metacarpal Bones - Metacarpalia
  5. Trapezoid - Os trapezium
  6. Trapezoid bone - Os trapezoideum
  7. Head bone - Os capitatum
  8. Hook leg - Os hamatum
  9. Pincushion of the hand -
    Os scaphoid
  10. Moonbear - Os lunatum
  11. Triangular leg - Os triquetrum
  12. Pea leg - Os pisiforme
  13. Sesambein - Os sesamoideum
  14. Elle - Ulna
  15. Spoke - radius

Mayo Clinic Minute: Relief for achy wrists (December 2019).


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