Wrist pain or open wrist is a syndrome inhibiting use of a hand due to pain in anatomical structures of the wrist. [1] It most commonly results from an injury to a ligament. [1] The pain may be sharp from a traumatic injury or from chronic repetitive wrist activities. [1]
Pain may be caused after exerting the wrist, as may occur during weight lifting, in any weight-bearing or athletic activity, manual labor, or from injury to nerves, muscles, ligaments, tendons or bones of the wrist. [2] [3] Wrist pain may result from nerve compression, tendonitis, osteoarthritis or carpal tunnel syndrome.
Wrist anatomy includes 20 individual ligaments attaching the eight carpal bones between the radius and ulna bones of the forearm and the metacarpal bones of the hand. [1] Location and dynamic function of the wrist ligaments determine susceptibility to injury. Wrist structures prone to injury are the triangular fibrocartilage complex and the scapholunate ligament. [1]
Wrist sprains may occur when a ligament is ruptured or lacerated in severe trauma, stretched or twisted. [1] Commonly, wrist pain is caused by sudden load-bearing or twisting effects, such as falling from a height with an outstretched hand. [1] Rupture of multiple wrist ligaments in a more severe event may require surgical repair. [1]
Injury to and inflammation of the scapholunate ligament is a common wrist injury. [1] Injuries to the triangular fibrocartilage complex may result from chronic repetitive movements by wrist flexion-extension, supination-pronation, or sudden radius-ulna rotation. [1]
Osteoarthritis, typically in elderly people, and rheumatoid arthritis are other common causes of wrist pain. [4]
Wrist pain can be a symptom of injury and several types of non-injury pathophysiology including: [1] [2] [4] [5]
The hallmark symptom of carpal tunnel syndrome is tingling (paresthesia), which is not commonly associated with pain. [2] Ulnar nerve entrapment at Guyon's canal causes weakness in specific muscles, but is not typically painful. [2]
Wrist pain has a prevalence of 10-14% in the general population. [3] [4] It is highly prevalent in people performing physically demanding activities, such as manual laborers and athletes. [3]
The physical exam may show tenderness by palpation over the scapholunate ligament on the back of the wrist, immediately below the radius. [1] [4] Swelling and deformities are the two clinical signs associated with arthritis. The wrist is clinically tested by slight flexion while the physician feels the back of the wrist with the thumb. [4] The physician may also test the range of motion by flexion, extension, radius, and ulna deviation, with normal ranges of 65-80 degrees of flexion, 55-75 degrees of extension, 30-45 degrees of ulna deviation, and 15-25 degrees of radius deviation. [4] Conventional radiography may be used for detection of wrist bone pathologies. [4]
After applying hot or cold pads in the first moments, if there is no inflammation, the use of a simple leather or neoprene wrist brace (or even a steel-reinforced one), is recommended in order to rest the wrist. [5]
The carpal bones are the eight small bones that make up the wrist (carpus) that connects the hand to the forearm. The term "carpus" and "carpal" is derived from the Latin carpus and the Greek καρπός (karpós), meaning "wrist". In human anatomy, the main role of the carpal bones is to articulate with the radial and ulnar heads to form a highly mobile condyloid joint, to provide attachments for thenar and hypothenar muscles, and to form part of the rigid carpal tunnel which allows the median nerve and tendons of the anterior forearm muscles to be transmitted to the hand and fingers.
In human anatomy, the wrist is variously defined as (1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand; (2) the wrist joint or radiocarpal joint, the joint between the radius and the carpus and; (3) the anatomical region surrounding the carpus including the distal parts of the bones of the forearm and the proximal parts of the metacarpus or five metacarpal bones and the series of joints between these bones, thus referred to as wrist joints. This region also includes the carpal tunnel, the anatomical snuff box, bracelet lines, the flexor retinaculum, and the extensor retinaculum.
De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painful. On some occasions, there is uneven movement or triggering of the thumb with radial abduction. Symptoms can come on gradually or be noted suddenly.
Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.
The scaphoid bone is one of the carpal bones of the wrist. It is situated between the hand and forearm on the thumb side of the wrist. It forms the radial border of the carpal tunnel. The scaphoid bone is the largest bone of the proximal row of wrist bones, its long axis being from above downward, lateralward, and forward. It is approximately the size and shape of a medium cashew nut.
The radius or radial bone is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna. The ulna is longer than the radius, but the radius is thicker. The radius is a long bone, prism-shaped and slightly curved longitudinally.
A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.
Finkelstein's test is a test used to diagnose de Quervain's tenosynovitis in people who have wrist pain.
The carpometacarpal (CMC) joints are five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones.
The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.
The triangular fibrocartilage complex (TFCC) is formed by the triangular fibrocartilage discus (TFC), the radioulnar ligaments (RULs) and the ulnocarpal ligaments (UCLs).
A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala are often described as having "hands" instead of paws on their front limbs. The raccoon is usually described as having "hands" though opposable thumbs are lacking.
The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates it is not used. In those cases, forelimb plus joint is used.
The hand is a very complex organ with multiple joints, different types of ligament, tendons and nerves. Hand disease injuries are common in society and can result from excessive use, degenerative disorders or trauma.
Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.
Extensor tendon compartments of the wrist are anatomical tunnels on the back of the wrist that contain tendons of muscles that extend the wrist and the digits.
The extrinsic extensor muscles of the hand are located in the back of the forearm and have long tendons connecting them to bones in the hand, where they exert their action. Extrinsic denotes their location outside the hand. Extensor denotes their action which is to extend, or open flat, joints in the hand. They include the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), extensor digitorum (ED), extensor digiti minimi (EDM), extensor carpi ulnaris (ECU), abductor pollicis longus (APL), extensor pollicis brevis (EPB), extensor pollicis longus (EPL), and extensor indicis (EI).
Radial dysplasia, also known as radial club hand or radial longitudinal deficiency, is a congenital difference occurring in a longitudinal direction resulting in radial deviation of the wrist and shortening of the forearm. It can occur in different ways, from a minor anomaly to complete absence of the radius, radial side of the carpal bones and thumb. Hypoplasia of the distal humerus may be present as well and can lead to stiffness of the elbow. Radial deviation of the wrist is caused by lack of support to the carpus, radial deviation may be reinforced if forearm muscles are functioning poorly or have abnormal insertions. Although radial longitudinal deficiency is often bilateral, the extent of involvement is most often asymmetric.
Wrist osteoarthritis is gradual loss of articular cartilage and hypertrophic bone changes (osteophytes). While in many joints this is part of normal aging (senescence), in the wrist osteoarthritis usually occurs over years to decades after scapholunate interosseous ligament rupture or an unhealed fracture of the scaphoid. Characteristic symptoms including pain, deformity and stiffness. Pain intensity and incapability are notably variable and do not correspond with arthritis severity on radiographs.
Ankle problems occur frequently, having symptoms of pain or discomfort in the ankles.