You use your hands for just about everything: eating, working, dressing, caring, communicating, cleaning, driving … the list goes on. And you might not realize just how much you use your hands (from your wrist down to your fingers) until you start to feel a pain or twinge that starts to limit your daily functioning.
Nick Newsum, MD, orthopedic surgeon with fellowship-training in hand, wrist, elbow and microsurgery, shares the top four causes of wrist pain and effective treatments to help many patients reduce pain and get back to living their best life.
de Quervain’s Tenosynovitis
“de Quervain’s tenosynovitis is one of the top conditions that I see in the office with the chief symptom of wrist pain on the thumb side of the wrist, and it affects mostly women with a 20:1 ratio of women to men with the condition,” reports Dr. Newsum.
“It’s thought to be an overuse condition that often affects new mothers — either during pregnancy or postpartum. In fact, it has often been referred to as “mommy’s wrist.” It might happen because of the new repetitive motion of picking up and holding a baby combined with hormonal fluctuations, an increase in fluid in the body or the general swelling of ligaments, tendons and joints throughout the body due to surges in the hormone progesterone,” he adds.
Pain is focused around the thumb side of the wrist where two thumb tendons travel in the same space.
The second most common population at risk for de Quervain’s tenosynovitis is women between ages 40 and 60. The symptoms frequently appear suddenly with pain, swelling and limitations in using the wrist during motions like opening up a jar or waving goodbye.
“For women in this age group, we don’t always have an identifiable cause,” confirms Dr. Newsum.
Treatment for this condition is generally conservative, starting with a steroid injection. Dr. Newsum says that for 60% of his patients, one steroid injection reduces the inflammation and heals the injury. Sometimes, patients may need a second injection and in very rare cases, surgery.
Another common cause of wrist pain is a ganglion cyst.
“These cysts can occur at any age from kids to elders. In fact, I had one when I was eight years old that I had surgically removed,” says Dr. Newsum.
He explains that these cysts can occur because of a weakness in the joint capsule that allows some joint fluid to escape and enter into a space under the skin on the top or bottom of the wrist. Once it is trapped there, it cannot flow back into the joint. It appears as a bubble-like fluid-filled area on the wrist.
This fluid and swelling can cause a variety of symptoms, including pain.
“Sometimes, the fluid/cyst doesn’t necessarily form a large lump on the wrist, so someone might have the symptom of pain during a particular motion, but not attribute it to a cyst,” notes Dr. Newsum.
In this case, Dr. Newsum might order an MRI of the wrist to determine the cause.
Initial treatment for a ganglion cyst is often a splint to stabilize the wrist, activity limitations, or in some cases the cyst can be drained. There are times, however, when a ganglion cyst might need to be removed surgically.
Arthritis can cause wrist pain, but usually in people age 40 and older.
The wrist is a far less common joint to get arthritis compared to other joints such as the shoulder, knee and hip, but according to Dr. Newsum, and it can occur from natural wear and tear like any other joint, but it can also occur as the result of a wrist injury that happened even decades earlier because of a ligament tear.
“When you tear a ligament in the wrist, bones move in an abnormal fashion. This abnormal motion causes the breakdown of cartilage that acts as a cushion between the two bones within the joint. When cartilage wears down, bone rubs upon bone and causes bone spurs, which is one aspect of arthritis.”
Symptoms of wrist arthritis include pain, swelling, stiffness and loss of normal range of motion.
Initially, treatment may involve a wrist splint, over-the-counter anti-inflammatory medications such as ibuprofen, topical anti-inflammatories, activity modifications and sometimes a steroid injection.
If these initial treatments are not successful, there are cases where surgery is recommended for long-term relief.
Gout or Pseudo Gout
Gout or pseudo gout are two different inflammatory conditions that cause pain and inflammation in the lining of the wrist joint, which is filled with fluid produced by the joint lining (synovium). In health, fluid lubricates joints so they pass normally. If the synovium is injured, however it can thicken and get inflamed.
Dr. Newsum explains, “These two conditions cause crystals to form in the joint fluid. We can see the crystals when we look at a sample of the fluid under a microscope.”
Gout can present in the wrist similar to the “classic” symptom of a big, swollen big toe. The wrist can suddenly appear red or pink, stiff and difficult to move or bend.
Some people rush to the emergency room thinking it is an infection, and are often treated as such because the symptoms are similar, but when there is no improvement they are then often referred to a specialist and this often ends up being the diagnosis.
“To treat the inflammatory aspects and crystals that are causing the symptoms, we generally prescribe oral steroids if multiple joints are involved or a localized steroid injection if just one joint is affected. There are also several anti-gout medications that can be a part of long-term management,” says Dr. Newsum.
Gout is somewhat of a metabolic issue, caused by a buildup of uric acid in the body that precipitates in the joint fluid. A steroid can calm down the inflammation and oral medications can stop the production of the uric acid to prevent the crystals from forming.
Here’s What to Do if You Have Wrist Pain
If you experience sudden wrist pain that’s not related to trauma or a more serious injury, Dr. Newsum has some general recommendations.
- Get a simple wrist splint at any pharmacy or drug store and wear it for two weeks.
- Use over-the-counter pain relievers as needed, such as Tylenol or ibuprofen
- Rest your wrist and limit your activity
“If you’re still in pain or concerned after two weeks, go see an orthopedic specialist, especially if after an injury,” Dr. Newsum advises.
Another thing to be mindful of is your smart phone or device use.
“People underestimate how much they are on phones and holding their wrists in abnormal positions. There’s a lot of medical research starting to look into the cell phone wrist/hand -conditions and it could be an under-appreciated contributed to wrist pain,” Dr. Newsum concludes.
If you’re experiencing wrist, hand or shoulder pain, turn to our experts for help. Orlandohandsurgery.com