The wrist is a very complex joint made up of many tiny bones and ligaments. With so many individual parts and pieces all working together to make up one functional joint structure, a lot can go wrong. Just one stretched tiny ligament or injured little bone can wreak havoc on the wrist as a whole and lead to chronic wrist pain and even arthritis. So what exactly can go wrong in the wrist?
Today we’re going to look at wrist instability, injury to the TFCC, wrist tendonitis, and irritated nerves as potential causes or wrist pain.
Wrist Pain Due to Instability
One of the most common things we see in patients with wrist pain is instability. Typically this occurs because at some point in the patient’s history, something happened to stretch or injure the ligament. The catalyst for this injury could have even occurred many, many years prior. For example, maybe as a young adult, you sprained your wrist playing volleyball. Or maybe a few years ago you fell and caught yourself on your outstretched hand. You may not even remember an injury ever happening, but over time, the ligament has loosened even more and the instability has worsened, allowing your tiny wrist bones too much movement.
Pain and swelling may have set in due to the excessive wear and tear on the wrist joint from the instability. Instability often isn’t diagnosed as most doctors aren’t taught to look for these injuries to these tiny ligaments. MRIs aren’t usually helpful because these are still images and in order to visualize instability, the wrist needs to be imaged while in motion, something your interventional orthopedic physician has the capability to do. He or she can also treat the instability with platelet-rich plasma injections in the lax ligament to tighten it up and provide stability to the wrist.
Wrist Pain Due to an Injury to the TFCC
The triangular fibrocartilage complex (TFCC) is, as the name implies, a triangular complex of many small ligaments. It is located on the pinkie side of the wrist. It defines wrist motion as well as provides a meniscus-like cushioning for this area of the wrist.
Unfortunately, when there is an injury to the TFCC, it’s often attributed to an ulna bone being too long. The ulna is one of two long bones (the other is the radius) that make up the forearm—it lives between the inner, or medial, side of the elbow and the pinkie-side of the wrist. The surgical solution is to cut out some of the ulna to shorten the bone (we’ll provide more information on this surgery, which is on our top 10 dumb surgeries list, in Monday’s blog).
There are many other issues that can injure the TFCC—frequent repetitive motions that create excessive wear and tear, past trauma to the ligament, particularly anything that would cause the wrist to be bent too far backward, and so on. Again, your interventional orthopedic physician can treat TFCC injuries nonsurgically with ultrasound-guided injections of PRP or stem cells.
The nerves that supply the wrist start all the way up in the cervical spine. More specifically, the C8 nerve is the one that supplies the wrist. It can become irritated or pinched anywhere along the nerve branch (e.g., at the neck, the shoulder, the elbow, the wrist), and can present as pain in the wrist with or without pain anywhere else. Over time, with chronic nerve irritation, it can even become scarred down, making matters worse. As with instability, most doctors don’t even know to look for this kind of nerve issue, and, again, an MRI won’t reveal it. Your interventional orthopedic physician, however, is trained to find these subtle nerve issues as well as treat it.
Depending on where the nerve injury is, physical therapy may be sufficient, but in some cases treatment may be needed. This involves ultrasound-guided injections of growth factors around the irritated nerves, or in more challenging cases, using fluoroscopy (real-time imaging) guidance.
Wear and tear and prior traumas can also cause tendon problems in the wrist. Tendon damage can lead to tendon pain and inflammation, or tendonitis. Any of the issues we’ve covered in this post—instability, a TFCC injury, an irritated nerve—can lead to wrist tendonitis. Your interventional orthopedic physician is well trained in diagnosing and treating wrist tendonitis. First, the root cause will be addressed (one of those issues mentioned above), and then the damaged tendon will be treated with PRP injections.
The key to getting rid of wrist pain is to find out what’s causing it in the first place. Wrist surgeries, such as osteotomy (removing bone, for example, ulnar shortening), neurotomy (nerve surgery), fusion (fusing bones together), debridements, often create more problems than they solve, so in all but the most extreme cases, they should be avoided. The goal should be to seek nonsurgical regenerative medicine solutions to treat the cause of your chronic wrist pain.