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Virtually everything we do with our arms and hands involves our wrists.  Wrist pain can be debilitating causing restricted movement and activity.  What are the causes of wrist pain with activity?   Why does my wrist hurt all of sudden?  When should I see a doctor for wrist pain?  Are there new treatment options?   Let’s dig in.

Wrist Anatomy

The wrist is composed of 8 carpal bones that are divided into two rows.  The closest row (proximal)  contains 4 bones which include the scaphoid and lunate.  The furthest row also contains 4 bones which include the trapezium and trapezoid.  The bones the forearm (radius and ulna) connect with the carpal bones and form a joint.  Cartilage lines the surfaces between each joint. The bones held together by an extensive number of ligaments on both the front and back of the wrist (1).  The stability of the wrist joint is dependent upon these ligaments.

Causes of Wrist Pain with Activity

Fractures

All bones are susceptible to injury.  Fracture of the forearm bone (distal radius) is most common and is typically associated with falling on an outstretched arm (2).  The scaphoid is the most commonly fractured carpal bone and typically occurs with falling on an extended wrist (3).

Tendon Injuries

Tendons are thick cords of collagen that connect muscle to bone.  Inflammation and injury to wrist tendons can cause wrist pain with activity.  The most common tendon injury in athletes is de Quervain’s tenosynovitis (4).  Intersection syndrome can also cause wrist pain with activity and is caused by friction of the extensor tendons as they cross one another in the forearm (5).

TFCC Tears

TFCC stands for the triangular fibrocartilage complex.  It is a cartilage structure on the pinky side of the wrist that provides cushion and support between the bones in the forearm and the carpal bones. It is identified by the red circle in the picture on the right.  Injury is common in athletes who grip and rotate bats, racquets and golf clubs.

Ligament Tears

Ligaments are thick bands of connective tissue that connect one bone to another.  Ligaments provide critical stability and support for the wrist (7).  Hyperextension of the wrist can lead to ligament tears.  Ligament injury can lead to wrist instability which in turn can lead to additional wrist injuries including arthritis and tendon injuries.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common condition in which the median nerve is compressed at the level of the wrist.  Symptoms include wrist pain with activity and numbness and tingling in the thumb, index and middle finger.

Arthritis

Generalized wear and tear or trauma can result in arthritis in the wrist joint.  Symptoms include swelling, redness and wrist pain with activity.  There are three primary types of arthritis that affect the wrist: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

Why Does My Wrist Hurt all of a Sudden?

Abrupt wrist pain can be the result of a fracture, ligament injury or overload of the tendons.  Evaluation by a physician trained in Interventional Orthopedics is best as they are experts in evaluating wrist and other joints using the SANS approach.  SANS is an acronym and stands for  Stability, Articulation, Neurologic and Symmetry.  In this model, the stability, articulation, neurologic and symmetry of a given joint should be evaluated for best clinical outcomes.  To learn more about Interventional Orthopedics please click on the video below.

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When Should I See a Doctor for Wrist Pain?

If pain persists and interferes with daily activities it is time to see an Interventional Orthopedics physician.  Physical therapy is typically the first line of treatment.  When conservative treatment fails patients are oftentimes referred for steroid injections which should be avoided due to the significant side effects which include damage to the wrist cartilage, tendons, and ligaments.  Patients are then oftentimes referred for surgery.  There are many different surgical options which include wrist replacement.  A recent study that reviewed more than 100 surgeries of 3 different types demonstrated more than half of the patients reported complications (8).

New Treatment Options

At the Centeno-Schultz Clinic, we are experts in the management and treatment of wrist pain with activity.  Board-certified, fellowship-trained physicians perform the evaluation and review all the possible sources of wrist pain with activity.  Precise ultrasound-guided injections of PRP and bone marrow concentrate are used to facilitate your body’s own healing without the side effects of steroids or the risks of surgery.  To learn more about our outcomes click here.

In Conclusion

The wrist is a complex joint involving 8 carpal bones, the bones of the forearm ( the ulna, and radius).  They are held together by critical ligaments that provide stability for the wrist joint.  There are multiple causes of wrist pain with activity which include fractures, tendon injuries, TFCC tears, ligament tears, carpal tunnel, and arthritis.  Abrupt onset of wrist pain with activity may be due to a fracture or injury or overload of the tendons and ligaments.  Steroids are toxic and should be avoided.  Surgery is associated with significant side effects.  Precise injections of PRP and bone marrow concentrate are natural alternatives in the treatment of wrist pain with activity.

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1.Dean B, Henari S, Thurley N, Little C, McNab I, Riley N. Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis. F1000Res. 2018;7:1484. Published 2018 Sep 18. doi:10.12688/f1000research.16218.2.

2.Chen NC, Jupiter JB, Jebson PJ. Sports-related wrist injuries in adults. Sports Health. 2009;1(6):469–477. doi:10.1177/1941738109347981

3. Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg. 1999;33:423-426.DOI: 10.1080/02844319950159145.

4.Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Med. 2005;35(6):537–55. doi: 10.2165/00007256-200535060-00005.

5. Hanlon DP, Luellen JR. Intersection syndrome: a case report and review of literature. J Emerg Med. 1999;17(6):969–71. doi: 10.1016/S0736-4679(99)00125-0.

6.Avery DM 3rd, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res. 2016;11(1):99. Published 2016 Sep 16. doi:10.1186/s13018-016-0432-8.

7. Taleisnik JTaleisnik J (1985) The anatomy of the wrist. in The wrist. ed Taleisnik J (Churchill Livingstone, New York), pp 1–39,

8.Gaspar MP, Lou J, Kane PM, Jacoby SM, Osterman AL, Culp RW. Complications Following Partial and Total Wrist Arthroplasty: A Single-Center Retrospective Review. J Hand Surg Am. 2016;41(1):47-53.e4.DOI: 10.1016/j.jhsa.2015.10.021.

 

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