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Wrist Pain Specialist Clinic

Wrist pain is a common complaint. Many types of wrist pain are caused by sudden injuries that result in sprains or fractures. But wrist pain also can be caused by more long-term problems — such as repetitive stress, arthritis and carpal tunnel syndrome.

Because so many factors can lead to wrist pain, diagnosing the exact cause of long-standing wrist pain sometimes can be difficult. An accurate diagnosis is crucial, however, because proper treatment depends on the cause and severity of your wrist pain.

DeQuervain's Tenosynovitis

DeQuervain’s Tenosynovitis

SYMPTOMS OF WRIST PAIN

Wrist pain may vary, depending on what’s causing it. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing type of pain. The precise location of your wrist pain also can give clues to what might be causing your symptoms.

When to see a doctor
Not all wrist pain requires medical care. Minor sprains and strains, for instance, usually respond to ice, rest and over-the-counter pain medications. But if pain and swelling last longer than a few days or become worse, see your doctor. Delays in diagnosis and treatment can lead to poor healing, reduced range of motion and long-term disability.

CAUSES OF WRIST PAIN

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand. Tough bands of ligament connect your wrist bones to each other and to your forearm bones and hand bones. Tendons attach muscles to bone. Damage to any of the parts of your wrist can cause pain and affect your ability to use your wrist and hand.

Injuries

  • Sudden impacts. Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures. A scaphoid fracture involves a bone on the thumb side of the wrist. This type of fracture may not show up on X-rays immediately following the injury.
  • Repetitive stress. Any activity that involves repetitive wrist motion — from hitting a tennis ball or bowing a cello to driving cross-country — can inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours on end without a break. De Quervain’s disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

  • Osteoarthritis. In general, osteoarthritis in the wrist is uncommon, usually occurring only in people who have injured that wrist in the past. Osteoarthritis is caused by wear and tear on the cartilage that cushions the ends of your bones. Pain that occurs at the base of the thumb may be caused by osteoarthritis.
  • Rheumatoid arthritis. A disorder in which the body’s immune system attacks its own tissues, rheumatoid arthritis is common in the wrist. If one wrist is affected, the other one usually is, too.

Other diseases and conditions

  • Carpal tunnel syndrome. Carpal tunnel syndrome develops when there’s increased pressure on the median nerve as it passes through the carpal tunnel, a passageway in the palm side of your wrist.
  • Ganglion cysts. These soft tissue cysts occur most often on the top of your wrist opposite your palm. Smaller ganglion cysts seem to cause more pain than do larger ones.
  • Kienbock’s disease. This disorder typically affects young adults and involves the progressive collapse of one of the small bones in the wrist. Kienbock’s disease occurs when the blood supply to this bone is compromised.

RISK FACTORS

Wrist pain can happen to anyone — whether you’re very sedentary, very active or somewhere in between. But your risk may be increased by:

  • Sports participation. Wrist injuries are common in many sports, including bowling, golf, gymnastics, snowboarding and tennis.
  • Repetitive work. Almost any activity that involves your hands and wrists — even knitting and cutting hair — if performed forcefully enough and often enough can lead to disabling wrist pain.
  • Diseases and conditions. Your risk of developing wrist pain is increased if you have diabetes, leukemia, scleroderma, lupus or an underactive thyroid gland.

TREATMENTS

Treatments for wrist problems vary greatly, depending on the type, location and severity of the injury, as well as on your age and overall health.

Medications
Over-the-counter pain relievers may help reduce wrist pain. Stronger pain relievers are available by prescription.

Therapy
If you have a broken bone in your wrist, the pieces will need to be aligned so that it can heal properly. A cast or splint can help hold the bone fragments together while they heal.

If you have sprained or strained your wrist, you may need to wear a splint to protect the injured tendon or ligament while it heals. Splints are particularly helpful with overuse injuries caused by repetitive motions.

Surgery
In some cases, surgery may be necessary. Examples include:

  • Severely broken bones. A surgeon may connect the fragments of bone together with metal hardware.
  • Carpal tunnel syndrome. If your symptoms are severe, you may need to have the tunnel cut open to relieve the pressure on the nerve.
  • Tendon or ligament repair. Surgery is sometimes necessary to repair tendons or ligaments that have ruptured.

CURE YOUR WRIST PAIN TODAY. CALL +65 6471 2744 or SMS to +65 92357641 for APPOINTMENT TODAY

Ligament Injuries to the Wrist

Wrist injuries are common. If a wrist injury causes significant damage to the ligaments, it can result in serious problems in the wrist. Such an injury typically continues to cause problems unless corrected.

This guide will help you understand

  • how ligament injuries of the wrist occur
  • what your doctor will do to diagnose serious ligament injuries
  • what treatment options may be recommended

Anatomy

What structures are involved?

The front, or palm-side, of the wrist is referred to as the palmar side. The back of the wrist is called the dorsal side.

The wrist is made up of eight separate small bones, called the carpal bonesThe carpal bones connect the two bones of the forearm, the radiusand the ulna, to the bones of the hand.The metacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to thephalanges, the bones in the fingers and thumb.

The carpal bones are arranged in two rows: the proximal row of four bones sits next to the forearm (radius and ulna), and the distal row of four bones connects to the metacarpal bones. These two rows of bones work together like the links in a chain to allow the hand to move up (dorsiflex) and down (palmarflex). The connections between each carpal bone also allow the bones to shift as the hand is moved sideways (radial deviation and ulnar deviation).

One reason that the wrist is so complicated is because every small bone forms a joint with the bone next to it. Articular cartilage covers the ends of bones where they meet in a joint. Articular cartilage is a smooth, slippery substance that lets the bones slide against one another without causing damage to either surface.

Ligaments connect all the small wrist bones to each other. Ligaments also connect the bones of the wrist with the radius, ulna, and metacarpal bones.These ligaments are important in balancing the movement of all of the wrist bones.

When one or more of these ligaments is injured, the way the bones move together as a unit is changed. This can lead to problems in the wrist joint that cause pain. Eventually, arthritis may develop in the wrist joint.

Causes

How do ligament injuries of the wrist occur?

By far the most common way the wrist is injured is a fall on an outstretched hand. (The same type of force can happen in other ways, such as when you brace your self on the dashboard before an automobile crash.) Whether the wrist is broken or ligaments are injured usually depends on many things, such as how strong your bones are, how the wrist is positioned during the injury, and how much force is involved.

Any kind of injury to the wrist joint can alter how the joint works. After a wrist injury, ligament damage may result in an unstable joint. Any time an injury changes the way the joint moves, even if the change is very subtle, the forces on the articular cartilage increase. It’s just like a machine; if the mechanism is out of balance, it wears out faster. Over many years, this imbalance in joint mechanics can damage the articular cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint can no longer compensate for the damage, and the wrist begins to hurt.

Symptoms

How do I know if I have a ligament injury of the wrist?

When an injury occurs, pain and swelling are the main symptoms. The wrist may become discolored and bruised. Doctors refer to this as ecchymosis. The wrist may remain painful for several weeks. There are no specific symptoms that allow your doctor to determine whether a wrist ligament injury has occurred.

Once the initial pain of the injury has subsided, the wrist may remain painful due to the instability of the ligaments. If the ligaments have been damaged and have not healed properly, the bones do not slide against one another correctly as the wrist is moved. This can result in pain and a clicking or snapping sensation as the wrist is used for gripping activities.

In the late stages, the abnormal motion may cause osteoarthritis of the wrist. This condition can cause pain with activity. During activity, the pain usually lessens, but when the activity stops, the pain and stiffness often increase. As the condition worsens, a person may feel pain even when resting. The ability to grip with the hand may be diminished. The pain may interfere with sleep.

Diagnosis

What tests will my doctor do?

The diagnosis of ligament injuries of the wrist begins with a medical history. Your doctor will want to know about any injuries to the wrist, even if they were years ago and healed without much problem.

Your doctor will then physically examine your wrist joint. It may hurt when your doctor moves or probes your sore wrist. But it is important that your doctor sees how your wrist moves, how it is aligned, and exactly where it hurts.

You will need X-rays. X-rays are usually the best way to see what is happening with your bones. After a wrist injury, X-rays can help determine whether a wrist fracture has occurred. X-rays can also help your doctor determine whether certain types of ligament injuries have occurred by looking at how the bones of the wrist line up.

If X-rays do not show enough information, other tests may be ordered to view the ligaments better. In some cases, an arthrogram of the wrist is used. This test requires that dye be injected into one of the small joints of the wrist. Special X-rays are then taken to look for leakage of the dye out of the joint. This may help confirm that the ligaments are torn.

More recently, doctors are also using magnetic resonance imaging (MRI) to look at the wrist ligaments. The MRI machine uses magnetic waves to create pictures that look like slices of the wrist joint. Unlike X-rays, an MRI scan shows the soft tissues such as ligaments quite well and can sometimes confirm the presence of a torn ligament in the wrist.

Finally, for cases in which the diagnosis is still in question, arthroscopy of the wrist joint may be used to determine whether a ligament injury is causing the continued symptoms. The arthroscope is a miniature TV camera that is inserted into the wrist joint to allow the surgeon to see the ligaments that may be torn. In some cases, the arthroscope may also be used to assist with repair of the ligaments at the same time.

Treatment

What can be done for ligament injuries of the wrist?

The first challenge in treating a ligament injury of the wrist is recognizing that it exists. Many patients fall and injure their wrist and assume they have a sprain. They treat the sprain with rest for a few weeks, and then resume their activities. Many ligament injuries go unrecognized until much later when they cause problems.

The treatment of a ligament injury depends on whether it is an acute injury (just happened within weeks) or a chronic injury (something that happened months ago).

Nonsurgical Treatment

A wrist injury that causes a partial injury to a ligament, a true wrist sprain, may simply be treated with a cast or splint for three to six weeks to allow the ligament to heal.

Surgery

In cases where the ligaments are completely torn and the joints are no longer lined up, surgery may be suggested to either repair the ligaments or pin the bones together in the proper alignment to hold them in place while the ligaments heal.

There is no single operation that is used to fix ligament injuries of the wrist. Several surgical procedures are used depending on the problem.

Percutaneous Pinning and Repair of the Ligaments

If the ligament damage is recognized within a few weeks after the injury, the surgeon may be able to insert metal pins to hold the bones in place while the ligaments heal. This procedure is called a percutaneous pinning. (Percutaneous means through the skin; an incision is not required.) The surgeon uses a fluoroscope to watch as the pins are placed. The fluoroscope is a type of continuous X-ray machine that shows the X-ray image on a TV screen.

In some cases, getting the bones lined up properly is not possible, and an incision must be made to repair the ligaments. The longer the surgery is done after the initial injury, the less likely it is that the bones can be aligned properly. It is also less likely that torn ligaments will heal once scar tissue has developed over the ends. The metal pins are placed to hold the bones still while the ligaments heal. The pins are usually removed four to six weeks after the procedure.

Ligament Reconstruction

When the ligament damage is discovered six months or more after the initial injury, the ligament may need to be reconstructed. This procedure involves making an incision over the wrist joint and locating the torn ligament. Once this is done, a tendon graft is used to replace the ligaments that have been torn. The tendon graft is usually borrowed from the palmaris longus tendon of the same wrist. This tendon doesn’t do much and is commonly used as a tendon graft for surgical procedures around the hand and wrist. The tendon is removed from the underside of the wrist through one or two small incisions.

Again, metal pins are used to hold the bones stationary while the tendon graft heals. The pins are removed six to eight weeks after the surgery.

Fusion

When the ligament instability is discovered long after the injury and arthritis is present in the joints between the unstable bones, a fusion may be suggested. Two or more bones are fused by removing the cartilage surface between the bones. When the raw bone surfaces are placed together, the bone treats them as it would a fracture. The surfaces heal together. The bones fuse into one bone. This stabilizes the motion between the bones and reduces the pain that occurs when the arthritic joint surfaces rub together.

If the entire wrist has become arthritic from longstanding instability, a complete wrist fusion may be required.

Rehabilitation

What should I expect after treatment?

Nonsurgical Rehabilitation

After wearing a splint or cast for three to six weeks, your doctor may have you work with a physical or occupational therapist. Treatments are used to help you regain wrist range of motion, strength, and function.

After Surgery

If you have surgery, your hand and wrist will be bandaged with a well-padded dressing and a splint for support. Physical or occupational therapy sessions may be needed for up to three months after surgery. The first few treatment sessions focus on controlling the pain and swelling after surgery. Patients then begin to do exercises that help strengthen and stabilize the muscles around the wrist joint. Other exercises are also used to improve the fine motor control and dexterity of the hand. The therapist suggests ways to do activities without straining the wrist joint.

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Hand, Finger and Wrist Injuries

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or an injury.

Finger, hand, or wrist injuries most commonly occur during:

  • Sports or recreational activities.
  • Work-related tasks.
  • Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools.
  • Accidental falls.
  • Fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury.

In children, most finger, hand, or wrist injuries occur during sports or play or from accidental falls. Any injury occurring at the end of a long bone near a joint may injure the growth plate (physis) and needs to be evaluated.

Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk of accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, or a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

  • Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity. See a picture of a bruise (contusion) .
  • Injuries to ligaments. See a picture of a torn thumb ligament  as in skier’s thumb.
  • Injuries to tendons, such as mallet finger.
  • Injuries to joints (sprains).
  • Pulled muscles (strains).
  • Broken bones (fractures), such as a wrist fracture .
  • Dislocations.
  • Crushing injury, which can lead to compartment syndrome.

Overuse injuries

Overuse injuries occur when too much stress is placed on a joint or other tissue, often by “overdoing” an activity or repeating the same activity. Overuse injuries include the following:

  • Carpal tunnel syndrome is caused by pressure on a nerve (median nerve ) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand. See a picture of carpal tunnel syndrome .
  • Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.
  • De Quervain’s disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become inflamed. See a picture of de Quervain’s disease .

Treatment

Treatment for a finger, hand, or wrist injury may include first aid measures; medicine; “buddy-taping” for support; application of a brace, splint, or cast; physical therapy; and in some cases, surgery. Treatment depends on:

  • The location, type, and severity of the injury.
  • How long ago the injury occurred.
  • Your age, health condition, and activities (such as work, sports, or hobbies).

Stop the pain and get your hand checked. Call +65 6471 2744 (24 Hours) or SMS to +65 9235 7641

Sprained Wrist

One of the most common causes of wrist pain in athletes is a sprained wrist. A wrist sprain typically occurs after a fall on an outstretched hand stretches or tears the ligaments of the wrist. Common causes of wrist sprains include falls during sports such as inline skating, snowboarding, soccer, football, baseball, and volleyball. When an athlete falls on the outstretched hands, the muscles, tendons and ligaments in the wrist take the majority of the impact, and can be stretched and possibly torn. If these tissues are inflexible or weak, the risk of injury increases.

It’s helpful to understand the difference between a sprain and a strain.

A sprain is an injury to a ligament, the tough, fibrous tissue that connects bones to other bones. Ligament injuries involve a stretching or a tearing of this tissue.

A strain is an injury to either a muscle or a tendon, which is the tissue that connects muscles to bones. Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear.

Signs and Symptoms of a Sprained Wrist Prevention In the wrist, a sprain is much more common that an strain due to the number of ligaments that support the bones in the wrist. A wrist sprain typically causes pain, tenderness, and swelling over the wrist after a fall. It will be red, tender and warm to the touch. There may be bruising, decreased range of motion, and a dull deep ache in the wrist.

If you have these symptoms after a fall on a hand, you should see a physician for an exam to make sure there is not fracture. One particular fracture to the scaphoid (or navicular) bone in the wrist can be fairly serious if not treated properly. For this reason, any wrist injury should be seen by a physician for an evaluation.

Wrist sprains (like other sprains) are graded according to severity:
Grade 1 (mild) — over-stretching / micro-tears of ligaments
Grade 2 (moderate) — partial ligament tears and mild joint instability
Grade 3 (severe) — severe or complete ligament tears and significant joint instability

Sprained Wrist Treatment

R.I.C.E is the first line treatment of a sprained wrist. This includes:

  • Rest. Stop activity and don’t use the injured wrist for 48 hours or until the pain and swelling has subsided.
  • Ice. Ice the wrist by applying a cold pack (wrapped in a towel) or a bag of crushed ice to the wrist for 15 minutes, several a day for several days, until swelling subsides. Don’t ice you injury for more than than 20 minutes at a time.
  • Compression. Use an elastic compression bandage to wrap the wrist and limit swelling. Start the wrap at the base of the fingers and stop just below the elbow. The wrap should be snug, but be careful not to cut off circulation to the fingers.
  • Elevation. Keep the injured wrist higher than your heart as often as possible during the day and at night for the first two days after the injury. This will help drain fluid and reduce swelling around the wrist.
  • Bracing. Your doctor may recommend that you use a brace to immobilize your wrist, especially when playing sports. cast
  • Immobilization. If you have a severe sprain, your doctor may recommend a cast for two to three weeks.
  • Rehabilitation Exercises. You may also see a physical therapist for flexibility, range of motion, and strengthening exercises for the injured wrist.
  • Surgery. In rare cases, surgery may be needed to repair a ligament that is torn completely or if there is a bone fracture.

Sprained Wrist Prevention

Wearing protective gear, such as wrist guards, may help prevent wrist sprains in some sports. Playing by the rules, and simply being aware of your surroundings may also help prevent falls that lead to wrist sprains.

Stop the pain and get your Wrist checked! Call +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg