Diagnosis
If pain is frequent, the wrist should be examined by a physician for swelling, deformation and the strength of the grip. In addition, the range of movement must be assessed extensively. Above all, the exact localization and intensity of the pain in the wrist can provide an initial indication of the causative disease.
An x-ray of the wrist provides information about whether the bony structures in the area of the wrist are affected (e.g. by a fracture), whether wear and tear in the wrist (wrist arthrosis) or arthritis (inflammation of the wrist) is present. If the main cause is a hidden fracture (occult fracture of the wrist, i.e. a wrist fracture that is not visible on X-ray), a computed tomography (CT) scan can be performed in cases of doubt. The improved resolution of the CT makes hidden wrist fractures visible.
If the patient insists on a soft tissue injury, i.e. injury to ligaments, discus traingularis or cartilage, the most valuable examination is the MRI of the wrist. The MRI can also reliably detect inflammation of the tendons or wrist, as well as the bone. However, for bone injuries, MRI of the wrist is clearly inferior to CT, as the resolution of MRI is lower.
Arthroscopy can be used to look at the inside of the wrist. Arthroscopy of the wrist is a rare indication and is considered if the triangular disc or free joint bodies in the wrist are injured. In cases of loss of sensitivity, it often makes sense to perform a neurological nerve test.
Which doctor treats wrist pain?
In almost all cases, wrist pain is due to acute or chronic changes in bones, ligaments, cartilage and other joint structures. An orthopedic surgeon should be consulted for these diseases of the musculoskeletal system. Inflammations and degenerative diseases can be conservatively accompanied and treated by an orthopedic surgeon.
Acute injuries, however, often require surgical treatment in order to suture or screw together damaged bone and cartilage. This treatment can be performed by a trauma surgeon, orthopedic surgeon or plastic surgeon. A particular medical specialization is hand surgery, which is also provided by these surgical disciplines.
Hand surgeons have particular expertise in the treatment of the small and delicate structures of the wrist. The treatment of wrist pain is primarily based on the causative disease. As a rule, the pain phenomena that occur, regardless of the underlying cause, can be treated quite well.
In general, pain in the wrist, whether caused by overloading or by a fall, should be treated by immobilization and cooling.Since the wrist is used a lot in everyday life, it is recommended to put on a bandage or splint to really protect it from stress. You can also use taping to allow certain movements and prevent others. A plaster splint is rarely applied to keep the wrist really still.
To relieve the pain, painkillers can be taken, which also have a decongestant effect. This also reduces the inflammatory reaction in the wrist. This can be done with tablets (such as ibuprofen) or locally, for example with a Diclofenac (Voltaren) ointment dressing.
In the case of swelling, the wrist should be held up so that the blood can drain more easily. In this case, the affected hand can also be placed higher than the rest of the body on some pillows while sleeping. If the cause is known, specific therapeutic measures can be applied.
In the case of a ganglion, for example, it can help to drain the collected fluid in the ganglion sac by means of puncture. Surgical removal can also be considered. In the case of tendosynovitis, the hand should be immobilized and the triggering movement reduced to a minimum.
If this is not sufficient, a cortisone injection can also achieve an improvement. Rarely is surgery with splitting of the tendon sheath necessary. In the case of bone fractures, surgical therapy is often necessary so that the fracture can heal completely.
If this is not done, a malposition can result and lead to long-term pain. In the case of well-standing, smooth fractures, immobilization with a plaster cast may also be sufficient. In the case of rheumatic diseases, experienced rheumatologists must weigh up the therapeutic options.
Frequently, medication is required here. In infected wounds, antibiotics may be necessary to prevent the infection from spreading. In summary, it can be said that in most cases the regular application of anti-inflammatory ointments is sufficient to achieve effective pain relief.
In addition, the consistent wearing of a support bandage can alleviate the pain in the wrist. Various medications can be used for serious underlying diseases. After the diagnosis has been made, the attending physician will inform the affected patient about the necessary/possible treatment measures.
An alternative to bandage, splint and plaster is the so-called taping/taping. This can also be used to stabilize the wrist and promises better wearing comfort. By guiding the ligaments, it can continue to allow and support certain movements, while other movements are specifically slowed down.
This allows the hand as a whole to be moved and used even more easily. It is also much lighter than a plaster cast. Tapes can also be used prophylactically.
For example, many professional athletes use them to prevent injuries and to support tendons, joints and muscles that are subject to heavy strain. Boxers and other martial artists also tape their wrists to keep them stable during the application of force. Tapes should be applied by experienced therapists to achieve sufficient stability in the joint.
However, it should be considered which immobilization measure is more suitable, since a tape can naturally not be as stable as a plaster splint. Depending on the objective, however, it is a good alternative. Another type of taping is the so-called kinesio tape. This differs from classic taping, because the tapes are elastic and contribute less to stability and guidance (you can usually recognize these tapes by their bright colors). The effect of these tapes is controversial.