Brief overview
- Causes: e.g. tendonitis, ganglion, carpal tunnel syndrome, lunate malacia, osteoarthritis, rheumatoid arthritis, injuries such as broken bones, ligament or disc injuries.
- When to see a doctor? If there is a visible misalignment of the hip joint, for example after an accident or fall. If the pain persists for a long time and becomes more severe.
- Diagnosis: Doctor-patient consultation to take a medical history (anamnesis). Examination and palpation of the wrist to check for misalignment, swelling and/or heating as signs of inflammation. Specific provocation tests such as Phalen’s test to diagnose carpal tunnel syndrome. Ultrasound for suspected tenosynovitis or ganglions. X-ray if a bone fracture or osteoarthritis is suspected.
- Treatment: depending on the cause, e.g. immobilization and cortisone administration for carpal tunnel syndrome, rarely surgery. In the case of tendon sheath inflammation, brief immobilization, local cooling, electrotherapy, anti-inflammatory drugs, etc. For bone fractures, usually plaster cast. For lunate malacia: immobilization in the early stages, otherwise surgery. For osteoarthritis: conservative therapy (medication, physiotherapy, etc.), possibly surgery.
Pain in the wrist: causes
Injuries as a cause of wrist pain
Injuries (for example during sport or due to a fall) often lead to pain in the wrist. These include, for example, bone fractures in the wrist area as well as ligament and disc injuries.
Bone fracture
A fall on the hand can break the radius near the wrist. The wrist pain that occurs with such a “wrist fracture” (distal radius fracture) is particularly noticeable when the hand is turned outwards or the forearm is turned. In addition, the wrist may swell, become immobile and show a visible deformity.
A fall on the hand can also cause a carpal bone – usually the scaphoid bone – to break. A typical symptom of a scaphoid fracture is pain in the so-called tabatiere – the small, elongated triangular depression on the back of the wrist between the hand and thumb.
Ligament and disc injuries
An injury to the ulnar disc also causes pain in the wrist. This is a cartilage disc that lies between the ulna (ulna) and the carpal bones. It can tear in the event of an accident. A typical sign of a torn disc is pain on the ulnar side (little finger side) of the wrist.
In older people, the cartilage disc frays. This can also lead to the typical pain on the little finger side of the wrist.
Inflammation as a cause of pain in the wrist
Acute or chronic inflammation of the tendon sheaths in the wrist can also cause wrist pain. In older people in particular, rheumatoid arthritis usually triggers the inflammation.
Tendon sheath inflammation
Tendon sheath inflammation in the wrist is mainly caused by chronic overuse. Those affected feel a painful pulling sensation in the wrist. The joint often swells and becomes hot.
Tendovaginitis stenosans de Quervain (“housewife’s thumb”) is a special form of tendinitis. In this case, the first extensor tendon compartment in the wrist is inflamed. Sufferers mainly experience pain when gripping or holding something tightly. The pain can radiate into the thumb and forearm.
Rheumatoid arthritis
Osteoarthritis as the cause of wrist pain
Osteoarthritis (joint wear and tear) is characterized by load-dependent pain in the wrist. The radiocarpal joint is usually affected by osteoarthritis. This is the connection between the radius bone of the forearm and the carpal bones. Radiocarpal joint arthrosis often occurs when a bone in this area has not grown together straight after a fracture.
Other causes of pain in the wrist
Wrist pain can also have other causes. The possibilities range from nerve compression (carpal tunnel syndrome) to dying bone tissue (lunate malacia).
Carpal tunnel syndrome
Signs of carpal tunnel syndrome include pain and discomfort as well as numbness in the affected hand or arm. The symptoms usually occur at night.
Ganglion
A ganglion can develop in the area of the wrist (especially on the back of the hand). This is a gelatinous, fluid-filled, benign tumor that is connected to the wrist or to a tendon sheath. A ganglion can be recognized by the typical bulging, elastic, smoothly bordered swelling. The pain in the area of the ganglion can vary in intensity.
Lunate malacia
In lunate malacia (Kienböck’s disease), bone tissue of the lunate bone (os lunatum; one of the eight carpal bones) dies off. The symptoms include more or less severe pain in the wrist. The tissue above the lunate bone in particular reacts painfully to pressure. As the disease progresses, the wrist may also become less mobile.
Pain in the wrist: when do you need to see a doctor?
If you experience acute pain in your wrist after an accident (e.g. falling on your hand), you should see a doctor. This is especially true if you notice other symptoms such as a misalignment of the wrist. Persistent or increasing wrist pain of unknown cause should also be checked out by a doctor.
Pain in the wrist: examinations
First of all, the doctor will talk to you to get a picture of your medical history (anamnesis). They may ask the following questions, for example:
- Does the wrist pain tend to be stabbing or pulling?
- Does the pain radiate into the hand and forearm?
- Does it only hurt when you rest your hand or also at rest?
- Is the pain always there or only with certain movements?
- Did the pain occur acutely (e.g. after an accident) or did it develop gradually?
- Is only one joint affected or do both wrists hurt?
- How long have you been suffering from wrist pain?
- Do you have any other complaints such as sensory disorders in your hands (e.g. numbness)?
- Do you frequently strain your wrists at work or in your free time? For example, do you regularly work with a jackhammer or on a computer or do you cycle a lot?
- Do you suffer from conditions such as rheumatism, gout or diabetes?
The doctor also examines whether the wrist is functioning normally. For example, you will be asked to flex or extend the joint and make a fist.
Sometimes the doctor also uses so-called provocation tests, such as the Phalen test: you have to press the backs of your hands against each other for 30 to 60 seconds. If this intensifies the symptoms, you probably have carpal tunnel syndrome.
Further examinations
Depending on the suspected cause, the doctor will carry out further examinations. If the pain in the wrist is accompanied by nerve damage in the hand, for example, a neurological examination (measurement of nerve conduction velocity = electromyography) can help. Ultrasound can be used to detect ganglions or tendon sheath inflammation. The doctor can detect bone fractures and osteoarthritis on an X-ray.
Wrist pain: what helps?
How wrist pain is treated depends on its cause. Here are some examples:
Carpal tunnel syndrome is usually treated conservatively by immobilizing the wrist and injecting cortisone if necessary. Surgery is only necessary if conservative treatment does not help or if the pain in the wrist has been present for months.
Even with a scaphoid fracture, those affected generally have to wear a plaster cast for some time.
In the early stages of lunate malacia, the wrist is immobilized. In advanced stages, surgery is required.
If a disc tear is responsible for the pain in the wrist, the cartilage disc must be sutured.
In the case of wear-related (degenerative) disc damage, however, conservative treatment is usually sufficient. This involves cooling and immobilizing the affected wrist. Anti-inflammatory medication is also used. If this does not improve the pain in the wrist, the discus can be surgically removed.
Tips and exercises for wrist pain
Pain in the wrist often indicates overuse. Anyone who works a lot with a mouse on a computer, for example, will be familiar with the typical cramped posture of the wrist. This can lead to permanent pain in the wrist, which can sometimes radiate into the arm and shoulder. This is known as RSI syndrome (repetitive strain injury) or simply “mouse hand”. This can lead to secondary conditions such as tendinitis or carpal tunnel syndrome.
- Stretch your arms out straight in front of you. Then clench your fists with your thumbs on the outside and remain in this position for about 10 seconds. Then spread your fingers apart for another 10 seconds.
- Extend the arm of your mouse hand straight out in front of you. Tilt your wrist so that the fingers of your hand are pointing vertically upwards. With your other hand, press your fingers towards your chest for around 10 seconds.
- Touch the tips of the index, middle, ring and little fingers of the same hand in turn with the thumb of your mouse hand. Then repeat the exercise in reverse order.
You can repeat these exercises several times as required.
If you have wrist pain, it can also help to operate the computer mouse with the other hand from time to time or to use an ergonomic mouse or roller bar mouse. Yoga is also a good tip.
