Wrist pain

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, the ligaments or tendons located in this area. Its onset can have numerous origins: at the root of the disorder, in fact, there can be bone fractures, nerve compressions, arthritis of various kinds, inflammation or ruptures of the tendons, etc.
To establish the most appropriate therapy, a diagnostic search for the triggering causes is needed, based on an accurate physical examination and other more specific controls, such as x-ray examination, magnetic resonance imaging, arthroscopy, etc.

is a narrow joint complex (hence a "joint) located between the forearm and hand. It is composed of 8 thin bones, arranged in two rows of 4, which are called carpus. The carpus is interposed between the radius, which is the "bone of the forearm", and the metacarpus, which is the bone complex that makes up the fingers of the hand.

Figure: the carpal bones (highlighted in yellow).

The union and movement of the various bony structures mentioned above are guaranteed by a different number of ligaments, the best known of which are the transverse carpal ligament and the dorsal carpal ligament.
Furthermore, always at the level of the wrist bones, several tendons are inserted; tendons are connective structures, similar to ligaments, which connect muscles to bones.

acute (sudden and violent), such as a severe sprain or fracture, or from a chronic problem, such as arthritis or carpal tunnel syndrome.

SUDDEN TRAUMAS

The most common injuries to the wrist are on the one hand bone fractures or sprains from impact against the ground, and on the other, inflammation or bone stress fractures.

Figure: Scaphoid bone of the wrist.

Bone fractures and sprains from impact against the ground usually arise as a result of an accidental fall forward, as the person who is falling places his arms and hands in front of the body, as if he were to protect himself.
A classic fall fracture is the fracture of the scaphoid bone, located at the base of the thumb.
Bone fractures and stress inflammations. The continuous repetition, with the wrist, of certain movements can cause the rupture of some carpal bones or the inflammation (if not the laceration) of some tendons located in the area. Fractures or inflammations that occur in this way are known as stress fractures or inflammation.

ARTHRITIS

There are two arthritis that can cause wrist pain:

Osteoarthritis or arthrosis. Characterized by wear and tear of the articular cartilages, it rarely arises at the wrist. According to some statistical studies, its appearance in this area is usually subsequent to a previous trauma, which can also date back to many years earlier. The classic symptom of osteoarthritis is pain in the thumb.
Rheumatoid arthritis. It is an autoimmune disease, in which the immune system, instead of defending the organism from the threats of the external environment, attacks it in the joints, causing them to degenerate.
The wrist is one of the sites most affected by rheumatoid arthritis.

RISK FACTORS

Any individual can be prone to wrist pain, whether they lead a sedentary life or lead a very active life. Nonetheless, the people most at risk are those who carry out repetitive and very intense manual labor, those who practice sports that are stressful for the wrist - such as golf, tennis, snowboard or gymnastics - and, finally, those who suffer from diseases chronic severe conditions, such as diabetes, leukemia, scleroderma, or systemic lupus erythematosus.

according to patients, it gives rise to a dull pain, similar to toothache; inflammations of the tendons generate excruciating and very acute pain, and severely limit joint mobility; fractures and sprains, in addition to the sense of pain, are characterized by swelling and difficulty in movement.

WHEN TO SEE THE DOCTOR? COMPLICATIONS

Wrist pain should attract the attention of sufferers, especially if it causes severe pain for several days, persistent swelling, limited joint mobility, tingling, numbness, or if it responds poorly to basic treatments such as ice and rest.
Neglect of the aforementioned symptoms can markedly slow down the healing process and leave permanent and very unpleasant consequences (such as anatomical defects or reduced joint capacity).

and electromyography.
Only with an accurate diagnosis is it possible to plan the most appropriate therapeutic treatment.

OBJECTIVE EXAMINATION

During the physical examination, the doctor asks the patient to indicate the painful points, observes the appearance of the wrist (if it has redness, swelling or particular signs), tests the joint mobility to identify any anomalies and, finally, tests the strength of the wrist. "limb.
According to the results of these observations, he decides how and whether to continue the investigations with further diagnostic tests.

IMAGE DIAGNOSTICS

The most common imaging tests are:

The X-ray examination is useful for highlighting bone fractures and signs of osteoarthritis.
Computed axial tomography or CT scan. It shows in detail the bone and joint anomalies, however its execution exposes the patient to ionizing radiation.
Bone scan. Through the injection of a radiopharmaceutical intravenously, it allows to obtain images relating to the anatomy and metabolic activity of the bones. It is a very sensitive diagnostic test (because it clearly shows if there are pathological changes), but at the at the same time also non-specific (as it does not clarify the nature of the disturbances highlighted).
Nuclear magnetic resonance or MRI. It highlights the appearance of the bones and soft tissues present in the wrist. Unlike the CT scan, it does not involve exposure to ionizing radiation.

ARTHROSCOPY

If imaging is unclear or poor in information, your doctor may opt for diagnostic arthroscopy. Arthroscopy is a minimally invasive surgical procedure, which involves the insertion into the wrist of a particular instrument, equipped with a camera and called an arthroscope. The arthroscope camera is connected to a monitor, on which it projects, in real time and for the operating surgeon, everything it "sees".

ELECTRONEUROGRAPHY AND ELECTROMYOGRAPHY

Electroneurography is a diagnostic test that detects how fast the transmission of nerve signals is. Electromyography, on the other hand, allows us to measure the response of muscles to nerve stress.
Both procedures require the use of electrodes and are practiced in suspected cases of carpal tunnel syndrome.

, anti-inflammatory and painkilling drugs, casts, braces or surgery.

REST

Whatever the cause of wrist pain, rest is always a good and recommended remedy. Failure to observe it can, even in less serious cases, lead to unpleasant consequences. Often, in fact, to avoid a stress fracture or a tendon injury it is sufficient to rest the joint at the first painful signs.

ICE

Ice packs are a great remedy in most circumstances. In fact, the so-called cryotherapy (from the Greek "cold treatment") has very powerful analgesic effects (ie against pain), as it slows down the transmission of painful impulses; moreover, it has anti-edema effects (ie against edema or swelling), as it prevents the extravasation of blood into the surrounding tissues.
In less severe cases, ice combined with rest is the best remedy, because it is inexpensive, highly effective and virtually free of side effects (when used correctly).

DRUGS

The most used anti-inflammatory and painkilling drugs, in case of wrist pain, are ibuprofen and paracetamol.
In case of severe pain, corticosteroids could also be an excellent solution. However, these powerful anti-inflammatories should only be taken on prescription from the doctor, as they have several side effects.

N.B. the term anti-inflammatory means "against" inflammation. "Inflammation is a very particular and complicated process, which mainly causes pain and swelling.

PLASTERS AND GUARDS

In case of bone fractures (both from impact and from stress), the most popular therapeutic treatments are casts or splinting, as they allow the bones to strengthen and heal properly.
In case of sprains to the ligaments or inflammation of the tendons, however, the most applied remedies are braces, as they limit the most dangerous and painful movements for the wrist.

SURGERY

Surgery is usually provided when the causes and extent of wrist pain are serious and relevant. There are surgical interventions for:

Very severe bone fractures. The surgical operation serves for the insertion of metal plates, which favor the welding of the fractured bones.
Carpal tunnel syndrome. The operation involves the section of the transverse carpal ligament, in order to reduce the crushing of the median nerve. It is performed when the symptoms of carpal tunnel syndrome last for more than six months and are particularly annoying.
The rupture of ligaments or tendons. The operation serves to reconstruct or replace broken ligaments or tendons.

, which provides the right amounts of calcium; Calcium is the key mineral for making bones strong and less prone to fractures.

Keep the areas where you spend most of your time in order, as falls (with subsequent fracture of one or more bones) are often due to forgotten obstacles around the house or in the premises where you work.

Use adequate protection when practicing certain sports, such as snowboarding, skating, etc.

Follow the advice intended for the prevention of carpal tunnel syndrome. Although a certain correlation between certain manual activities and carpal tunnel syndrome has not yet been demonstrated, there are a number of useful precautions (available on the following web page), which should be followed.