Wrist pain can be difficult to diagnose and treat due to the complex nature of the wrist and hand as well as the strain we place upon that area every day.  Pain at rest is possible but most common is pain with movement or gripping something.  People often complain about pain with some sort of activity, such as lifting a gallon of milk, turning the forearm while lifting something.  Inflammation in tendons that cross the wrist will typically be painful with strong gripping movements while pain that occurs with simply moving your forearm and wrist generally indicates ligament or cartilage problems.

There are two rows of wrist (carpal) bones.  The proximal row moves against the forearm bones (radius and ulna) and consists of 3 bones (4 if you include the pisoform bone which is embedded in the flexor carpi ulnaris muscle).  The distal row moves against this row and also against the hand bones or metacarpals, of which there are 5.  All these bones are held together by strong ligaments, creating joints that need to be moved by muscles and tendons.  So, there are lots of structures that can be injured and cause pain! 

As with most injuries, you should start by reviewing your own history to determine if there was an event that caused the injury.  Look for any change in activity or activity level, any outside factors such as work conditions or demands requiring an awkward strain or any pattern in activity that will reproduce the pain.  It is also important to note anything you can do to alleviate the pain such as rest, anti-inflammatory medicine or a change in activity.  You should only consider medications if you have consulted with your physician to insure that you are an appropriate candidate. 

If you find yourself sitting around with nothing to do, take your thumb or forefinger and gently poke around in the area you are having pain.  If you can find a painful spot then you most likely have found an inury and inflammation in a ligament or tendon.  If you think you are directly on the bone, it is also possible that you have found a stress fracture.  If you find some mile pain that you can make worse by moving your wrist forward, backward or side to side, then it is likely you may have injured a ligament or the capsule that surrounds each joint may be inflamed and is getting pinched with movement.

There is also a triangular piece of cartilage on the ‘pinky’ side of the wrist that helps give the wrist both stability and mobility.  In some cases, a lot of manual labor, twisting, or a hard fall onto your hand or wrist can tear this cartilage, called the triangular fibrocartilage complex, or TFCC. 

Frequently the initial treatment for a wrist injury involves the use of over-the-counter anti-inflammatory medicine, applying ice and even perhaps using a wrist splint or support.  Using anti-inflammatories should be done with caution and under the supervision of a physician as some people can be at risk for stomach or intestinal problems. 

Treatment begins with basic bending (flexion) and straightening (extension) exercises using light weights.  As strength increases and pain decreases, repetitions can increase as well as weight or other resistance.  Gentle stretching can also be added to the rehabilitation routine as long as it does not aggravate the pain and it should be limited to specific structures involved.

On the side of the thumb, the wrist tends to be susceptible to tendon injuries.  These tendons go through tissue ‘sheaths’ that protect and help the tendon glide as the wrist and fingers go through their repeated motions throughout the day.  There are two main tendons that are affected and they cross the wrist to go up the side and back of the thumb.  If you look at the back of your hand and pull your fingers back while spreading your fingers, you should be able to see these two tendons. 

As these tendons pass through the sheaths, inflammation or adhesions (scar tissue) can affect the gliding and cause pain and problems moving or grasping something.  Treatment for this condition should decrease inflammation, break up scar tissue adhesions and stretch the tendons and muscles.  Depending on how long the condition has been present, exercises may also need to be added to restore muscle strength.  The muscle and tendon that pull the thumb away from the hand is particularly susceptible to this type of injury and is called De Quervain’s disease.  Frequent and consistent stretching and use of cold therapy can be helpful in breaking the scarring and re-gaining mobility.