Wrist & Hand Pain Overview
Wrist and hand pain is an extremely common condition and a common reason someone will visit their chiropractor. By far the largest cause of wrist & hand pain that presents to our Balmain chiropractors is a wrist sprain. Here is an overview of wrist & hand pain conditions.
Subtypes of wrist & hand pain
Generally speaking, wrist & hand pain conditions can be categorised into three main subtypes:
- Mechanical (i.e., overuse) conditions
- Pathological conditions (e.g., inflammatory and degenerative arthritides, autoimmune conditions, fractures and dislocations and benign cysts etc.)
- Serious medical conditions (i.e., red flags such as cancers and tumours, infections)
Mechanical conditions of the wrist & hand
Mechanical conditions of the wrist & hand refer to any type of abnormal loading or traumatic injury (e.g., strain/sprain, overuse, blunt trauma, cramps etc.) to contractile (i.e., muscles, tendons and attachments) and non-contractile (i.e.,joint capsules, ligaments, nerves and their sheaths, bursae, and cartilages etc.) tissues of the wrist & hand. Mechanical conditions are the most common subtypes of wrist & hand pain and commonly present to our S3C chiropractors. Mechanical injuries can affect several tissue types, including:
- Tendons (e.g., tendinopathies)
- Muscle-tendon structures (e.g., tennis elbow)
- Soft tissue compartments (e.g., compartment syndrome)
- Periosteum cartilage, which is the covering of the bone (e.g., shin splints)
- Bursa (e.g., bursitis)
- Nerve tissue (e.g., neural mechanosensitivity)
- Bone (e.g., stress fractures)
The following are types of mechanical conditions of the wrist & hand:
- Carpal tunnel syndrome
- de Quervain’s tenosynovitis
- Wrist sprain (e.g., radiocarpal, intercarpal, ulnocarpal and radioulnar ligaments)
- Wrist strain (e.g., wrist flexor and extensor groups)
- Carpal instability
- Triangular fibrocartilage complex injuries
- Trigger finger/thumb
- Writers cramp
Pathological conditions of the wrist & hand
Pathological conditions include any abnormal anatomical or physiological conditions and objective or subjective manifestations of disease to tissue, not classified as disease or syndrome. Pathological conditions of the wrist & hand are vast, the incidence is variable and there are several risk factors that can predispose people to pathological conditions. In the case of fractures and dislocations, these types of injuries are relatively common, affecting 72 people per 100,000 per year in the general population, and indeed the incidence would be higher in contact sporting populations like basketball, netball and football. Conversely, autoimmune conditions are relatively uncommon in the general population affecting 5 per 100,000.
The following are types of pathological conditions of the wrist & hand:
- Fractures (e.g., Colles fracture, Smiths fracture, scaphoid fracture, metacarpal fractures)
- Rheumatoid arthritis
- Psoriatic arthritis
- Complex regional pain syndrome
- Dupuytren’s Contracture
- Gamekeeper’s Thumb
- Ganglion cysts
- Raynaud’s phenomenon
Serious medical conditions of the wrist & hand
Serious medical conditions include those that are potentially life-threatening and require immediate medical attention. There are important signs and symptoms to look out for when ruling out serious pathology. In medicine, these are referred to as red flag signs and symptoms. Red flags symptoms pertaining to the wrist & hand conditions include:
- Unrelenting pain, not associated with movement, and that keeps you awake during the night
- Unexplained and significant weight loss/gain or fever/chills
- Symptoms that spread into the arm(s), especially severe pain, numbness and/or tingling and/or weakness, and especially if it is aggravated by lifting and exertion.
- Progressive weakness in the arms with progressive muscle wasting
The following are types of serious medical conditions of the wrist & hand:
- Metasteses (i.e., cancers)
- Myocardial infarction (i.e., a heart attack)
- Complete lacerations to arteries and nerves
How are wrist & hand pain conditions diagnosed?
Like any presenting condition, the first thing clinicians will do is take a thorough case history and systems review. A thorough physical, neurological and functional examination is also undertaken. After this point, a differential diagnosis (i.e., a working diagnosis, subject to change with further investigation).
If further investigation is warranted
After a physical exam and symptom review, a doctor may also diagnose wrist pain and the underlying condition by:
Medical imaging scans – including an X-ray, CT scan, and MRI.
Arthroscopy – this procedure involves a small cut on the wrist. A small instrument that has a tiny camera attached is inserted in through the cut. The pictures from the camera are then projected onto a computer monitor for the doctor to see.
Nerve conduction studies – these measure how fast nerve impulses travel through the carpal tunnel region of the wrist.
How are wrist & hand pain conditions treated?
How the wrist & hand is managed is largely determined by the condition. If the presentation appears to be of mechanical in nature, the protocol is for the patient to undergo a 6-8 week trial of conservative management. If there is no improvement or worsening of the condition, further investigation like scans may be required. If the condition appears to be pathological, medical intervention can be used alongside conservative management. Serious medical conditions require immediate medical/surgical referral.
The key to getting the right treatment for your wrist and hand problem is seeking help from a chiropractor or physiotherapist who knows the wrist and hand well. At Sydney Spine & Sports Centre (S3C) we have a passion for fixing joint and muscle problems and the wrist and hand is of particular interest for us. We use evidence-based treatments to reduce wrist and hand pain and improve wrist and hand function. Our chiropractors and physiotherapists use the latest and highest standards in national and international guidelines to ensure you get the absolute best.Treatment for wrist pain depends on the cause of the pain and its severity. The least invasive treatment is given first before treatments are recommended. They include:
Home treatment – often simply resting the wrist as much as possible to allow it time to heal is effective. Pain medication and ice may also be recommended to reduce inflammation and pain.
Splints – in some cases, wearing a wrist splint can help. Splinting may prevent certain wrist movements that cause irritation. A splint might also reduce squeezing of the nerve.
Exercises – depending on the type of pain, wrist exercises may work. Certain exercises can be prescribed to stretch and lengthen muscles and tendons. When it comes to which exercises to do, patients should get recommendations from a doctor or physical therapist.
Additional treatment – cortisone injections, which decrease inflammation and reduce pain can be effective.
Surgery – only used if less invasive treatments have not worked. The type of surgery performed depends on the cause of the pain. Surgery for carpal tunnel syndrome involves cutting a ligament in the wrist to release pressure on the nerve.