Wrist pain is a specific discomfort that indicates the presence of a pathological process in the area of the wrist joint, wrist bones, and nearby soft tissues. It can be dull, acute, constant, short-term, diffuse, local, irradiating, etc. Often associated with the time of day or physical activity. Causes of pain in the wrist are determined by the survey, physical examination, radiography, ultrasound, MRI, CT, arthroscopy, laboratory tests. Until the etiology of the pain syndrome is established, rest, taking analgesics is recommended.
The most common traumatic causes of pain in the wrist are bruises and damage to the ligaments of the wrist joint. A bruise occurs upon impact, characterized by moderate pain. Subsequently, the pain becomes dull, gradually subsides within a few days. Local swelling, hyperemia, bruising may be detected. Limb function is moderately or slightly limited.
Ligament injuries (sprains, tears, ruptures) develop when falling on an unbent or bent hand, eversion of the hand. At the time of injury, victims sometimes feel a crack due to the rupture of the fibers. The pain is sharp, explosive, superficial, localized in the projection of the ligament. After the injury, it subsides, but then again intensifies due to increasing edema. The function of the hand is limited, there is a sharp pain when trying to deflect the hand in the direction opposite to the damaged ligament.
Compartment syndrome is not an independent condition, it is formed against the background of severe injuries (fractures, dislocations), limb compression, tumors, and inflammatory processes. Especially often detected in children with hand injuries, it can cause Volkmann's contracture. Accompanied by significant swelling, increasing pressing or arching pain, which does not correspond to the severity of the pathology, is not eliminated by conventional painkillers.
A fracture of the beam in a typical place develops when falling with support on the palm, accompanied by unbearable explosive deep pain, sometimes combined with a crunch. Then the intensity of the pain decreases somewhat, but the pain remains very bright, intensifies with the slightest movement. The joint quickly swells, deformation is possible. With epiphysiolysis of the radius in children, the symptoms are similar, but less pronounced, so the pathology is sometimes mistaken for a bruise.
Galeazzi injury is a combination of a fracture of the lower third of the beam and a distal dislocation of the ulna. Accompanied by unbearable pain in the forearm and wrist joint, deformity of the forearm, protrusion of the head of the ulna from the side of the little finger. With dislocations of the hand caused by a blow or a fall on the hand, the pain is also explosive, unbearable, but spreads along the wrist, combined with a sharp deformity of the limb.
Fractures of the bones of the wrist are formed with a direct blow or fall, manifested by very intense pain in the depths of the base of the palm, rapidly increasing swelling. Distinctive features are the inability to clench the hand into a fist due to pain (fractures of the scaphoid and pisiform bones, de Quervain's fracture dislocation) or increased pain during dorsal extension of the hand (fracture of the lunate bone).
With arthrosis of the wrist joint, wrist joints, the pain is initially short-term, non-intense, without a clear localization. They appear mainly at the beginning of movements, after significant loads, sometimes they disturb “for the weather”. In the future, they become longer, spilled, combined with transient stiffness. In the final stages, the pain syndrome is prolonged, occurs at rest, at night. The joint is deformed, movements in it are limited.
Kienböck's disease is characterized by sudden pain during movement, stress on the arm. The pain is deep, localized along the midline at the base of the wrist, aggravated by pressure on the back surface, flexion of the hand. The pain syndrome gradually increases over several months, complemented by an increasing limitation of passive and active movements. Often there is a bilateral lesion.
Patients with chondromatosis complain of minor or moderate deep diffuse pains of indistinct localization, restriction of movements, crunching during movements. Infringement of freely lying intra-articular bodies provokes blockades, manifested by sharp pain, restriction or impossibility of movements. With frequent blockades, contractures can form.
Aseptic arthritis is characterized by diffuse dull pulling or aching pain. The starting point is trauma, infection or rheumatic process. At first, the pains are insignificant, intermittent, appear or intensify in the afternoon and after exercise. Then the arthralgias become prolonged, spread throughout the joint, and do not disappear at rest.
In infectious arthritis, the pains are jerking, shooting, bursting, throbbing. Their intensity rapidly increases to the point of unbearable. Increasing swelling, diffuse reddening of the joint, significant local hyperthermia, deterioration, fever are detected. Attempts to move and touch the joint are sharply painful.
Osteomyelitis of the radius and carpal bones usually develops after open injuries and operations on the joint. Signs of suppuration are found in the wound area. The pains are growing, from dull they are transformed into sharp, drilling, tearing. The general condition of the patient progressively worsens. There are signs of intoxication, general and local hyperthermia.
Synovitis of the wrist joint occurs against the background of other diseases. Accompanied by arching dull pain, which gradually increases with the accumulation of fluid, quickly weakens after puncture of the joint. On examination, the joint is enlarged in volume, its contours are smoothed.
Tuberculosis of the bones of the wrist, wrist joint is rare, usually combined with tuberculous lesions of another joint (knee, elbow), may be bilateral. Initially, there is a slight pulling or aching pain in the muscles, non-intense arthralgia after exercise. With progression, the pain syndrome intensifies, supplemented by redness, swelling, joint deformity, general weakness, subfebrile condition.
Gonorrheal arthritis of the wrist joint is more common in women, it can be combined with damage to the elbow joint. Sharp diffuse pains are observed at rest and during movements. With passive movements, the pain syndrome is less pronounced than with active ones. Palpation reveals painful points in the areas of attachment of tendons and ligaments to the bones. The joint is edematous, hyperemic. Body temperature is elevated to febrile numbers, chills are possible.
The osteoarticular variant of sporotrichosis in clinical manifestations resembles chronic arthritis. The pains are undulating, aching or pulling, aggravated after physical exertion. Puffiness, local hyperemia are possible. Over time, deformations form.
De Quervain's disease (stenosing ligamentitis) is manifested by aching, pressing pain during abduction and extension of 1 finger, deviation of the hand towards the little finger. The pains gradually progress, begin to bother even with minor movements, sometimes they are permanent or appear at rest. They are localized at the base of the hand, the wrist joint, the lower part of the forearm from the thenar side. In half of the cases, irradiation is noted in 1 finger, forearm, shoulder, elbow joint.
Professional tendovaginitis of the hand develops acutely, begins with a pulling pain in the projection of a particular tendon (depending on the nature of the load), which increases with movement. Accompanied by edema, hyperemia. Then the inflammation becomes chronic. Pain will decrease, disturb only with repetitive movements, pressure on the tendon area. With infectious tendovaginitis, all symptoms are more pronounced, the pain is twitching or bursting, there is no chronization.
Hygroma of the wrist joint can proceed painlessly or be accompanied by mild pulling pains during movements. More often it is formed on the back, less often on the palmar surface of the joint. It is a soft or hard elastic formation without edema and redness.
Benign tumors proceed for a long time. Osteoid osteomas of the bones of the wrist are more often diagnosed in young men; due to their small size, they can remain visually invisible, but are manifested by sharp pains in the affected area. With chondromas, pain is not intense, due to the growth of neoplasia, deformation occurs over time, palpation reveals a solid, painless formation in the wrist area.
Malignant tumors in the projection of the wrist occur quite rarely. They are characterized by a progressive pain syndrome, a rapid deterioration in the general condition. At first, the pains are not intense, dull, aching, without a specific localization, then - sharp, twitching, bursting, burning, cutting. In the final stage, the pain syndrome becomes unbearable, it is eliminated only by narcotic analgesics.
For rheumatoid arthritis, symmetrical joint damage is typical. The severity of pain is determined by the activity of the pathological process.
In primary and secondary (against the background of other rheumatic pathologies) polymyositis, the articular syndrome is often manifested by the involvement of the wrist and hand joints. The pains are dull, aching, pressing or bursting, aggravated after exertion, limiting movement. The joints are edematous, the skin over them is hyperemic. Common muscle pains, progressive muscle weakness are found.
Multiple joint involvement, including the wrist, can be seen in systemic scleroderma. Pain sensations are aching, pulling, aggravated during physical activity. Patients complain of stiffness. On examination, swelling is determined, sometimes flexion contractures are formed. The skin on the body is thickened, dry, rough. Violations of the functions of internal organs are possible.
In rheumatoid-like and pseudophlegmonous forms of gout, one or more joints are affected. In the first case, the pain syndrome resembles that of rheumatoid arthritis, in the second, acute pain and signs of inflammation are noted. With an infectious-allergic form of gout, pain can occur in various joints, including the wrist, and quickly migrate from one joint to another.
The defeat of the wrist joint is typical for pseudogout (pyrophosphate and hydroxyapatite arthropathy). Usually one joint is involved. In the acute form of pain, intense, burning or cutting, the skin over the joint is swollen, reddened, movements are painful. Attacks pass within a week, in the period between attacks, half of the patients have no complaints. The rest have a moderate pain syndrome, which increases with movement and weakens at rest.
Carpal tunnel syndrome, caused by compression of the median nerve, is characterized by burning shooting pains, tingling, numbness of the palmar surface of the hand. Pain radiates to the wrist joint, forearm, less often to the fingers. Due to pain attacks, patients wake up at night. The severity of the pain syndrome decreases when lowering the arms, waving or shaking the lowered arms, rubbing the palms. Perhaps unilateral and bilateral defeat.
A similar clinical picture is observed with other neuropathies of the median nerve (for example, post-traumatic). With neuropathy of the ulnar nerve due to compression in the Guyon canal, pain is localized to the hypothenar zone and the base of the hand, with other lesions of the same nerve, it spreads to the wrist and hand from the forearm. With damage to the radial nerve, pain on the back of the hand is disturbing, aggravated by bending the elbow. With all neuropathies, pain is causal in nature, paresthesias, weakness, and numbness of the hand are observed.
In case of injuries, the diagnosis is made by traumatologists. For other pathologies, the examination is carried out by orthopedists or rheumatologists. In the process of diagnosis, data from surveys, physical examination, and additional studies are used. The following instrumental and laboratory methods are used:
In case of injuries, immobilization is carried out with a splint or a hand is suspended on a scarf bandage. Apply cold. With intense pain syndrome, an anesthetic is given. For pains of non-traumatic origin, the hand is provided with rest, in the absence of signs of inflammation, local anesthetics and warming agents are used. Severe pain, significant swelling, hyperemia of the wrist, general hyperthermia, weakness, weakness indicate the presence of an inflammatory process that requires immediate specialized treatment.
The basic therapeutic measure for pain in the wrist is a special regimen that reduces the load on the arm. A plaster splint is applied to the patient, orthoses are recommended, and certain types of physical activity are excluded. In case of traumatic injuries, reposition or reduction is performed. Patients are prescribed:
Surgical interventions are performed by open access or using arthroscopic equipment. Taking into account the nature of the pathological process, perform:
In the postoperative period, rehabilitation measures are carried out, including massage, exercise therapy, physiotherapy. In case of tumor processes, the treatment plan, according to indications, is supplemented with chemotherapy or radiation therapy.