Our wrists have a fantastic design, it is a joint capable of a variety of movements and it is vital in our everyday lives. From washing and dressing to feeding and exercise – we use our wrists for absolutely everything – we would be lost without it.
This article aims to inform you about how the wrist works, common problems experienced and solutions to make your wrist pain better or to prevent you from getting it in the first place.
General Anatomy
If we start with a simple run-through of how the wrist is made up this can give the basis of our understanding of it how it functions. Listed below are the main structures of the wrist:
Bones – the radius and ulnar are the 2 bones of the forearm – they sit on to the first row of carpal bones of the hand to form the wrist joint.
Joints – there are 3 joints of the wrist;
- Radiocarpal joint – is where the radius (forearm bone), joins with the first row of the hand bones (scaphoid, lunate, and triquetrum).
- Distal radioulnar joint – the two forearm bones connect to form this joint.
- Ulnocarpal joint – the ulna, the other forearm bone, connects to the lunate and triquetrum (hand/wrist bones).
Ligaments provide strength and connection to the wrist. The ligaments attaching bone to bone to ensure the security of the structure. There are 2 types of ligaments in the wrist;
- Extrinsic – connect the wrist and hand to the forearm.
- Intrinsic – connect all of the wrist bones together.
Tendons – the connective tissues that supply movement to the wrist by attaching from the forearm and on to the hand bones to help move the wrist in flexion and extension. Again there are 2 types of tendons in the wrist;
- Flexor tendons – flex the wrist into a forward bend.
- Extensor tendons – extend the wrist into a backwards position.
To add to the wrist tendons there are also tendons which operate finger movements which run alongside the wrist tendons. The wrist joint is a dynamic and capable of circumduction, ulnar and radial deviation, flexion and extension, making it extremely mobile.
Important notes to make you aware of for the wrist, are regarding one of the ligaments and nerves that supply the wrist which is commonly involved in carpal tunnel syndrome. The hand is supplied by the median, ulnar and radial nerves.
The median nerve passes underneath the transverse carpal ligament which sits horizontally across the wrist. In carpal tunnel, the median nerve can be compressed by the tightening of this ligament.
There is also another small structure called the triangular fibrocartilage complex (TFCC) which is a cartilage structure located on the little finger side (ulnar) of the wrist. Its role is to supports the small carpal bones in the wrist. The TFCC provides stability to the forearm bones when the hand grips or the forearm rotates.
Symptoms
When developing wrist pain there is commonly tenderness to touch and press due to the joints close proximity to the skin and size of the bones involved. If we compare this to the knee or hip it may be difficult to palpate any of the pain we are experiencing in those joints due to their size and also the joint pain being inside the body. The wrist is easier to manipulate and press on to see where your pain is. Your pain could cause symptoms to refer to your hand and also into the forearm.
Accompanying your pain could be swelling – if you have hurt your wrist in any way due to trauma then for it to heal, it may produce swelling to protect the joint and allow the healing process to occur.
A by-product of the swelling or injury may be discolouration and bruising. Increases in fluid in the joint will almost certainly cause tightness and restriction of movement.
Joint stiffness is also a common complaint if the joint and bones themselves are aggravated, the wrist may be difficult to move and you not have full movement. The reduced movement will affect your wrists ability to carry weight and also exert pressure if you need to support yourself.
Nerve symptoms are again important to mention regarding carpal tunnel syndrome for the wrist – you may find symptoms of tingling, numbness and pain in the middle three fingers and thumb. Pain to the wrist joint may also be present.
Causes
Trauma
Because of the wrists size and also its involvement in most daily tasks there is a high chance that if you develop wrist pain it may be due to an accident or impact.
Falling on to an outstretched hand or having the wrist forcefully moved against its will can cause injury and damage to the joints and soft tissues resulting in pain developing. Falls on to outstretched hands can result to fracture of the forearm bones and of the scaphoid hand bone which can be extremely painful and in some cases difficult to diagnose and heal.
If you have had any falls on to your hand or wrist that are taking long periods to heal be sure to check with a health professional in case a fracture is missed.
Repetitive strain
This is a term commonly used when people perform the same movement in a high frequency and certain tissues can become strained and sore. It is common for people working in production type roles and manufacturing lines where they have repetitive tasks to perform for long periods.
The wrist can become overused in many types of roles, especially desk work if you do not have a good setup or the correct equipment.
Tendinitis
Similar to repetitive strain but it just affects tendons of the wrist and hand causing them to become painful and weak. When they become overused and unhappy, they develop small tears in the tissue which results in pain. This can cause swelling when at its worse and pain during activity.
Carpal Tunnel Syndrome
This involves compression of the median nerve at the wrist joint causing pain at the wrist and nerve referred symptoms into the fingers. Symptoms are more common at night. Physiotherapy may be able to resolve this problem but surgery does prove effective if your symptoms do not go away.
The procedure is simple and involves the release of the ligament trapping the median nerve at the wrist. People who work with their hands in the office and manual settings both can suffer from this problem.
Ganglion Cyst
If you develop a small bump on the top of the wrist which is semi-firm to the touch then you may have a ganglion cyst. Ganglions are small swellings in the tendon sheath which increase in size and protrude to form a bump in the skin.
They are caused by forced extension or flexion to the wrist or overuse which aggravates the tendon. Best case scenario is that they settle of their own accord providing the activity that aggravated them has stopped, worst case they become painful and need a more invasive approach such as lancing (needle insertion) which helps the swelling to reduce and resolve.
TFCC Sprain / Tear
As discussed in the anatomy section, the small triangle-like structure at the side of the wrist and hand can become aggravated. If there is any task you perform repetitively which puts pressure on the ulnar aspect or your wrist is forced into ulnar deviation then you may find this causes aggravation or a tear to the TFCC.
Osteoarthritis
The natural process of ageing causes a reduction in the smooth surfaces of our joints and cartilage. This can cause swelling, pain and stiffness which will occur in flares but will resolve again. Typically at age 50 and onwards we have a degree of arthritis in most of our joints. This does not mean our joints are going to be painful, it simply shows the age of our joints, many people with clinically diagnosed arthritis do not have symptoms – it is only when it flares it can become symptomatic.
Supplements
Let’s take a look at some handy supplements which may help your wrist remain healthy.
Vitamin D – is proving a popular supplement within research currently for the maintenance and regulation of calcium absorption which is important for your bones – this is important as when we age we can lose bone density. Vitamin D is available for free from the sun – if you are lucky enough to be somewhere with a good amount…..or high strength capsules can be bought which ensure you get your recommended amount.
CBD – is short for cannabidiol which is the non-psychoactive property of cannabis which may help with pain relief and inflammation management. Your body has receptors for CBD in the brain and at various locations in the body thus being helpful if you are experiencing wrist pain or inflammation. You can get CBD in balms to rub on your wrist, tinctures to place under your tongue and oil capsules to take orally.
Calcium, Magnesium & Zinc – is a popular mineral stack which when taken together contributes to regulating new cell formation in muscle and bone and helping us to rest and repair properly.
Turmeric – a strong anti-inflammatory spice due to the active ingredient of curcumin. Turmeric is typically used in curries and soups for flavour and colouring but studies have suggested that high doses of this spice can be combative against inflammation. High strength turmeric supplements in tablets and tinctures are available to buy, you can also add more to your home cooking.
Exercises
Movement and strengthening for all joints is an essential task – here are 4 simple exercises to perform for the wrist and forearm which will help to prevent and also ease your wrist pain.
Passive wrist stretches
Using your other hand – bend or extend your wrist to its furthest reach and then gently apply some pressure and hold to stretch the wrist for 10-15 seconds. These type of stretches are recommended to be done daily if you have a job where you are using your hands repetitively. Hourly stretches of the wrist area stop chronic problems from building up in your wrist. This is a great preventative exercise.
Active wrist range of motion
How often do you move your wrist in all directions to its fullest capability? Potentially not very often – to maintain a pain-free joint – move the wrist in circumduction one way for 20 seconds then go the other way for 20 seconds.
Weighted wrist extension/flexion/deviation
Adding weight is a great way to strengthen the wrists. You may want to start with small weights such as tinned food but if you have small dumbbells or elastics you can use these. In a controlled manner, slowly move the weight in the desired direction and repeat until tired.
Press Ups / Pull Ups
If moving small weights is too basic for you then we have a more advanced option you can have a go at to strengthen your wrists. Classic exercises such as press-ups and pull-ups involve your full body weight being exerted through your wrists – this is the ultimate strengthening exercise and allows your wrists to build up resistance and resilience!
Boxing Bag
Another great way to load the bones of your wrist is to punch a boxing bag. Loading bones and joints with weight are recommended for developing strong bones for the future – regular boxing bag rounds will contribute to stronger bones and joints.
Thanks for taking the time to read our guide to wrist pain. We hope you have found this helpful and that you can use the information to keep your wrists healthy!