FAQ Category: Wrist

Guyon’s canal syndrome is much less common than carpal tunnel syndrome (CTS), yet both conditions can occur at the same time. The numbness caused by these two syndromes affects the hand in different locations. When the median nerve is compressed in CTS, pain and numbness spread into the thumb, index finger, middle finger, and half of the ring finger. Compression of the ulnar nerve in Guyon’s canal syndrome usually causes numbness in the pinky and half of the ring finger. 

Symptoms usually begin with a feeling of pins and needles in the ring and little fingers. This is often noticed in the early morning when first awakening. This may progress to a burning pain in the wrist and hand followed by decreased sensation in the ring and little fingers. The hand may become clumsy when the muscles controlled by the ulnar nerve become weak. Weakness can affect the small muscles in the palm of the hand and the muscle that pulls the thumb into the palm. Gradual weakness in these muscles makes it hard to spread your fingers and pinch with your thumb.  

You’re not the first golfer to experience this problem. The wrist bone commonly broken from a ground-slamming divot is the hamate bone. It is near the wrist on the pinky side of the palm of the hand.

The hamate bone forms one side of Guyon’s canal, the small passageway that surrounds the ulnar nerve as it travels into the hand. In the hand, the ulnar nerve goes to the ring and pinky fingers, the small muscles in the palm of the hand, and the muscle that pulls the thumb into the palm of the hand.

A fractured hamate bone in the wrist can pinch the ulnar nerve inside Guyon’s canal and produce symptoms of weakness as you’ve described. Be sure to let your doctor know about these symptoms.

In rare cases, the ulnar artery that travels right beside the ulnar nerve may be damaged and form a blood clot. The symptoms caused by the clot mimic problems of Guyon’s canal syndrome (pinching of the ulnar nerve in the wrist). The clot is believed to shut off the blood supply to the nerve, which in turn causes symptoms.

The main reason for replacing any arthritic joint with an artificial joint is to stop the bones from rubbing against each other. This rubbing causes pain. Replacing the painful arthritic joint with an artificial joint gives the joint a new surface, which lets it move smoothly without causing pain.

Many operations are used to treat problems in the wrist. A fusion surgery can get rid of pain and restore strength in badly degenerated wrist joints. Fusion surgeries make the wrist strong again, but they greatly reduce the wrist’s range of motion. This makes fusion surgery a poor choice for some people.

Arthritis caused by systemic diseases, such as rheumatoid arthritis, often affects both wrists. People with arthritis in both wrists probably should not have two fusion surgeries. Two wrist fusions make it very difficult to do everyday activities. If both wrists require surgery, many surgeons recommend fusing one wrist for strength and replacing the other wrist with an artificial wrist joint. This allows the patient to have one strong hand and one hand with a good range of motion.

After surgery, your wrist will probably be put in a splint and covered by a bulky bandage. You may also have a small plastic tube that drains blood from the joint. Draining prevents excessive swelling from the blood. (This swelling is sometimes called a hematoma.) The draining tube will probably be removed within the first day.

The bandage and splint will keep the wrist in a natural position during healing. Your surgeon will want to check your wrist within five to seven days. Stitches will be removed after ten to fourteen days, although most of them will have been absorbed into your body. You may have some discomfort after surgery. Your doctor can give you medication to control any pain.

You should keep your hand elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting.

You will wear an arm-length cast with the wrist placed in a neutral position for up to six weeks after surgery. A physical or occupational therapist will direct your recovery program. Recovery from wrist replacement surgery takes up to three months.

A scaphoid fracture that doesn’t heal within several months is considered a nonunion. If the injury is fairly recent, your doctor might recommend more time in the cast. He or she might also prescribe an electrical stimulator. The electrical stimulator is a device that sends a small electrical current to your scaphoid bone. You wear it like a large bracelet for ten to twelve hours a day. Electrical current has been shown to help the bones heal. If the nonunion is quite old, or if the cast and the electrical stimulator fail to heal the fracture, your surgeon will probably suggest surgery.

If the fracture is identified immediately and is in good alignment, the chances are good the bone will heal. Patients generally wear a cast that covers the forearm, wrist, and thumb for up to twelve weeks. The doctor takes X-rays at least once a month to check the progress of the healing. Once your doctor is sure the fracture has healed, the cast will be removed. Even with this type of treatment, however, there is still a risk that the fracture may not heal well and will become a nonunion.

Beyond observation, closed rupture with multiple needle punctures is another nonsurgical treatment option for dorsal wrist ganglions. In this procedure, the cyst wall is punctured with a needle, and anti-inflammatory and numbing drugs are injected into the cyst. This treatment can shrink the cyst and alleviate symptoms. However, the ganglion is likely to reappear.

Most ganglions cause a bump or mass on the wrist. The mass may appear suddenly, or it may develop over time. The ganglion may occasionally increase or decrease in size.

The wrist may ache or feel tender. The ganglion may also interfere with activities. A volar wrist ganglion may compress the median or ulnar nerve, causing trouble with sensation and movement. An occult dorsal wrist ganglion may be quite painful and tender, even though it is smaller than other ganglions. Typically the symptoms from a ganglion are not harmful and do not grow worse. These cysts will not turn into cancer.

A scaphoid fracture is almost always caused by a fall on the outstretched hand. We commonly try to break a fall by putting our hands out for protection. Landing on an outstretched hand makes hand and wrist injuries–including a fracture of the scaphoid bone–fairly common.

Observation is often sufficient treatment for wrist ganglions. Ganglions typically are harmless and do not grow worse over time. Nor do they usually cause damage to the tendons, nerves, or the joint as a whole. Additionally, as many as 50 percent of wrist ganglions may eventually go away by themselves.

The goal of conservative treatment is to help you manage your pain and use your wrist without causing more harm. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, to help control swelling and pain. Other treatments, such as heat, may also be used to control your pain.

Rehabilitation services, such as physical and occupational therapy, have a critical role in the treatment plan for wrist osteoarthritis. The main goal of therapy is to help you learn how to control symptoms and maximize the health of your wrist. You’ll learn ways to calm your pain and symptoms. You may use rest, heat, or topical rubs.

You may be issued a special wrist splint to immobilize and protect the wrist. Resting the joint can help ease pain and inflammation. Range of motion and stretching exercises can improve your wrist motion. Strengthening exercises for the arm and hand help steady the wrist and protect the joint from shock and stress. Your therapist will give you tips on how to get your tasks done with less strain on the joint.

To get rid of your pain, you may also need to limit your activities. You may even need to change jobs, if your work requires heavy, repetitive motions with the hand and wrist.

An injection of cortisone into the joint can give temporary relief. Cortisone is a powerful anti-inflammatory medication. It can very effectively relieve pain and swelling. Its effects are temporary, usually lasting several weeks to months. There is a small risk of infection with any injection into the joint, and cortisone injections are no exception.

Doctors don’t know why ganglions develop. In some cases, the wrist has been injured previously. Repetitive injuries, such as those that can occur from playing tennis or golf frequently, seem to play a role in ganglion development as well.

Doctors also don’t understand exactly how ganglions form. One theory suggests that wrist ganglions are formed when connective tissue degenerates, or is damaged by wear and tear. The damaged tissue forms a weakened spot in the joint capsule–just like a weak spot on a car tire that allows the inner tube to bulge through. The joint fluid may escape through this weakened area and begin to collect in a sack, or cyst outside the joint. Over time this cyst grows larger. The joint fluid seems to move out of the wrist joint into the ganglion, but not the other way. In the end, a clear, sticky fluid fills the cyst. The fluid is a mix of chemicals normally found in the joint. 

Pain is the main symptom of osteoarthritis of any joint. At first, the pain comes only with activity. Most of the time the pain lessens while doing the activity, but after stopping the activity the pain and stiffness increase. As the condition worsens, you may feel pain even when resting. The pain may interfere with sleep.

The wrist joints may be swollen. Your wrist may fill with fluid and feel tight, especially after use. When all the articular cartilage is worn off the joint surface, you may notice a squeaking sound when you move your wrist. Doctors call this creaking crepitus.

Osteoarthritis eventually affects the wrist’s motion. The wrist joint becomes stiff. Certain motions become painful. You may not be able to trust the joint when you lift objects in certain positions. This is because a pain reflex “freezes” the muscles when a joint is put in a position that causes pain. This happens without warning, and you can end up dropping whatever is in your hand.

A wrist fusion is a tradeoff. You will lose some motion, but you will regain a strong and pain-free wrist. Regaining strength is especially important to younger people who need to work with their hands. These patients need strength more than flexibility. Wrist fusion gives them a strong wrist that is good for gripping. Patients who need more movement than strength should consider another type of operation, such as an artificial wrist joint replacement.

Many wrist injuries, such as fractures and sprains, heal fairly easily. However, they can lead to problems much later in life. The injury changes the anatomy of the wrist just enough so that the parts no longer work smoothly together. The changes from the injury cause a lot of wear and tear on the wrist joint. Over time, this wear and tear degenerates the tissues of the joint, leading to wrist osteoarthritis. Doctors may also call this type of degeneration post-traumatic arthritis.

After surgery, you will wear an elbow-length cast for about six weeks. This holds the wrist still while the ends of the bones fuse together. Your surgeon will want to check your hand within five to seven days. Stitches will be removed after ten to fourteen days, although most of them will have been absorbed by your body. You may have some discomfort after surgery. Your doctor can give you pain medicine to control the discomfort.

You should keep your hand and wrist elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up.

If you still have pain, or if the stiffness in the joints above or below the wrist doesn’t improve, you may need a physical or occupational therapist to direct your recovery program.

Once the initial pain of the injury has subsided, the wrist may remain painful due to the ligamentous instability. If the ligaments have been damaged and have not healed properly, the bones do not slide against one another correctly as the wrist is moved. This can result in pain and a clicking or snapping sensation as the wrist is used for gripping activities. Talk to your doctor about ways to treat the pain and improve the stability of the wrist.