FAQ Category: Wrist

At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn’t treated, pain may spread up the forearm or further down into the wrist and thumb.

As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. If the condition is especially bad, there may be swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful.

Kienbock’s disease is a condition in which one of the small bones of the wrist loses its blood supply and dies, causing pain and stiffness with wrist motion. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint. While the exact cause of this uncommon disease isn’t known, a number of treatment options are available.

Repeatedly performing hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis. This inflammation can lead to swelling, which hampers the smooth gliding action of the tendons within the tunnel. Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb. In other cases, scar tissue from an injury can make it difficult for the tendons to slide easily through the tunnel.

Doctors have not determined exactly what causes Kienbock’s disease. A number of factors seem to be involved. Usually the patient has injured the wrist. The injury may be a single incident, such as a sprain, or it can be from repetitive trauma. But the injury alone does not seem to cause the disease.

The way that blood vessels supply the lunate bone of the wrist is thought to play a role in Kienbock’s disease. Some bones in the body simply have fewer blood vessels that bring in blood. The lunate is one of those bones. A bone with a limited blood supply may be more at risk of developing the disease after an injury. The reduced blood supply might be the result of a previous injury to the blood vessels

Other bones around the lunate may play a role in the disease, too. The length of the ulna, the bone of the forearm on the opposite side of the thumb, may be a factor. When the ulna is shorter than the radius, the lunate bone absorbs more force when the wrist is used for heavy gripping activities. Over time, this extra force may make it more likely for a person to develop Kienbock’s disease, since the person may be more likely to injure the lunate or the blood vessels around it as a result.

Kienbock’s disease is also sometimes found in people with other medical conditions that are known to damage small blood vessels of the body. Whatever the cause, the lunate bone develops a condition called osteonecrosis. In osteonecrosis, the bone dies, usually because it’s not getting enough blood.

The wrist joint is replaced with an artificial joint (also called a prosthesis) much less often than other joints in the body, such as the knee or the hip. Still, when necessary, this operation can effectively relieve the pain caused by wrist arthritis. When severe arthritis has destroyed the wrist joint, an artificial wrist replacement can help restore wrist strength and motion for many patients.

Intersection syndrome is a painful condition of the forearm and wrist. It can affect people who do repeated wrist actions, such as weight lifters, downhill skiers, and canoeists. Heavy raking or shoveling can also cause intersection syndrome.

The pain from intersection syndrome is usually felt on the top of the forearm, about three inches above the wrist. At this spot, two muscles cross over–or intersect–two underlying wrist tendons.

The friction on the wrist extensor tendons causes pain and swelling in the tenosynovium that covers these tendons. The friction hampers the smooth gliding action. You may hear a squeaking sound and feel creaking as the tendons rub against the muscles. This is called crepitus. You may have swelling and redness at the intersection point. Pain can spread down to the thumb or up along the edge of the forearm.

A wrist problem common among downhill skiers is called intersection syndrome. The pain from intersection syndrome is usually felt on the top of the forearm, about three inches above the wrist. At this spot, two muscles cross over–or intersect–two underlying wrist tendons.

The wrist extensor tendons are strained by activities that cause the wrist to curl down and in, toward the thumb. These wrists movements are especially common in downhill skiers when they plant their ski poles deeply in powder snow. Skiers also stretch these tendons when dragging their poles in the snow.

This is a problem due to overuse. Repeated actions of the forearm, wrist, and thumb causes rubbing where two thumb muscles cross over the top of two wrist extensor tendons. When the area becomes inflamed, you feel pain when you move your wrist because the swollen tendons are rubbing up against the thumb muscles.

Wrist extensor tendons work like the bow used by violin players. The wrist extensor tendons are like the bow, and the thumb muscles are like the strings. As the wrist curls down and in, the wrist tendons rub back and forth against the thumb muscles. The friction builds up, much like the effect of rubbing two sticks together. This leads to irritation and inflammation of the tenosynovium covering the wrist extensor tendons.

The wrist extensor tendons are strained by any activities that cause the wrist to curl down and in, toward the thumb. These wrists movements are especially common in downhill skiers when they plant their ski poles deeply in powder snow. The same movement is involved when pulling a rake against hard ground. Racket sports, weight lifting, canoeing, and rowing can also stress the wrist extensor tendons.

A ganglion is a small, harmless cyst, or sac of fluid, that sometimes develops in the wrist. Doctors don’t know exactly what causes ganglions, but a ganglion that isn’t painful and doesn’t interfere with activity can often be left untreated without harm to the patient. However, treatment options are available for painful ganglions or ones that cause problems.

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.

Yes. Researchers studied more than 5,000 snowboarders. Half used soft wrist braces; the other half didn’t. Significantly fewer injuries occurred in those wearing the braces. Only eight snowboarders wearing wrist braces ended up with a wrist injury, including three fractures and five sprains. Strikingly, 29 injuries were recorded in those who didn’t wear wrist braces. Two of these injuries involved fractures, and 27 were sprains. Based on the results of their study, the authors recommend that snowboarders wear wrist braces to protect against wrist injuries.

Scientists attempting to answer this question studied over 5,000 snowboarders. Half the snowboarders wore wrist braces; the other half didn’t.

Those wearing braces had significantly fewer wrist injuries. Only eight wearing the braces ended up with a wrist injury, including three fractures and five sprains. Strikingly, 29 injuries were recorded in those who didn’t wear wrist braces. Two of these injuries involved fractures, and 27 were sprains.

The results of their study led the authors to recommend that all snowboarders wear wrist braces to reduce the chances of a wrist injury.

Research shows that a rigid brace can protect the wrist but often causes unwanted side effects. The force of the impact shifts to either end of the rigid brace, which can cause a fracture in the bones at the top or bottom of the brace.

A soft wrist brace is probably safer for snowboarders than a hard, rigid brace. The main goal of any wrist brace is to absorb some of the impact of a fall, and this can be achieved with a soft brace.

It is true that snowboarders commonly injure their wrists. Beginners run an even higher risk, as do those who rent their equipment. Likely, a higher number of beginners rent, but this also highlights the importance of making sure your equipment is adjusted properly. Be aware that most wrist injuries occur from a backward fall. Such a fall may be unavoidable, but the injury generally results by placing the arms back to break the fall.

Wrist braces can help. A recent study of over 5,000 snowboarders supports the use of a soft, protective brace. Snowboarders who used wrist braces had fewer wrist injuries compared to those who didn’t. Such a brace helps absorb some of the impact of a fall, reducing the chance of a wrist injury.

While this could be a result of carpal tunnel syndrome, it could also be from pressure on nerves in the elbow, shoulder, or neck. Before assuming this problem is from carpal tunnel syndrome, see your doctor for a complete evaluation.

Your doctor’s advice is based on science. A recent study showed that ulnar osteotomy–a procedure to shorten the ulna bone along the inside edge of the wrist–is less successful for patients who smoke. Smokers took almost twice as long to heal as nonsmokers (seven versus four months). The bones in smokers’ wrists were more likely to show long delays in healing or fail to improve in a year’s time.

Why these disappointing effects? Researchers think that nicotine restricts the blood supply that bones need in order to heal. This does not mean that your surgery will be worthless. However, the benefits of surgery may take longer to kick in than they would if you kicked the habit. If you continue to smoke, you may have more luck with this surgery if your doctor uses a special grafting technique or keeps you in a cast longer afterward, to allow better healing.