FAQ Category: Wrist

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.

Both syndromes involve inflammation in the tendons of the wrist. However, the pain begins in different spots. Intersection syndrome causes pain at the intersection point, about three inches up the forearm. De Quervain’s tenosynovitis causes pain along the edge of the wrist, closer to the hand. Your doctor will examine your forearm and wrist carefully to locate exactly where your pain is coming from.

By far the most common way the wrist is injured is a fall on the outstretched hand. (The same type of force can happen in other ways–such as when you brace your self on the dash before an automobile crash.) Whether the wrist is broken or ligaments are injured usually depends on many things, such as how strong your bones are, how the wrist is positioned during impact, and how much force is involved.

De Quervain’s tenosynovitis is a condition that causes pain on the inside of the wrist and forearm just above the thumb. It is a common problem affecting the wrist and is usually easy to diagnose.

Proper treatment can help. This includes avoiding activities that cause symptoms. You may be issued a special wrist and thumb splint to prevent movement. Anti-inflammatory medications may also help control the swelling.

If these simple measures fail to control your symptoms, your doctor may suggest an injection of cortisone into the irritated tunnel. 

Your doctor may have you work with a physical or occupational therapist. The main focus of therapy is to reduce or eliminate the cause of irritation of the thumb tendons. Your therapist may check your workstation and the way you do your work tasks. Suggestions may be given about the use of healthy body alignment and wrist positions, helpful exercises, and tips on how to prevent future problems.

Any kind of injury to the wrist joint can alter how the joint works. After a wrist injury, ligament damage may result in an unstable joint. Any time an injury changes the way the joint moves, even if the change is very subtle, the forces on the articular cartilage increase. It’s just like a machine–if the mechanism is out of balance, it wears out faster.

Over many years, this imbalance in joint mechanics can damage the articular cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint can no longer compensate for the damage, and the wrist begins to hurt. Like other joint injuries, it is possible the altered joint will develop osteoarthritis.

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.

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.