Definition

Wrist pain is any pain or discomfort in the wrist.

Alternative Names

Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist

Causes

Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome. The carpal tunnel is an area in your wrist that is created by wrist bones and which contains the median nerve and tendons. You may feel aching, burning, numbness, or tingling in your palm, wrist, thumb, or fingers. The thumb muscle can become weak, making it difficult to grasp things. Pain may go up to your elbow.

Carpal tunnel syndrome occurs when the median nerve gets compressed at the wrist because of swelling of structures in the carpal tunnel or narrowing due to the bones of the carpal tunnel. This is the nerve in the wrist that allows feeling and movement to parts of the hand. Swelling can occur if you:

• Do repetitive movements with your wrist, such as typing on a computer keyboard, using a computer mouse, playing racquetball or handball, sewing, painting, writing, or using a vibrating tool
• Are pregnant, menopausal, or overweight
• Have diabetes, premenstrual syndrome, an underactive thyroid, or rheumatoid arthritis

Injury: Wrist pain with bruising and swelling is often a sign of an injury. Signs of a possible broken bone include deformed joints and inability to move the wrist, hand, or a finger. There can also be cartilage injuries in the wrist. Other common injuries include sprain, strain, tendinitis, and bursitis.

Arthritis: Arthritis is another common cause of wrist pain, swelling, and stiffness. There are many types of arthritis:

• Osteoarthritis occurs with age and overuse.
• Rheumatoid arthritis generally affects both wrists.
• Psoriatic arthritis usually accompanies psoriasis.
• Infectious arthritis is a medical emergency. Signs of an infection include redness and warmth of the wrist, fever above 100°F (37.7°C), and recent illness.

Other Causes

• Gout: This occurs when your body produces too much uric acid, a waste product. The uric acid forms crystals in the joints, rather than being excreted in the urine.
• Pseudogout: This occurs when calcium pyrophosphate crystals deposit in the joints, causing pain, redness, and swelling. The wrists and knees are most often affected.

Home Care

For carpal tunnel syndrome, you may need to make adjustments to your work habits and environment:

• Make sure that your keyboard is low enough that your wrists are not bending upward while you type.
• Take plenty of breaks from activities that aggravate the pain. When typing, stop often to rest the hands, if only for a moment. Rest your hands on their sides, not the wrists.
• An occupational therapist can show you ways to ease pain and swelling and stop the syndrome from coming back.
• Over-the-counter pain medicines, such as ibuprofen, naproxen, or acetaminophen can relieve pain and swelling.
• Various typing pads, split keyboards, and wrist splints (braces) are designed to relieve wrist pain. These may help symptoms. Try a few different kinds to see if any of them help.
• You may only need to wear a wrist splint at night while you sleep. This helps reduce the swelling. If this does not help, you may need to wear the splint during the day as well.
• Apply warm or cold compresses a few times during the day.

For a recent injury:

• Rest your wrist. Keep it elevated above the heart level to reduce any swelling.
• Apply an ice pack to the tender and swollen area. Wrap the ice in cloth. Do not place ice directly on the skin. Apply the ice for 10 to 15 minutes every hour for the first day and every 3 to 4 hours after that.
• Take over-the-counter pain medicines, such as ibuprofen, naproxen, or acetaminophen. Follow package instructions on how much to take. DO NOT take more than the recommended amount.
• Ask your health care provider if it's OK to wear a splint for several days. Wrist splints can be purchased at many drugstores and medical supply stores.

For non-infectious arthritis:

• Do flexibility and strengthening exercises every day. Work with an occupational therapist to learn the best and safest exercises for your wrist.
• Try the exercises after a hot bath or shower so that your wrist is warmed up and less stiff.
• DO NOT do exercise when your wrist is inflamed.
• Make sure that you also rest the joint. Both rest and exercise are important when you have arthritis.

When to Contact a Medical Professional

Get emergency care if:

• You are unable to move your wrist, hand or a finger.
• Your wrist, hand, or fingers are misshapen.
• You are bleeding significantly.

Contact your health care provider right away if you have any of the following:

• Fever over 100°F (37.7°C)
• Rash
• Swelling and redness of your wrist and you have had a recent illness (like a virus or other infection)

Contact your provider for an appointment if you have any of the following:

• Swelling, redness or stiffness in one or both wrists
• Numbness, tingling, or weakness in the wrist, hand, or fingers with pain
• Lost any muscle mass in the wrist, hand, or fingers
• Still have pain even after following self-care treatments for 2 weeks

What to Expect at Your Office Visit

Your provider will perform a physical exam. You will be asked about your symptoms. Questions may include when the wrist pain began, what may have caused the pain, whether you have pain elsewhere, and if you have had a recent injury or illness. You may also be asked about the type of job you have and your activities.

X-rays may be taken. If your provider thinks that you have an infection, gout, or pseudogout, fluid may be removed from the joint to examine under a microscope.

Anti-inflammatory medicines may be prescribed. Injection with a steroid medicine may be done. Surgery may be needed to treat some conditions.

References

Donohue KW, Fishman FF, Swigart CR. Hand and wrist pain. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 53.

Marinello PG, Gaston RG, Robinson EP, Lourie GM. Hand and wrist diagnosis and decision making. In: Miller MD, Thompson SR. eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 67.

Zhao M, Burke DT. Median neuropathy (carpal tunnel syndrome). In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 36.