Top 10 Wrist Joint Problems and Conditions
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Conditions of the Wrist

Dr.Surya Rao Poodipeddi profile Authored by Dr.Surya Rao Poodipeddi on 25 Apr 2014 - 14:28.

The wrist joint is prone to several injuries and its complaints are common. There are several conditions which can affect the wrist joint. These include:

  • Fracture
  • Sprain in the wrist
  • Injury to the wrist
  • Carpal tunnel syndrome
  • Arthritis of the wrist joint
  • Rheumatoid arthritis of the wrist joint
  • Ganglion cyst  in the wrist
  • Gout
  • Inflammatory conditions of wrist joint.
  • Dislocations of the wrist joint

Fracture Wrist:

When a bone is broken we call it as fracture. When a bone in the wrist joint is broken we term it as wrist fracture. The wrist joint is formed with the help of several small bones called carpals and two long bones in the forearm called Radius (the one towards the thumb and the ulna (the one towards the little finger). Any of these bones can break. The common bone to break is the lower end of the radius.

Broken bones are a pretty common occurrence in our lives.  And while all bones can break, the one joint that seems most prone to fractures is the wrist.  The wrist breaks because we use it to stop our fall and the force of the fall is greater than the strength of our bones.  Sometimes fractures occur on their own without a fall due to a condition called osteoporosis where the bones become brittle and develop a tendency to break even at the slightest force.

Fracture of the lower end of the radius is commonly known as Colle’s fracture and generally occurs due to a fall on the outstretched hand. The normal tendency when a person loses balance and falls is to protect oneself by taking the weight on the outstretched hand (extended hand). However, while so doing the wrist gets stretched beyond permissible limits (a phenomenon called hyper extension) to withstand the force which results in breakage of the radius at its lower end.  

The fracture occurs about one inch above the wrist joint resulting in pain, swelling and the typical deformity like a dinner fork which is termed as “dinner fork deformity (all the four fingers bend down and the wrist adopts a downward drop with inability to extend the hand because of severe pain if any attempt to raise the hand is made.

Treatment is usually a plaster cast and putting the hand in a sling and rest to the joint for about 4 to 6 weeks. In some cases the fall may result in breakage of both the bones with or without any dislocation of the radio-ulnar joint. In cases where the fracture involves the cartilage of the bone and those in whom the fractured ends are displaced there may be a need for surgical correction.

Sprain in the wrist:

A sprain happens when the fall happens in an awkward position twisting the wrist or the wrist bending backwards and tearing the ligaments that connect bone to bone within the joint and result in injury called a sprain. A sprain can be with or without a fracture.

A sprain can lead to swelling, persistent pain whenever an attempt is made to move the joint, bruising and discoloration of the skin due to the injury sustained during the fall, tenderness (pain on touch) at the site of the sprain and a feeling that something is torn inside. The victim also experiences a warm, feverish feeling around the area of sprain.

A sprain in the wrist has different grades depending on the degree of injury to the tissues. These include:

Grade 1: A mild sprain is due to probably stretched out ligaments.

Grade 2: Moderate sprain is when some of the ligaments are torn. Grade 2 sprains may involve some loss of movement.

Grade 3: Includes a severe sprain where it tears through the ligament. These require medical attention and good care. The torn ligament may carry with it a small chip of the bone resulting in an avulsion fracture.

Whatever be the degree of involvement a sprain needs a thorough examination and proper diagnosis to avoid any problems later which if present may even need surgical intervention.

Diagnosis of a sprain is based on history of injury, pain and swelling with loss of function and can be confirmed through X-ray or MRI of the part.

Treatment of a sprained wrist consists of rest to the joint for at least 48 hrs, application of ice over the area of involvement to reduce swelling. The ice should not be applied directly on the skin, but must be used as an ice cap or wrapped in a towel and applied on the area for about 20 minutes. Use of an elastic bandage helps compressing the swelling giving relief.

Elevation of the hand above the level of the heart reduces throbbing and gives good relief from pain. Pain killers like Ibuprofen or Aspirin give some relief. If pain and swelling persist beyond 48 hours one needs immobilization with a wrist splint. Severe sprains may require surgical attention.

Injury to the wrist is another condition commonly affecting the wrist joint alone or associated with other parts that form the joint. A fall on the outstretched hand is the commonest cause for injury to the wrist. Anything can hit the wrist with a force leading to injury over the part where something heavy has fallen. Sometimes lifting or pulling heavy objects may cause severe injury to the wrist.

Repetitive use of the wrist joint leads to inflammation resulting in pain. However, this cannot be considered as a true sprain and the pain goes off if the joint is rested.

Intensity of pain or the ability to move the wrist cannot be considered as reliable signs to determine if the wrist is broken or sprained. However, characteristic symptoms usually noticed include: swelling, warm sensation at the injury, painful wrist, discoloration, limited ability to move and deformity.

The right time to rush to a doctor is when severe pain, deformity, numbness or disability to move the wrist. If there is no deformity and the pain is tolerable, routine pain killers may help. If the pain persists beyond 24 hours, a doctor must be consulted.

If there is obvious deformity and severe swelling with pain it might mean a broken bone which requires immediate correction and immobilization. It is also possible that the swelling and pain are due to dislocation (displacement of normal position of the bones forming the joint) without any break in the bone.

Treatment depends on the problem. A simple sprain needs rest to the part, application of ice packs and use of pain killers. A fracture needs correction and immobilization with a plaster left in place for 4 to 6 weeks. A dislocation must be attended to under anesthesia. An experienced doctor may reduce the dislocation even without anesthesia.

Severe sprain without dislocation or a fracture needs splinting and arm sling to avoid pain while attempting any movement.

Arthritis of the wrist joint: As the name implies any inflammatory disorder of the joint is known as arthritis. Any type of arthritis can affect the wrist. However, the commonest type is rheumatoid arthritis. It affects one in every 100 persons and is three times more common in women than in men.

If a child is affected we term it as juvenile rheumatoid arthritis. There is no cure for this condition and treatment mainly consists of reducing the pain and further progression of the disease. Use of anti-inflammatory drugs give temporary relief.

Gout: This condition is another type of arthritis affecting the wrist joint. It is associated with purine metabolism and is mainly due to excess amount of uric acid in the blood and urine. Anti-gout treatment with colchicin provides relief to a large extent, though relapses are very common.

Ganglion cyst in the wrist:  A ganglion is a cyst that develops under the skin near a joint and is filled with a jelly like fluid. If present on the wrist or back of the hand it is known as ganglion cyst of the wrist.

Ganglions are extremely common and relatively painless. They most commonly occur on the wrist or back of the hand. If there are no symptoms ganglion cysts are better left alone. If they become uncomfortable or painful excision through surgery under local anesthesia is the only option.

Several other conditions can affect the wrist joint. Only the common conditions encountered are described in brief.

Most of the conditions mentioned can be avoided if care is taken in avoiding a fall or preventing a fall on the outstretched hand during a fall. Change in life style and habits and if possible a change in professions responsible for repetitive movement, practice of regular exercises goes a long way in preventing some of the conditions described above.

Carpal tunnel Syndrome: The characteristic symptom of this condition is tingling and pain in the hand and forearm due to compression of the nerve in the wrist. Repetitive movement of the hand over the wrist is the principal cause for this malady.

 

 

*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.