#condition - Hand & wrist
Pain in the wrist
Acute pain in the wrist is most commonly caused by a fall onto the outstretched hand. As this is, unfortunately, a fairly common experience for most of us, minor sprains of the wrist a well known to settle uneventfully after a few days. Most patients correctly identify when the pain is a little worse than this and identify when they may have sustained a fracture. Bruising and swelling are frequent features of a wrist fracture, but fractures can occur without these signs being present.
There are no wrist injuries that need to be treated within 48 hour is apart from open fractures, dislocations, and injuries where there is altered circulation or sensation. Fortunately most of these more severe injuries are obvious and patients direct themselves immediately to an emergency department or minor injuries unit. If the pain has settled promptly in 48 hours then no further action needs to be taken. If doubt remains then a clinical examination and possibly further investigations are indicated.
The commonest causes of wrist pain after a fall that feels more like a sprain than a fracture, but that fails to settle in 48 hours, are:
- scaphoid fracture
- scapholunate ligament injury
- triangular fibro cartilage complex (TFCC) injury
- extrinsic ligament injury
- tendon injury
All of the above can be identified by a combination of clinical examination and xrays and scans were necessary.
This may occur as a result of a previous injury. Undiagnosed fractures or injuries to the scapholunate ligament or TF CC are the common causes of persistent pain. If pain persists for longer than 3 months after an injury and the cause is not clear then a wrist arthroscopy may be indicated.
If there is no history of injury then the common causes are:
- inflammatory arthritis
- degenerative arthritis
- wrist ganglion
In addition to physical examination, further imaging in the form of scans and xrays will help to establish the cause in these cases and occasionally blood tests will be required.