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Wrist pain- causes

Radial –scaphoid fracture most common carpal fractures fall on an outstretched hand with wrist dorsiflexed and radially deviated tenderness over the anatomical snuff box , dorsoradial aspect of the wrist or scaphoid tubercle , pain with axial pressure on the 1st metacarpal bone + wrist may be swollen proximal pole of the scaphoid is relatively avascular and at high risk of nonunion and avascular necrosis combination of snuffbox swelling can be missed initially on clinical & radiological examination further assessment with CT / MRI can be helpful

 

Scaphoid non union patient may not recall the traumatic event can present with persistent wrist pain or new onset wrist pain

 

First carpo-metacarpal thumb arthritis – 2nd most common jt involved in wrist OA after DIP jt pain and swelling at the base of thumb reduced pinch & grip strength

 

Other causes – Scapho- lunate instability -ligamentous injury due to disruption of the mechanical linkage between the scaphoid and lunate de Quervain’s disease other fractures as radial styloid , trapezium , base 1st MC, trapezoid post-trauma arthroses

 

Triangular fibrocartilage complex tear – frequent wrist injuries which involve the cartilaginous meniscus between the radius & ulna TFCC complex stabilises the wrist at the distal Rad-ul jt & ulnocarpal articulations pain over the ulnar aspect of the wrist with clicking when hyperpronating and supinating ( opening jars or doors ) point tenderness – in the hollow between the pisiform , the flexor carpi ulnaris and ulnar styloid.

 

Distal radioulnar jt instability instability can happen due to distal radius fracture malunion , ulnar styloid fracture malunion , DRUJ dislocation

 

Extensor carpi ulnaris pathology external carpi ulnaris tendinitis ECU subluxation ( often sports related injury )

Volar aspect carpal tunnel syndrome ulnar neuropathy (Guyon’s canal synd ) fracture ( hamate , pisiform )

 

Dorsal aspect – wrist sprain fracture ( distal radius , capitate , lunate , trapezoid ) dislocations ( perilunate , lunate ) ganglion cyst Kienböck disease ( avascular necrosis of lunate ) Intersection syndrome

 

Diffuse – osteoarthritis , inflammatory arthritis ( rh arthritis , gout ) SLE involving the wrist OA can also be secondary to pre-existing damage to the wrist jt as fractures , ligamentous injuries or Kienbock’s disease.

REFERENCES

  1. Liao JC, Chong AK, Tan DM. Causes and assessment of subacute and chronic wrist pain. Singapore Med J. 2013 Oct;54(10):592-7; quiz 598. doi: 10.11622/smedj.2013205. PMID: 24154586. Causes and assessment of subacute and chronic wrist pain – PubMed (nih.gov)
  2. Prasad G, Bhalli MJ. Assessing wrist pain: a simple guide. Br J Hosp Med (Lond). 2020 May 2;81(5):1-7. doi: 10.12968/hmed.2019.0051. Epub 2020 May 11. PMID: 32468936 Assessing wrist pain: a simple guide – PubMed (nih.gov).
  3. Shehab R, Mirabelli MH. Evaluation and diagnosis of wrist pain: a case-based approach. Am Fam Physician. 2013 Apr 15;87(8):568-73. Erratum in: Am Fam Physician. 2013 Oct 1;88(7):427. PMID: 23668446. Evaluation and diagnosis of wrist pain: a case-based approach – PubMed (nih.gov)
  4. Hayat Z, Varacallo M. Scaphoid Wrist Fracture. [Updated 2022 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536907/

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