Wrist; a multiplex joint present at the junction of forearm and the hand, allowing a multifold movement required in hand movements. Wrist is the one of the most vulnerable joint and wrist pain is commonest complaint, universally.
Wrist is not a single joint; its complexity can be appreciated by looking at any wrist joint’s X-ray; bone looks like a mosaic. There are 2 forearm bone ends, 8 carpal bones (small bunch of nugget shaped bones at the base of hand) and 5 more elongated bone ends (metacarpal) next to these 8 small bones, making it total of 15 bones. Then there are multiple other structures for stabilization and function of these bones.
The cause of the wrist pain could be due to many factors reason being the complex joint’s framework. Proper diagnosis is the key to the treatment. Here are some of the commonest conditions presenting with wrist pain.
o Osteoarthritis: the wear and tear disease is infrequent in wrist joint; people with history of injury tend to develop it. The joint becomes tender and swollen making wrist bending difficult and ultimately loss of grip is seen.
o Rheumatoid arthritis: an autoimmune disorder that in majority of case will present bilaterally. The joint is painful, tender, swollen and warm to touch. Advanced RA can cause degeneration of long bone, ensuing tendon damage which leads to bent wrist.
· Gout: a condition in which the body produces uric acid in excess and its crystals start to deposit in joints spaces causing inflammation there. Wrist is one of the favorite sites of gout attack. There is also a condition, which has same presentation but in it calcium starts getting deposited in the joints it is called pseudo-gout, this hits wrist and ankle joint.
· Sprain: there are many ligaments connecting all the small bones to each other and also to the 2 bones of the forearm, to keep the balance and move these as a unit. Any trauma that overstretches these ligaments can cause sprain in any of the joints in the wrist area. Depending upon the degree of stretch the damage can be simple tear to total detachment of the ligament. In acute case there will be pain and swelling or sometimes ecchymoses (black and black or purple spots). The joint gets unstable and the cartilages covering the joint surfaces of the bones bear the burden and or the time if not treated right these become the cause of arthritis.
· Carpal tunnel syndrome: increased pressure in the carpal tunnel located on the inner side of wrist causes a nerve (median nerve) irritation leading to pain and other symptoms like numbness, tingling and weakness of muscles innervated by this nerve. Symptoms are noticed more in the day time initially. This is seen more in women and obese people.
· Tendon injuries: are also common at the wrist and could be any of the following tendonitis (inflammation), tendinosis (slow progressive degeneration), tendinopathy (tendon injury) or tenosynovitis (tendon’s covering inflammation). Most of cases of these are overuse or repetitive strain injury. Sportsmen, assembly workers, or people working on computer are prone to such injuries. Symptoms mainly are pain, tenderness or swelling of the tendon. The area may feel warm, stiff but this is resolved on its own over a period of time.
· Fracture: wrist is most vulnerable to fracture and most of these are at lower end of the 2 long bones of the fore arm. Common in any age but older people are more at risk.
o Colles’ fracture & Smith’s fracture are fractures of the long bone on the thumb side
o Scaphoid fracture
o Barton’s fracture
o Chauffeur’s fracture
o Greenstick fracture (seen only in children)
o Fracture of the long bone on the little finger side
· Kienböck’s disease; necrosis (death) of bone, due to compromised blood supply to one of the small bones in the wrist. There will symptoms similar to sprain, painfully stiff wrist over a period of time. This is thought to occur due to some neglected injury leading to blood supply interruption to the bone.
The diagnosis of any of these will be done on through history and physical examination. Normal labs and some specific test along with X-ray, MRI, ultrasound and nerve conduction test will determine the condition.
Treatment in most of the cases will be RICE, NSAIDs or steroids. Splinting or casting depending on the damage. For specific conditions particular medications have to be prescribed. Surgery is always the last option. In all the above conditions, Chiropractic therapy is a part and parcel of the treatment.
‘Walk in Chiropractic Associates’ is state of an art office in Houston, can help you in such conditions. Our highly prestigious and experienced chiropractor’s team will evaluate the cause of your wrist pain and formulate the most suitable plan for early and prolong relief.
Don’t wait any longer call us (713) 529-4808 and book an appointment for earliest evaluation and hence speedy recovery. We are at 2002 Binz Street, suite B, Houston, TX 77004.