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Wrist

Wrist Pain

The wrist is a commonly seen injured joint in the body. Problems include sprains and strains as well as fractures which can occur with lifting and carrying heavy objects, while operating machinery, bracing against a fall, or from sports-related injuries.

Some of the common wrist injuries include:

Sprains and Strains: Sprains and strains are the two most common types of injuries affecting the wrist. A sprain refers to an injury to a ligament and a strain refers to a muscle injury. Sprains and strains occur due to excessive force applied during a stretching, twisting, or thrusting action.  Most sprains and strains will repair themselves with adequate rest, ice application, compression, and elevation. Surgery is occasionally required to repair the damage.

Ligamentous Injuries: Ligaments are tissues that connect bones to other bones. They are made up of several fibers and one or all the fibers may be involved. Complete ligament injury occurs when all the fibers are torn. A ligament injury may cause pain and swelling and limit the movement of wrist joints. Ligament injuries are effectively treated with splinting and taping with restriction of movement of the injured structures.

Fractures: A fracture is a break in the bone which occurs when more force than the bearable limit is applied against a bone. Crushing injuries to the wrist occur due to high degrees of force or pressure and may also cause fractures. A fracture may cause severe pain, swelling, bruising or bleeding, discoloration of the skin and limit the mobility of the limb. Fractures of the wrist bones can be treated by using a cast or splint while the bone heals. Sometimes surgery may be needed where plates, pins or screws may be placed to keep the joint stable while healing.

Repetitive Trauma Syndrome: Repetitive stress injury occurs because of repeated similar movements for long periods of time. This often causes pressure on the joints resulting in inflammation, pain, and decreased function in the extremity. The condition is more likely to develop with repetitive, rapid, forceful and prolonged movements of the wrist, or from vibration or frequent pushing, pulling or carrying heavy objects.  Carpal tunnel syndrome is the most common of these syndromes.

Carpal Tunnel Syndrome: Carpal tunnel syndrome is a condition characterized by numbness or pain in the thumb and first two fingers and occurs when the median nerve is compressed at the wrist. Carpal tunnel syndrome is often a common complaint in individuals who use their hands for prolonged periods of time in an occupation such as computer work. Immobilization of the affected part for a certain period may help heal the condition. Medications, physical therapy, and surgery may also be recommended. Often, splinting for a short period of time can treat the condition.

Any problem causing pain, swelling, discoloration, numbness or a tingling sensation, or abnormal position of the wrist that persists for more than two or three days should be evaluated by your doctor to establish the cause and obtain the best treatment as early as possible.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area.

Symptoms

Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength.

Causes

Exact causes of the condition are not known. However certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor in the canal.

Conservative Treatment Options

Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:

  • Treating underlying medical conditions
  • Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks
  • Rest the hand for 2 weeks or more
  • Ice packs to avoid swelling
  • Avoid activities that tend to worsen the symptoms
  • Medications such as non-steroidal anti-inflammatory drugs and steroid injections
  • Strengthening and stretching exercises once symptoms diminish

Surgery

If conservative treatment options fail to resolve the condition your surgeon may recommend surgical procedure.

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release Surgery Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Post-Operative Care

Your surgeon may suggest you practice certain post-operative procedures for better recovery and to avoid further complications.

  • Elevate the hand above heart level to reduce swelling.
  • A splint may be worn
  • Ice packs to the surgical area to reduce swelling.
  • Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering.
  • Physical therapy may be ordered to restore wrist strength.
  • Eating a healthy diet and not smoking will promote healing

Risks and Complications

Most patients suffer no complications following carpal tunnel release surgery. However, some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.