Wrist Pain

Muscle pain

Technically there are no muscles in the wrist itself, there are merely tendons that crosses the wrist, and their muscle bellies are located in the forearm.

Tendon pain

Tendons on the Palm side of your wrist

On the palm side of the hand there are a group of tendons that bend the wrist forward, then there are a group of tendons that run across the wrist further up to the fingers. The tendons that mainly bends the wrist are the Flexor Carpi Ulnaris and Flexor Carpi Radialis, these anchor directly onto the small carpal bones.  One tendon assists with bending the wrist called the Flexor Palmaris longus.

Tendons moving the wrist

Flexor Carpi Ulnaris & Radialis, are two tendons that anchor directly onto the wrist, with your palms facing upward, Ulnaris on the inside and Radialis on the outside, separately each one can pull the wrist more inwards (Ulnaris) or outwards using (Radialis). When they contract together their combined force bends the wrist forward.

Cut to these tendons may leave you unable to bend your wrist. If it happens in isolation, Ulnaris will have loss of movement inward, similarly when Radialis is cut you will lose the ability to move your hand outwards. Other pain in the wrist tendons may be caused by irritations to these tendons namely Flexor Carpi Ulnaris & Radialis Tendinitis.

Tendons running across the wrist to the fingers

The tendons that run to the fingers are a collection of ropes that forms 3 group.

The fist 4 tendons runs at the top (called Superficialis) to the middle part of the finger. Flexor Digitorum Superficialis. You will to be unable to bend the middle joints of your fingers when these tendons are cut.

Deep to this group is another group of 4 tendons that run to the tips of your fingers, Flexor DIgitorum Profundus. You will to be unable to bend the tip joints of your fingers when these tendons are cut.

Flexor Pollicis Longus runs to the thumb. You will to be unable to bend your thumb when this tendon is cut.

At the top of the wrist

On the palm side of the hand there are a group of tendons that bend the wrist forward, then there are a group of tendons that run across the wrist further up to the fingers. The tendons that mainly bends the wrist are the Flexor Carpi Ulnaris and Flexor Carpi Radialis, these anchor directly onto the small carpal bones.  One tendon assists with bending the wrist called the Flexor Palmaris longus.

Nerve pain

Carpal Tunnel syndrome is the most common nerve problem encountered in the wrist. This involves narrowing of the space inside your wrist that directly puts pressure on the Median nerve that supplies your thumb, index finger & middle finger.

The Ulnar nerve runs through its own tunnel called the guyon’s canal. Ulnar nerve damage & injury causes nerve pain radiating towards the little and ring finger.

Radial nerve rus over the thumb side of the wrist and mainly supplies the top part of the thumb, top of the whole hand up until the middle joint of the fingers. A drop wrist is the most common injury to the Radial nerve leaving you unable to lift your wrist & finger up.

Joint pain

There are 8 small Carpal bones tightly arranged next to each other in two rows in the wrist, the Lunate bone connects to the Ulna and the Scaphoid connects to the Radius.

The most commons condition that affects these contact-points between the bones are joint degeneration or arthritis. Arthritis of the wrist joints are a combination of wear & tear and destruction of the cartilage (cushioning) where the bones meet.

Osteoarthritis is progressive wasting away of the bone, like the tires on your car that’s thread gets driven through. Rheumatoid arthritis is a autoimmune, inflammatory disease where your own immune system destroys the inner cushioning between the contact surfaces of the bone.

Then the normal alignment of the carpal bones are disrupted you may have dislocated your wrist. The Scaphoid and Lunate regularly dislocate, and is always accompanied by ligament strains or tears.

Ligaments pain

Ligaments in your wrist must keep the bones in positions and keeps the joint stable. The ligaments that must keep the carpal bones stable are very tight & stiff. A very small amount of force is needed to tear these ligaments, due to this inability to have some leeway or ‘give. Thus it’s highly likely to tear these ligaments when the carpal bones are dislocated.

Fractures brings its own complications due to the ligaments that attach onto certain parts of the bone, segments of the bone that breaks away and leaves the rest of the bone vulnerable. These separated fragments will increase its likelihood to dislocate.

Wrist fractures

Due to the small size of the carpal bones they are prone to fracture quite easily and any disruption or excessive force can crack and injure these vulnerable bones.

The Radius is more common to fracture first because it’s attachment to the wrist is bigger as compared to the Ulna. Pain on the side of the thumb is more prominent. The most clear sign of this type of wrist fracture is that you will have difficulty to lift the  thumb up (like showing the OK or “sharp” sign)

An Ulna fracture is on the side of the pinky. Almost all of the fractures to the Ulna break off the Ulnar Styloid process. The Ulna Styloid process  is a prominent knob that can be seen on the outside and top of your wrist. If you suspect a fracture, pressing on this knob may be extremely painful and our patients even report not being unable see the knob after it is broken.

Wrist fractures and dislocation almost always happen together.

Hand Injuries

1. Finger Dx
2. Thumb Dx
3. Hand Dx
4. Elbow Dx

What needs to be tested to determine the source of your hand pain

• Grip Strength
• ROM
• Sensation
• Stability
• Joint alignment
• Nerve tension test
• Tendon gliding test