At Michigan Orthopaedic Surgeons, we put wrist pain to rest.

Cause

Carpal tunnel syndrome is a common condition that causes pain, numbness and tingling in the hands and arms. The condition occurs when the median nerve (one of the major nerves in the hand) is compressed or squeezed as it travels through the wrist. This puts pressure on the nerve instead of lubricating, as it normally would.

Who’s Likely to Get It

Studies have shown that women and older people are more likely to suffer from this condition.

Symptoms

Symptoms begin gradually and are not necessarily associated with a specific injury. Initially, they may come and go. However, as the condition worsens, the symptoms will occur more frequently and last for longer periods of time. This includes:

• Numbness, tingling, burning and pain in the wrist
• Pain or tingling that travels up the forearm toward the shoulder
• Weak and clumsy hands, potentially making it more difficult to perform fine motor functions, such as buttoning your clothes

Treatments

Although slowly, carpal tunnel syndrome will worsen over time if it remains untreated. Thus, medical evaluation is recommended as early as possible. In some cases, early treatment can slow, or even stop, the progression of the disease.

Nonsurgical options include:

• Bracing/splinting: Wearing a brace or splint at night keeps the wrist from bending during sleep. And keeping the wrist in straight or neutral position will reduce pressure on the nerve in the carpal tunnel. Wearing a splint during the day, when engaged in activities that aggravate the symptoms, is also recommended.
• Non-steroidal anti-inflammatory medication: Drugs such as ibuprofen and naproxen can help reduce pain and inflammation.
• Activity change: Often, symptoms occur as the result of a patient having a hand and/or wrist in the same position for long periods of time, particularly when they are extended or flexed.

If nonsurgical treatment is unsuccessful in reducing symptoms, a doctor may recommend a surgical option. The procedure for carpal tunnel syndrome is called carpal tunnel release. There are two forms of the procedure, but the desired outcome for both is to release pressure on the median nerve.

• Open carpal tunnel release: During the procedure, the doctor will divide the transverse carpal ligament (the roof of the carpal tunnel), increasing the size of the tunnel and subsequently decreasing pressure on the median nerve.
• Endoscopic carpal tunnel release: A special knife is used to divide the transverse carpal ligament, similar to the open carpal tunnel release procedure.

Cause

Ganglion cysts are common masses or lumps in the hand and/or the back of the wrist. The cysts are fluid-filled and can quickly appear/disappear and increase/decrease in size.

It is unclear what causes them, but they are typically harmless and not cancerous. (Note: Ganglion cysts that develop at the end joint of a finger are known as mucous cysts, and they are associated with arthritis in the fingers.)

Who’s Likely to Get It

Ganglion cysts are most common in people between the ages of 15-40, and women are more likely to be affected than men. These types of cysts are also common among gymnasts, as they frequently apply stress to their wrists.

Symptoms

Most ganglion cysts form a visible lump, but smaller cysts can remain hidden underneath the surface of the skin. Ganglion cysts do not normally result in other symptoms, but if the cyst puts pressure on a nerve, it can cause pain, tingling and muscle weakness.

Treatments

Ganglion cysts do not typically require treatment unless they become painful or interfere with normal function. Most will disappear over time. However, if necessary, nonsurgical options include:

• Immobilization: Activity can cause the cyst to increase in size or increase pressure on the nerve, which can result in pain. As pain decreases, a doctor may prescribe strength and range of motion exercises.
• Brace/splint: Using a wrist brace or splint can reduce the size of the cyst.
• Aspiration: If the cyst causes great pain or limits regular physical activity, the fluid may be drained from the cyst in a procedure called aspiration. This procedure frequently fails to eliminate the ganglion cyst completely, because the connection to the joint is not removed. In that sense, ganglion cysts can act like weeds – growing back if the root is not removed. Many ganglion cysts return after the aspiration procedure, but it’s recommended for those located on top of the wrist.

Treatments

Your doctor may recommend surgical treatment if nonsurgical treatment is not successful. The surgical procedure to remove ganglion cysts is called excision. It involves removing the cyst and part of the joint capsule (or tendon sheath), which is considered to be the root of the ganglion. However, there’s still a chance the cyst could return after an excision.

Cause

Kienböck’s disease is a condition where the blood supply to the lunate, one of the small bones in the wrist, is interrupted. But because the bone is living tissue, it requires a regular supply of blood for nourishment. Thus, if the blood supply to a bone stops, that bone can die. This is known as osteonecrosis. The formal cause of Kienböck’s disease is not known.

Symptoms

The most common symptoms of Kienböck’s disease are as follows:

• Pain and swelling in the wrist
• Limited range of motion, stiffness and decreased grip strength
• Tenderness directly over the bone (top of the hand to the middle of the wrist)
• Pain or difficulty rotating the hand upward

Treatment

There is no complete cure for Kienböck’s disease, but there are both surgical and nonsurgical treatment options. In all options, the goal is to relieve pressure on the lunate and/or to restore blood flow to the bone.

In the initial stages of the disease, pain and swelling may be managed with anti-inflammatory medications, such as aspirin or ibuprofen. A doctor may recommend a splint or cast for two to three weeks. Immobilizing the wrist can also help relieve pressure on the lunate.

It’s important to monitor any changes in symptoms during the early stage of Kienböck’s disease. If the pain is not relieved with medication or other nonsurgical options, a doctor may recommend surgery. The choice of procedure will depend on several factors, including how far the disease has progressed and the patient’s activity level.

Cause

A scaphoid fracture is a break in one of the small bones of the wrist. This type of fracture occurs most often after a patient falls on an outstretched hand. A scaphoid fracture can also occur during sports activities or vehicle collisions.

Symptoms

Scaphoid fractures usually cause pain and swelling over the “anatomic snuffbox” (also known as the radial fossa) and on the thumb side of the wrist. The pain may be severe when the patient moves the thumb or wrist, or tries to pinch or grasp an object. However, unless the wrist is deformed, it may not be immediately apparent that a scaphoid bone is broken. With some scaphoid fractures, the pain is not severe and may be mistaken for a sprain.

Treatment

Treatment for a scaphoid fracture is dependent on the location of the break in the bone, whether the bone fragments are displaced and when the injury occurred.

If the doctor treats this type of fracture with a cast, the cast may include the thumb and extend above the elbow to stabilize the fracture. If the scaphoid is broken at the waist or the middle of the bone or closer to the forearm (proximal pole), healing can be more difficult. These areas of the scaphoid do not have a good blood supply. Thus, a doctor may use a bone stimulator to deliver low-intensity, ultrasonic or pulsed electromagnetic waves that stimulate healing.

If the scaphoid is broken at the waist or proximal pole, or if pieces of bone are displaced, the doctor may recommend surgery. The goal will be realigning and stabilizing the fracture, offering a better chance to heal. Procedures include:

• Reduction: During this procedure, the doctor will manipulate the bone back into proper position. In some cases, this is done using a limited incision and special guided instruments. In others, it’s performed through an open incision with direct manipulation of the fracture.
• Internal fixation: During this procedure, screws and/or wires are used to hold the scaphoid in place until the bone is fully healed. The location and size of the surgical incision is dependent on which portion of the scaphoid is broken.
• Bone graft: In some cases, a bone graft may be required. A bone graft is new bone that is placed around the broken bone to stimulate bone production and healing. The graft may be taken from the forearm bone in the same arm or from the hip.

Cause

Arthritis can affect many joints, and that includes the wrist. 

Types

The most common types of arthritis that affect the wrist are:

• Osteoarthritis: It can develop as the result of normal wear-and-tear on the wrist, and it’s common among people who have a family history of arthritis. With osteoarthritis, articular cartilage wears away, causing the bones to rub one another. There is little blood supply, which limits the body’s ability to heal or regenerate and, over time, the cartilage becomes rough and the bones rub together – leading to pain and stiffness in the affected joint.
• Rheumatoid arthritis: This is an autoimmune disease in which the body’s immune system attacks its own tissues. The standard defense would normally be to protect it from infection, but instead, it causes damage to normal tissue (such as cartilage and ligaments) and can soften the bone. Rheumatoid arthritis often affects the joint between the radius and ulna (the two bones of the forearm). The deformity in the ulna can cause wearing and possible rupture of the tendons that straighten the fingers, which can lead to deformity and loss of function in the hands.
• Post-traumatic arthritis: Post-traumatic arthritis develops after an injury, such as a broken wrist or torn ligament. Despite proper treatment, injured joints can be more likely to become arthritic over time.

Symptoms

Common symptoms of arthritis include pain and joint stiffness. When this occurs in the wrist, it can make simple tasks difficult and uncomfortable to perform. Symptoms and severity may vary, and some people do not experience any symptoms at all. However, most arthritis diseases tend to be chronic and permanent, often leading to more serious joint damage over time. Common symptoms include pain, swelling, reduced range of motion or stiffness, and weakness in the joint.

Treatments

While there is no cure for arthritis, there are treatments that can help manage the discomfort. For example, nonsurgical options can reduce the severity and frequency of symptoms, including:

• Activity modification: Limiting or stopping the activities that increase pain is the first step to relieving the symptoms.
• Splint: Wearing a splint can help support the joint and reduce stress during periods of activity.
• Medication: Non-steroidal drugs, such as ibuprofen and naproxen, can reduce pain and swelling.
• Exercise: Specific exercises can improve the range of motion and function in the wrist. A doctor or physical therapist will develop an exercise program that meets the specific needs of the patient.

If nonsurgical treatments are unsuccessful, consult a doctor for a recommended surgical treatment. The goal of surgical treatment is to reduce pain while maintaining hand function, and there are many procedures/options based on the severity of the condition.