Wrist Pain

Wrist pain in Pittsburgh, Fox Chapel and the surrounding areas can be a nagging complaint. We use our wrists all throughout the day, and when you have pain it can really slow you down. Wrist injuries can be due to trauma, such as one might experience in a contact sport, or overuse. Wrist injuries are not just limited to being sports injuries. They can be due to work activities, or just everyday life. The wrist is a complicated structure, and a vital one as well. It is important to ensure that you receive the appropriate evaluation and management when you suffer a wrist injury. For that reason I am going to go over some of the most common wrist injuries and fill you in on what you should know.

Some of the most common causes of wrist pain are as follows: carpal tunnel syndrome, cubital tunnel syndrome, de Quervain’s tenosynovitis, pronator syndrome, scapholunate dissociation, scaphoid fracture, triangular fibrocartilage injury, and tunnel of Guyon syndrome.

Carpal tunnel syndrome is the most well-known injury of the wrist. However many wrist conditions are misdiagnosed as carpal tunnel syndrome. When one has carpal tunnel syndrome they will present with numbness or tingling in the part of the palm closest to the thumb as well as into the thumb, index, and middle fingers. One might experience an overall decrease in sensation in the wrist which makes it hard to grip objects. The cause of carpal tunnel syndrome is due to compression of the median nerve which runs through a tunnel in the wrist created by the bones as well as the transverse carpal ligament. The condition can be due to sports or occupational overuse. The condition can often be diagnosed on a preliminary basis using in office orthopedic tests. Confirmational diagnosis is often unnecessary but can be done using an electro diagnostic study. The condition can be treated effectively with conservative therapies such as manipulation, soft tissue work, exercises prescription, and splinting. In some cases the condition may require further intervention where a referral to an orthopedic surgeon or pain medicine specialist is necessary.

Cubital tunnel syndrome will often present with pain in the forearm as well as numbness or tingling into the ring and or little finger. This condition is more common in sports that require a lot of throwing. Cubital tunnel syndrome in Pittsburgh, Fox Chapel, and the surroudning areas is caused by compression or irritation of the ulnar nerve. It can be evaluated using in office orthopedic tests that reproduce pain. Sometimes electro diagnostic studies may be done to make a definitive diagnosis. The condition can be hard to differentiate from tunnel of Guyon syndrome, but often knowing definitively is not necessary. The treatment for this condition involves conservative therapies. PRICE in addition to soft tissue work, and neural mobilization are often effective. If conservative therapies fail to treat the condition then surgical consultation should be considered.

This condition is due to overuse of the thumb or repetitive awkward hand positioning. One is likely to present with pain in the lateral side of the wrist which possibly extends into the thumb. This condition is due to repetitive micro trauma to the tendons that go into the thumb. This condition can be diagnosed with the in office orthopedic test known as Finkelstein’s test. The condition is treated with conservative treatment at Tauberg Chiropractic & Rehabilitation. The treatment should include attempts to decrease inflammation and reduce the amount of time the area is subjected to injury producing forces. Soft tissue work on the area can help healing and reduce pain. If the injury does not resolve with this treatment immobilization for a few weeks is the next step, followed by steroid injection.

Pronator syndrome is often due to overuse of the forearm. This may be caused by a sport, but is more commonly due to occupation. One will have pain in the soft underbelly of the forearm. The condition is caused by compression occurring in the forearm due to overuse. The overuse could cause one of several structures to tighten. This tightening causes compression of the structures under the tightened one. This can be diagnosed by palpating the area which will produce pain as well as orthopedic tests which will reproduce pain. Pronator syndrome is most often successfully treated with conservative therapies. Soft tissue work can be very effective for treating this condition. Rarely patients may need to be referred for more invasive procedures.

Scapholunate dissociation is one of many potential injuries which can occur after someone falls onto an outstretched hand. When one falls on their outstretched hand they usually land on the palm with initial impact to the side closest to the thumb. This causes the wrist to hyperextend and deviate to the ulnar side. This force can cause the scaphoid and lunate, two of the bones in the hand, to be pushed apart. This results in stretching or tearing of the ligament that holds the two bones together. One will experience pain and instability in the wrist after this injury. Orthopedic tests can help to focus in on the problem, but x-rays or MRI are needed to make a definitive diagnosis.  Surgery is often the treatment that is recommended for this injury.

Scaphoid fracture is the most common fracture of the bones in the hand. The scaphoid is the bone located at the base of the palm on the thumb side. This fracture is often caused by falling on an outstretched hand. X-rays are needed to diagnose scaphoid fractures. Holding a tuning fork to the bone can cause pain which may indicate to the clinician that x-rays are necessary. Scaphoid fractures should be further assessed by an orthopedic surgeon or pain medicine doctor. Casting or surgery may be necessary.

Triangular fibrocartilage injury is another common injury to occur on someone who falls on an outstretched hand. Although this injury is not always the result of trauma. It can be due to degeneration. The triangular fibrocartilage, or TFCC, is the complex of ligaments that supports the medial side of the wrist and hand. This is the side with the pinky finger. If one has TFCC damage they often experience pain that is persistent as well as possible instability of the wrist. Orthopedic tests can be used to help determine that the cause of pain is from the TFCC. X-rays can also be used. MRI is the only way to make a confirmational diagnosis of TFCC damage.  Confirmational diagnosis may not be necessary. TFCC injury is treated with protection and immobilization of the wrist for multiple weeks. If immobilization is unsuccessful surgery is often needed.

When one has tunnel of Guyon syndrome in Pittsburgh, Fox Chapel and surrounding areas, one will present with pain, numbness, or tingling in the ring or pinky fingers. The condition is caused by compression or irritation of the ulnar nerve in the tunnel of Guyon. The tunnel of Guyon is an area in the medial aspect of the wrist. For this reason forearm pain is not often present. The condition can be evaluated with in office orthopedic tests such as Tinel’s or just through palpation of the area. The condition is often effectively managed with conservative therapies such as soft tissue work, mobilization, and neuromobilization exercises.

The treatment for many of the conditions of the wrist involves using conservative therapies first. These conservative therapies are performed at Tauberg Chiropractic & Rehabilitation. In some cases further treatment may be required depending on the injury. Call us at 412-517-8124 to see if we can help you with your wrist pain.