Wrist pain can be debilitating – as you use your wrists in so many essential movements.
Wrist pain can be slightly challenging to diagnose, as there are many structures that could be at fault.
There are many common wrist issues that arise within the population of patients that we see.
1. Wrist Pain Causes
The wrist has many types of structures that can cause pain!
- Joint causes
- Tendon causes
- Tendon sheath causes
- Nerve causes
- Bone causes
There are many joints in the wrist – it’s made up of 8 carpal bones.
Common issues include:
Lunate bone dislocation and Scaphoid fracture.
Another common cause of wrist pain is degenerative change of the joint between the thumb and the Trapezium.
There’s a lot of movement at the wrist, so it goes without saying that there’s going to be degenerative change relatively easily.
There 17 separate muscles that have tendons crossing the wrist!
So there’s a high chance in this mobile area, that there will be significant possibility of pain arising within a tendon.
Sometimes this can be from an actual tear/strain but this is relatively uncommon.
What is more common is in fact:
Tendon sheath causes:
All tendons running over the wrist are surrounded in a tendon “sheath” which allows movement to occur – as the tendon slides within the sheath.
The sheath itself can become inflamed for several reasons giving rise to what’s known as “tenosynovitis”, which is very painful.
“Carpal tunnel syndrome” is the most common of these issues, and is caused by inflammation within the canal through which the nerve passes in the wrist.
There’s only a certain amount of space in the canal, so any inflammation can effectively decrease this space, and cause nerve related signs and symptoms.
Fractures are relatively common in the wrist from a fall.
Often these are actually lower arm bones (radius or ulnar) – and are usually immediately apparent.
What’s not necessarily apparent is a scaphoid fracture – where the bone is cracked after falling on an outstretched hand.
2. Wrist Assessment
Wrist assessment involves several steps:
- Active range of motion
- Passive range of motion
- Active resisted movements
- Special tests
- Diagnostic images
As there are several structures involved in specific pain, sometimes it’s not easy to diagnose.
This is especially the case of scaphoid injuries – as the bone can be fractured, but the fracture is not actually “visible” on imaging for around 21 days AFTER the injury.
Also what can easily trick clinicians is the fact that the painful structure is underneath another structure. e.g. lunate underneath extensor muscles.
Wrist pain can be also be referred from any muscle in the elbow that crosses the wrist.
3. Wrist Pain Diagnosis
The diagnosis of wrist pain depends on several factors.
To diagnose wrist pain, Osteopaths will:
Check active wrist range of motion.
We’re trying to see how good your movement is – initiated by YOU. Can you move your wrist in all directions? does it hurt in one direction? Multiple directions?
Is there pain at any point in movement? At what stage of the movement is it sore?
Check passive wrist range of motion.
Can WE take your wrist through range? i.e. not you doing the movement.
Will your brain let us?
If it doesn’t – the overriding “self protection” mechanisms are at play – usually indicating a structure that’s injured such as joint, tendon, or ligament.
Check “active-resisted” muscle strength.
There are no “perfect” muscle tests.
Your brain is in control.
Therapists think that they are testing specific muscles – but in reality – they’re firing up or testing muscles that form part of a chain.
So as Osteopaths – we’re thinking of the CHAIN of muscles above into the shoulder and elsewhere.
It’s amazing how we can sometimes stop your wrist pain by recruiting other related muscles!
After this – we’re looking for other signs with special tests, and if necessary – diagnostic imaging.
4. Wrist Exercises
Wrist pain exercises are in fact exercises of the wrist flexors, wrist extensors or wrist rotation muscles.
There are some great articulation exercises and some end range mobility type exercises to help with range of motion.
As with many things on youtube – depending on YOU, some of these exercises may in fact make you WORSE.
For example – if you’ve got tenosynovitis – the exercises in the video above would more than likely make you a lot worse.
Hence – it pays to get a proper diagnosis, by a practitioner such as an Osteopath, Physio or Chiro.
5. Wrist Pain Relief
Because wrist pain could be from bone, joint, arthritis, nerve, tendons and many other things, some manual therapy treatments may not change pain.
If we think that treatment will help you – we’ll offer it!
Medication for wrist pain relief
As we’ve said on many pages on this site, medication simply masks the true causes of the problem.
It can really help your pain levels, there’s no doubt about that. But please understand that it may not fix the “reason” you’ve got that wrist pain!
Osteopathy for wrist pain relief
Osteopathic treatment for wrist pain will only be effective if we’ve got a great history, and have performed a good physical assessment.
We’ve got to know what we’re dealing with to effectively help you with wrist pain.
Exercises for wrist pain relief
Exercises are almost always required to help wrist pain, but can in some instances make you worse as we highlighted above.
Osteopaths know the reasons why and when your wrist pain can be made worse, so we take steps to help you a lot BEFORE you start exercises.
6. Wrist Pain Prevention
Obviously we’d love to be able to prevent wrist pain in all people!!
To prevent the most common reasons for wrist pain requires just a bit of common sense really!
If you’re continually forcing the wrist into extension, you might have issues later on down the track.
Using your hands in a gripping motion a lot? You might have issues in your wrist after a while.
If you’ve broken your shoulder or your elbow you might have issues with your wrist at some point from altered mechanics – in the way you move.
Of course, if you’ve broken your wrist at some point, you might have issues in future with your wrist. There are no absolutes!
The only real true way to (probably) prevent most wrist pain is to over time, allow yourself or train yourself in body weight exercises such as yoga, to help you cope with the load and take weight through the wrist.
Yoga can be amazing for wrist health.
But it’s a practice! If your wrists are full of arthritis, you’re going to require modifications to movements to even approach the end range of joint movement.
But even in severe cases – you can work towards “more” movement.
7. Osteopathic Treatment of Wrist Pain
Manual therapy with an Osteopath can involve many different “treatments” but – there’s one thing for sure… Osteopaths never EVER just look at your wrist.
Osteopathic treatment of wrist pain will be dependent on what you present with, and why – as there are so many variables in wrist pain!
Typical Osteopathic treatment can/may involve a combination of:
- Soft tissue massage
- Joint mobilisation
- Dry needling
- Mobility exercises
- Ergonomic advice
The whole point of seeing an Osteopath for wrist pain is to a) diagnose the problem, and b) do something about it.
Remember – an Osteopath will not ONLY prescribe exercises, and will not ONLY do manual therapy.
We take a global view as to WHY the wrist problem is there, and provide you with a realistic solution.
What if you simply need a better keyboard and mouse set up?
What if you actually just need to free up your shoulder after the massive injury you did to it a few years ago that’s force it to be less mobile?
Seeing an Osteopath will shorten this process significantly.