What is wrist pain?
Wrist pain can be classified as any discomfort felt in the wrist. It can be caused by a variety of issues, including acute injury, arthritis, gout, carpal tunnel syndrome and more. Even though the wrist is a small part of the body, it has eight bones, as well as ligaments and tendons, making it a somewhat delicate and complicated area of the body.
What are the causes of wrist pain?
The following conditions are common causes of wrist pain: carpal tunnel syndrome, gout, osteoarthritis, rheumatoid arthritis, ganglion cysts, overuse injuries and tendonitis.
What is carpal tunnel syndrome?
The median nerve is one of the three major nerves in the forearm and wrist. Carpal tunnel syndrome occurs when the median nerve becomes compressed or pinched and becomes inflamed at the level of the wrist. It’s located on the palm side of your hand, providing sensation to the thumb, index finger and middle finger. The median nerve also provides the electrical impulse to the muscle leading to the thumb. Carpal tunnel syndrome can occur in one or both of your hands.
What are the symptoms of carpal tunnel syndrome?
Aside from causing wrist pain, carpal tunnel syndrome can lead to numbness, weakness, and tingling on the side of your hand near the thumb.
What are the risk factors for carpal tunnel syndrome?
Risk factors for carpal tunnel syndrome include:
-performing repetitive tasks with your hands, such as typing, drawing, or sewing
-pregnancy
-having certain medical conditions, such as diabetes, arthritis, kidney problems, or an underactive thyroid
-having a family history of carpal tunnel, as anatomic differences can run in families
-obesity
-advanced age
-smoking
-alcoholism
How is carpal tunnel syndrome diagnosed?
Dr. Kevin Mangum will do a thorough history and physical exam to make sure that this is the correct issue that you are dealing with. There are a few medical tests that are done that help confirm the diagnosis. Thenar atrophy, self administered hand diagram, carpal tunnel compression test (Durkan’s test), Phalen test, Tinel’s test, and Semmes-Weinstein testing are a few of the medical tests that help confirm carpal tunnel syndrome. Nerve conduction velocity (NCV) and electromyography (EMG) studies are also ordered to help confirm the diagnosis of carpal tunnel syndrome. Dr. Kevin Mangum has specialty training in diagnostic musculoskeletal ultrasound. Ultrasound has also been shown to be effective in diagnosing carpal tunnel syndrome.
How is carpal tunnel syndrome treated?
Carpal tunnel syndrome is treated conservatively at first, but if there is no improvement in the symptoms, then other and more advanced techniques are tried. Nonsteroidal anti-inflammatory drugs (NSAIDs), can be very helpful for pain. Using a wrist splint or night splint has been shown to be very helpful for patients with nighttime numbness, tingling and pain in their hands. Reducing and avoiding aggravating activities like a lot of wrist movements and gripping movements, have also been found to be helpful. If the conservative treatments are not helping, then we escalate therapy to corticosteroid injections. Dr. Kevin Mangum is a board-certified sports medicine physician who is trained in diagnostic and therapeutic ultrasound injections. Most of his patients have 90% of improvement with symptoms. If injections do not work, then surgery is recommended.
What is gout?
Gout is a type of inflammatory arthritis that is typically caused by a buildup of uric acid. Uric acid is a chemical produced when your body breaks down foods that contain organic compounds called purines.
Most uric acid is dissolved in the blood and removed from the body through the kidneys and excreted by urination. However, in some cases, the body produces too much uric acid, and in other cases, the body does not excrete uric acid sufficiently. This excess uric acid can be deposited in the joints, resulting in pain and swelling. Gout pain frequently occurs in the knees, ankles, wrists, and feet.
What are the risk factors for gout?
Common risk factors for gout include:
-overconsuming alcohol
-overconsuming foods and drinks high in fructose
-eating a diet high in purine-rich foods, like red meat and certain types of seafood
-living with obesity
-certain medications, such as diuretics
-other conditions, such as high blood pressure, diabetes, and kidney disease
How is gout diagnosed or confirmed?
The diagnosis of gout is best made by removing some fluid from the affected joint and testing it in the lab. The lab tests for certain crystals within the joint fluid. The joint fluid shows strongly negatively birefringent needle-shaped intracellular crystals. You can also test the serum uric acid; however, elevated uric acid is not diagnostic (80% of people with an elevated uric acid will never have a gout attack).
What is the treatment for gout?
The treatment for acute gout attacks is NSAIDs (Ibuprofen, indomethacin, colchicine – if the patient has a history of peptic ulcers) and corticosteroids, both orally and injected into the joint. Chronic gout can be treated with allopurinol and other medical management strategies to reduce uric acid.
What is the gout diet?
Some changes in your diet can help reduce the risk of a gout flare. Weight gain is a significant risk factor for gout in men, whereas weight loss reduces the risk. Intake of high-fructose corn syrup should be restricted. Patients with gout should limit their intake of purine-rich animal protein (e.g., organ meats, beef, lamb, pork, shellfish) and avoid alcohol (especially beer). Consumption of vegetables and low-fat or nonfat dairy products should be encouraged.
What is Arthritis?
Arthritis is an inflammation of the joints. The condition can cause swelling and stiffness in the affected body part. Arthritis has many causes, including normal wear and tear, aging, and overworking the hands.
There are many forms of arthritis, but the most common types that can affect the wrist include:
Rheumatoid arthritis (RA) is an autoimmune disease that can affect both wrists. It develops when the immune system mistakenly attacks the lining of your joints, including your wrists. This can cause painful swelling, which may eventually result in bone erosion.
Osteoarthritis (OA) is a degenerative joint disease that’s common among older adults. It is caused by a breakdown of the cartilage that covers the joints. The protective tissue is damaged [during the aging process or over time] and repeated motion. This increases the friction as the bones of the joint rub against each other, resulting in swelling and pain.
What are the risk factors for arthritis?
While arthritis can happen to anyone, especially as we age, there are some risk factors that can increase your chances of developing it. According to the Centers for Disease Control and Prevention, these factors include:
-living with obesity
-living with untreated infections
-smoking
-untreated joint injuries due to overuse (such as knee bending)
What are ganglion cysts?
Ganglion cysts are benign, noncancerous, and usually harmless lumps that occur most often in the hand, usually on the back of the wrist.
What causes ganglion cysts?
It’s not known what causes ganglion cysts, but, according to the American Academy of Orthopaedic Surgeons, they tend to appear most often in individuals from ages 15 to 40 years, gymnasts (because of the repeated stress to their wrists), individuals assigned female at birth. Many times, ganglion cysts are painless, but if they’re putting pressure on a joint or nerve, they can cause pain in the wrist area.
How are ganglion cysts treated?
Treatment for ganglion cysts varies from waiting to see if it will go away on its own, to wearing a splint, to draining it, injecting them with corticosteroid and finally surgically removing them.
Call today for an appointment with Dr. Kevin Mangum who is a sports medicine and family medicine physician practicing in salt lake city Utah who treats wrist pain.
References
Madden, Christopher, et al. Netter’s Sports Medicine E-Book. Elsevier Health Sciences, 2013.