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Eight small bones, a dozen tendons and the nerves to your hand, all crossing one joint. Where exactly it hurts narrows the cause faster than anything else.
The wrist is small enough that location does most of the diagnostic work. Point to the sorest spot and the list of possibilities shortens considerably.
Numbness is the dividing line. Pain alone usually means tendon, ligament or joint. Pain with pins and needles in the fingers points to a nerve — at the wrist, or sometimes higher, at the elbow or the neck. That changes both the tests and the treatment.
Falling onto an outstretched hand is the commonest way to hurt a wrist, and most of those injuries are sprains. The exception is worth knowing about.
The scaphoid can break and not show on the first X-ray. If it is missed, it may fail to heal, which causes long-term pain and arthritis.
The clue is tenderness in the hollow at the base of the thumb when you lift it, and the answer is a repeat X-ray or a scan rather than waiting to see.
See someone within a few days if, after a fall, the wrist is very swollen, looks bent, you cannot move or grip with it, or it is tender at the base of the thumb. A wrist that is hot, red and swollen with fever should be seen the same day.
Most wrist problems settle without surgery. The treatment depends entirely on which structure is involved, which is why the diagnosis comes first.
Adjusting the activity that provokes it, a splint where one helps — at night for carpal tunnel, or a thumb splint for de Quervain’s — and a short course of anti-inflammatory medication.
Targeted exercises, splint fitting and advice on how you use the wrist at work. For tendon problems this does more than medication.
A guided injection can settle de Quervain’s, thumb base arthritis or carpal tunnel symptoms, and is often what allows therapy to work.
Carpal tunnel release where numbness is constant or the muscles are wasting, fixing a fracture that will not heal on its own, removing a troublesome ganglion, or repairing a TFCC tear that has not settled.
Night symptoms, particularly numbness that wakes you and eases when you shake the hand, are typical of carpal tunnel syndrome. The wrist tends to bend during sleep, which raises the pressure on the nerve.
Most are ganglion cysts, which are harmless fluid-filled swellings. They are worth checking if they grow, become painful, or get in the way of movement.
X-rays show bone, not tendons, ligaments or cartilage. A scaphoid fracture can also be invisible on the first film. A normal X-ray with ongoing pain is a reason for further assessment, not reassurance on its own.
A splint rests the irritated structure and often settles symptoms, particularly at night. It works best alongside changing what provoked the problem, rather than as a permanent solution.
Not usually at first. Splinting and an injection help many people. Surgery is considered when numbness is constant, the muscles at the base of the thumb are wasting, or other treatment has not worked. See carpal tunnel syndrome for how it is told apart from a trapped nerve at the elbow or the neck.
No. Bring any X-ray or scan reports, and be ready to point to exactly where it hurts.
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Be ready to point to the sorest spot, and to say whether any fingers go numb. Those two answers do most of the work.
