Wrist connects forearm to arm and consist with few small bones which form a very delicate and complex joint structure. Wrist plays an important role for our hand by providing the stability, power and different direction to perform its function.
Wrist Joint and its anatomy
In leu of the nature of activity wrist bears a lot stress and strain and poses risk of injury and chronic wear and tear. There is various reason for wrist pain. Most common ones are:
Carpal Tunnel syndrome: Median nerve passes through a narrow fibro osseous tunnel at wrist. This tunnel gets narrowed due to various reasons and can compress the nerve which produces pain at wrist and hand. In long term produces neurological deficit at the nerve distribution distal to wrist. Clinical examination and nerve conduction study is the way of diagnosis. In initial stage exercise, brace and medication is the treatment. Sometimes local infiltration with steroid is helpful. If all these conservative measures fail to resolve the symptom then surgical decompression of the tunnel is the only treatment. This is done under local anesthesia as daycare procedure.
Carpal Tunnel Syndrome: Site of compression and symptom distribution
De Quervain's disease: This presents as pain at radial side of wrist while using thumb for hand function. Happens due to inflammation of two tendon that control thumb function. These two tendons pass through a tight fibrous band at wrist. Inflammation happens due to repeated friction of the tendons with this band. Women are affected more than men and nursing mothers are commonly affected with this condition. Rapid repetitive activities involving pinching, grasping or pushing have been considered at increased risk. Specific activity like excessive use of mouse and smart phone have been found to be associated with developing this syndrome. Splinting, icing, analgesic and local infiltration of steroid is effective but it takes quite a long to resolve this issue. In non-resolving condition surgical release of the band is the treatment of choice. This surgery is being done under local anesthesia in day care.
De Quervain's Disease, where it affects
How Nursing mother uses their thumb more and got De Quervain's Disease
AVN of Lunate: Reffer to AVN of bone in systemic disease of bone & joints
Fractur of scaphoid and related condition: scaphoid bone is situated at snuff box area of wrist. It makes the main weight transfer from forearm to thumb. Fracture happens due to fall on palm on an outstretched hand. Main symptom is pain swelling and difficulty in using wrist. Due to the peculiarity of the blood supply of this bone it has potential complication following fracture like non-union, and AVN with consequent wrist arthritis. Most of the time fracture requires surgical fixation with screw. Above complication can happen even after adequate treatment.
Mechanism of Scaphoid fracture
Surgical Fixation of Scaphoid Fracture
DRUJ injury and related condition: DRUJ stands for distal radio ulnar joint. It’s a joint complex consist with different ligament attaching distal radius and ulna, a cartilaginous disc situated between ulna and wrist bone and muscles attaching at ulnar end with ulnar collateral ligament of wrist joint. Acute injury happens commonly associated with wrist fracture and isolated fracture radius but may happen any trauma affecting wrist. Chronic pain may be due to altered ulnar variation and post trauma. Some times trivial wrist trauma escapes initial attention due to not affecting any bone but later on presents with chronic wrist pain. So any wrist injury with ulnar side pain and tenderness should evaluated properly to exclude any DRUJ injury and treated adequately.
