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| Spence Rehabilitation Center |
| 1650 45th Ave. Suite 2C |
| Munster, IN 46321 |
| Phone |
: (219) 513-2267 |
| Check out our new location! |
| 3170 Willowcreek Road |
| Portage, IN (Mondays Only) |
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What are causes of traumatic wrist pain? |
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If the pain resulted after a fall on an outstretched hand, |
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fracture, ligament strain, or bone dislocation should be |
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suspected. |
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| 1. |
Wrist sprain: |
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A tear of the ligaments that support the radiocarpal |
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joint which attached the hand to the arm. Wrist pain |
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and swelling resulting from sprain is usually mild with |
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near normal range of motion. Symptoms should |
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resolve within two weeks with conservative therapy |
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such as ice, immobilization, and gentle passive |
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stretching exercises. |
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| 2. |
Scaphoid fracture: |
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Can occur if there is a blunt blow to the wrist or a fall |
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forward onto an outstretched hand and wrist. This |
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fracture can be difficult to pick up because x-rays are |
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sometimes normal even if a facture is present. Also, if |
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not treated, the blood to the scaphoid bone can be cut |
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off which can lead to bone death and arthritis. |
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| 3. |
Lunate dislocation: |
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This is a small bone found in the wrist and also results |
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from a fall onto an outstretched hand. The distance |
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between the scaphoid and lunate is measured on X-ray. |
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If there is greater than a distance of 3mm then a |
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dislocation is present. |
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| 4. |
Distal radius fracture: |
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Sometimes referred to as a Colles fractures. |
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| 5. |
A hamate fracture: |
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Usually results from a direct blow to the wrist or chronic |
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repetitive strain with racket sports. There is usually |
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tenderness and weakness in grip strength. X-rays are |
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often normal so a CT or bone scan may be necessary if |
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it is still suspected. |
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What are some common causes of non-traumatic |
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wrist pain? |
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| 1. |
Radiocarpal arthritis: |
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Usually results in pain, swelling, and loss of range of |
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motion at the wrist. It can develop from multiple wrist |
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sprains, old fractures, rheumatoid arthritis, and gout. |
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| 2. |
Dorsal ganglion: |
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Usually develops from chronic irritation of the wrist |
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which leads to overproduction of joint fluid. The fluid |
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travels up to the subcutaneous tissues to form a fluid |
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filled sac. |
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| 3. |
Carpal tunnel syndrome: |
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Compression of the median nerve at the wrist. |
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Symptoms include pain and numbness in the thumb, |
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index, middle and part of the ring finger. Pain can |
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sometimes move up to the forearm and shoulder. |
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| 4. |
De Quervain's tenosynovitis is: |
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An inflammation
of tendons that make up the thumb |
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which usually develops from repetitive gripping and |
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grasping. |
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| 5. |
Carpometacarpal osteoarthritis: |
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Also caused by repetitive gripping and grasping as |
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well as excessive vibration. Symptoms included pain, |
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swelling, or enlargement at the base of the thumb. |
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| 6. |
Compression of the ulnar nerve in Guyon's |
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canal: |
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An uncommon syndrome where the ulnar nerve is |
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pinched at the wrist and usually causes numbness of |
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the small and ring fingers. |
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What Tests can be used to evaluate wrist pain? |
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| 1. |
X-ray of the wrist: |
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To check for fractures and arthritis. X-rays should |
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be ordered if there is history of trauma and focal |
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tenderness when touched. Simple sprains should |
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be normal. Osteoarthritis of the radiocarpal joint can |
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show narrowing of the joint space and irregularities of |
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the bony surface. A widened space of >3 mm between |
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the scaphoid and the lunate suggests lunate dislocation. |
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| 2. |
CT or bone scan: |
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Sometimes used to check for fractures of the scaphoid |
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in individuals with suspicious symptoms and normal |
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findings on plain x-ray. |
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| 3. |
Local anesthetic block/joint aspiration: |
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Can be used to draw fluid out of a joint to check for |
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inflammatory cells. Also, the carpal tunnel can be |
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injected with anesthetic to evaluate for carpal tunnel |
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syndrome. If the symptoms improve after injection, |
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carpal tunnel syndrome is more likely. |
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| 4. |
Electrodiagnostic testing: |
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(EMG and nerve conduction studies): |
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are used to check for compression of nerves such as |
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the median and ulnar nerves. |
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What are common treatment options for wrist pain? |
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Treatment will vary depending on the specific diagnosis
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but may include some of the following: |
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| 1. |
Acetaminophen: |
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Also known as Tylenol. |
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| 2. |
Non-steroidal antiinflammatories (NSAIDS): |
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To minimize pain and inflammation. Commonly |
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prescribed medications include ibuprofen and |
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naprosyn. |
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| 3. |
Splinting: |
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Can be applied to fractures and dislocations acutely |
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to keep the hand immobilized until they are seen by |
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a hand specialist. Splints can also be used to manage |
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many chronic conditions |
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a) |
Thumb spica splints: |
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Are used to manage De Quervain’s |
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b) |
Carpal tunnel splints: |
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Can be worn at night to manage carpal tunnel |
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syndrome. |
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| 4. |
Corticosteroid injections: |
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A high dose of steroid is administered to the affected |
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site to minimize inflammation and limit systemic side |
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effects. |
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a) |
CMC joint injection |
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b) |
Carpal tunnel injection |
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c) |
De Quervain’s injection |
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| 5. |
Modalities: |
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Can include heat, ultrasound, phonophoresis, |
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fluidotherapy, and paraffin. |
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