Wrist. Anatomy, where it is, how it hurts, causes, treatment

Any pain is painful and requires a response. However, pain in the wrists is also unpleasant because it entails limited mobility of the hand and the inability to perform simple movements. It happens that the patient finds it difficult to fasten a button or take a mug of tea from the table.

What can cause pain in the hands when bending? How to distinguish the cause of pain from symptoms? What can help when your wrist hurts? You will learn the answers to these and other questions by reading this article.

The specialists of our clinic solve such problems. Yes , we can help you with physical therapy!

Types of pain in the hands

Types of pain in the hands

If we talk about classification, then all pain in the wrists can be divided into 2 types depending on duration:

• periodic pain in the hands,
• constant pain in the hands.

Periodic pain is more severe and occurs when trying to turn the hand, clench the fingers, or make other movements in the wrist joint. Typically, such pain indicates a recent injury, sprain or dislocation of the joint.

Constant pain , in turn, is slightly less intense, but haunts a person for a long time. Sometimes the pain is so debilitating that a patient with arthritis may get out of bed at night to take pain medication.

Causes of pain in the hands

Causes of wrist pain

There are many reasons that can lead to wrist pain. They are divided into two large groups: physiological and pathological.

Physiological

Often, painful sensations in the wrist occur for reasons that do not have a pathological basis.

These include:

• Leaving your wrist in an awkward position for too long.
• Hereditary weakness of the ligaments of the hand.
• Long-term alcohol abuse.
• Taking medications without medical supervision. In this regard, drugs for the treatment of epilepsy are especially dangerous.
• Working on the keyboard.
• Features of professional activity. At risk are crane operators, drivers, carpenters, mechanics and construction workers who interact with jackhammers.
• Participation in certain sports: tennis, golf, performing exercises with a barbell, rowing.
• Carpal tunnel syndrome. It often occurs in pregnant women. This happens in the 2nd and 3rd trimester. The reason for its development is rapid weight gain. The syndrome manifests itself with symptoms such as: pain, numbness of the hand. The pain is especially intense during night rest.

Pathological

Pathological causes that can lead to wrist pain include:

• Tumors located on the arm.
• Injuries received. Pain occurs due to a dislocation, fracture, bruise, rupture or sprain. In the area of ​​damage, swelling forms and hematomas appear. All this increases the pain.
• Arthritis. Joints can be affected for various reasons. This includes infectious factors, as well as aseptic inflammation. Arthritis is one of the common causes of wrist pain.
• Arthrosis. This disorder can occur after a joint injury. Pain appears during exercise. At rest it is absent.
• Tenosynovitis or de Quervain's disease. This pathology develops in people who often perform the same type of joint movements. Pain occurs when the hand is abducted. It radiates to the thumb and elbow.
• Tunnel syndrome. It develops against the background of wear and tear of the tendons, as well as inflammation of the nerve fibers. People who work at a computer often suffer from carpal tunnel syndrome.
• Tendinitis. The disease occurs due to excessive stress on the wrist. Professional athletes often suffer from tendonitis.
• Gout. With this disease, excess amounts of uric acid or calcium salts accumulate in the joints. Exacerbation of the pathology is accompanied by intense pain, burning sensation, and pulsation in the affected area.
• Osteoarthritis. The pathology most often affects people aged 40-60 years. The disease is characterized by the destruction of bone tissue. Moreover, it can suffer anywhere, and not just in the area of ​​the metacarpophalangeal joint.
• Erythema nodosum. With this disease, adipose tissue becomes inflamed. Tumor-like neoplasms form in the affected area. The skin over them turns red, and they feel painful when touched.
• Brucellosis, gonorrhea and other diseases of an infectious nature.
• Tuberculosis of joints and bones. This disease rarely develops. It mainly affects older people. Most often, the spine, which experiences excessive stress, is affected. However, bone tissue can be damaged anywhere in the body.
• Peyronie's disease. A person experiences pain in the wrist. Only men suffer from this disease.
• IHD and myocardial infarction.
• Trigger finger.
• Ganglion or hygroma. With this disorder, bumps form under the skin. They will contain liquid that has the consistency of jelly.
• Kienbeck's disease.
• Spinal diseases. Many of them lead to compression of the roots and spinal nerves. This causes pain in certain areas of the body.
• Volkmann's contracture. With this disorder, the patient experiences obstruction of the ulnar artery.

The development of a particular pathology can be determined by the location of the pain. Often, painful sensations in the wrist can be caused by disorders such as:

• Damage to the central nervous system.
• Spinal diseases.
• Rheumatoid arthritis or arthrosis.
• Bone cracks or ligament damage.

Anatomy and structure

The wrist has a complex structure. The palmar part resembles a boat, concave inward. The back side is slightly convex, articular. The wrist is formed by eight small, irregularly shaped bones arranged in 2 rows. Compared to other structures of the hand, there is no radial structure.

The proximal row (located closer to the forearm) forms a convex surface. The distal one (located at the palm) connects to the previous row of joints.

The carpal bones, except the pisiform, have 6 surfaces. The anterior ones are slightly rough; the ligaments of the palm are attached to them. The upper (proximal) participate in the formation of the central head, the lower (distal) form the articular fossa. The lateral bones also articulate with each other.

The carpal bones form a small groove at the base of the palm. Muscles and tendons pass through it to allow the fingers to bend. The inner edge of the groove ends with uncinate and pisiform ossicles. They can be easily felt. The outer edge of the groove consists of two bones - polygonal and scaphoid.

The space between the bones is filled with nerve fibers, veins, and ligaments. The inside of the wrist contains cartilage and connective tissue. Many ligaments pass through it. The most important are those coming from the styloid processes. Between the tubercles of the ossicles there is a retaining ligament. It passes along the groove, along with the median nerve and tendons.

The carpometacarpal joints form the distal row. All, except the area near the thumb, are inactive, but with strong ligaments.

Almost all of them come from the capitate (central) - throughout the wrist:

• the dorsal ones connect the bones of the joint, prevent excessive displacement of the hand;
• palmar: the wrist holds the palm during extension, and the ulnar wrist strengthens the inner surface of the hand during extension;
• ligaments between the bones almost motionlessly fix the bones of the first row;
• lateral (radial and ulnar) prevents excessive displacement of the hand and does not allow it to be pulled inward too much.

The wrist is covered with thin skin. Each bone is covered with protective tissue. In the center of the connection there is large cartilage. It is necessary for shock absorption and rotation of the hand. Softens blows and protects bones from wear. Additional cartilage provides maximum alignment of the wrist elements. In its depths, protected by soft tissues, there are nerve fibers.

The groove of the wrist canal contains three main canals. They help separate nerves, veins and tendons into separate bundles. This eliminates their mechanical damage during movement. The ulnar is deep, where the artery, main nerve, and veins pass.

In the radial canal there is a tendon of the corresponding muscle, an artery that supplies the thumb. The carpal tunnel contains 9 tendons that are necessary for flexing the fingers, the median nerve, and an artery.

Symptoms and possible diseases

Wrist pain is the main symptom that will always be present. The person may also experience other signs of the disorder. They depend on the specific disease that caused the wrist pain.

Common symptoms include:

• Numbness in the palm and hand.
• Goosebumps.
• Burning and itching in the affected area.
• Trembling fingers, tingling in fingers.
• Increased pain at night, after intense physical activity.
• Crunching in a characteristic area.
• Weakness of the fingers when trying to grasp any object.
• Limitation of hand movements.
• Swelling in the fingers and palms. It can occur on one or both limbs.

Specific symptoms

Specific symptoms of wrist pain include:

• General deterioration in health.
• Hyperemia of hand tissues. Redness often appears after an injury.
• Anatomically incorrect position of the limb (after a fracture). Joint instability (after dislocation).
• Hemorrhages under the skin (after an open fracture).
• Pain when bending a limb.
• Joint deformity.
• Inability to perform any actions with the affected hand.
• Shortness of breath, pain in the chest and heart area.
• Burning, itching, tingling of the limb.
• Hyperemia of the skin, which is located above the affected area.
• Increased body temperature.
• Muscle weakness.

The listed symptoms are more common than others. They can accompany acute and chronic wrist pain. The exact clinical manifestations depend on the specific pathology that caused the pain syndrome.

Functions and properties

The carpal bones are small movable structures that make it possible to manipulate the hand. This allows you to take and release objects, move them away, bring them closer. If you bend the brush 90 degrees, it is used as a support. This is necessary for some sports and dancing. Support is also required in everyday life.

The wrist helps move the arm or hand in the desired direction, influences the motor activity of the fingers, and provides sudden or smooth movement. At the same time, the wrist corrects movements in the vertical and horizontal planes.

The wrist joint is made up of three bones of the proximal row - with three sides, the lunate and the boat-like one. But the main role is given to the radius. Rotation (including circular rotation) of the hand occurs due to elastic cartilage. All other movements are associated with the midcarpal joint and have an irregular shape.

When is it necessary to see a doctor?

A doctor should be contacted immediately if a person experiences symptoms such as:

• Loss of sensation in fingers.
• Painful sensations persist for several days.
• After putting pressure on the arm, the pain becomes stronger.
• The wrist is deformed.
• Swelling or thickening forms in the affected area.
• The person cannot move the limb.
• The pain gets worse when you move your arm.
• When you try to move the brush, you hear a crunching and squeaking sound.

Treatment

Features of treatment of the initial stage of the disease:

1. The hand is immobilized for 14 days. To do this, apply a splint or splint made of plaster.
2. To relieve pain, use external ointments: diclofenac, voltaren, fastum-gel.
3. For severe pain, nonsteroidal anti-inflammatory medications are needed: movalis, ibuprofen, ketorol, diclofenac.
4. Glucocorticoid injections: hydrocartisone, diprospan, kenalog.
5. It is necessary to apply a cold compress of ice 3-4 times a day. This is usually done in the first few days.
6. Physical therapy will help improve blood flow and metabolism in the problem area. It can be used when there is an acute inflammatory process.

Of the conservative methods of treatment, many physiotherapeutic methods will also be useful:

• electrophoresis using lidase;
• magnetic therapy;
• ultrasound therapy;
• ozokerite;
• laser treatment;
• mud and paraffin compresses;
• massage with special ointments, manual therapy.

Sometimes the disease cannot be detected in the early stages. In severe and advanced cases, when conservative methods do not work, surgery is performed by excision of the problem part.

Full recovery after surgery occurs within 3 months. Athletes can engage in their activities after 3-4 months. To speed up tissue renewal and restoration, you need to actively move the brush. After the operation, you can immediately develop the thumb, and after a few days - the entire hand.

Which doctors should you consult if your wrist hurts?

To find out the cause of wrist pain, you need to contact such specialists as:

• Therapist
• Traumatologist.

  You should visit a doctor after an injury, regardless of its origin. If it is not possible to get to a traumatologist, then you need to go to see a surgeon.

• Orthopedist.

  A doctor is consulted when, in addition to pain in the wrist, a person notices swelling in a characteristic area, and when moving, a creaking and crunching sound is heard. Pain may also occur when moving the thumb and index finger. These symptoms indicate peritendinitis.

• Rheumatologist.

  Symptoms that should force a person to contact this specialist: paroxysmal pain (they can last from several hours to several days), redness in the joint area, local increase in body temperature. When a joint becomes deformed after the end of an attack of pain, gout or pseudogout can be suspected. Other signs may indicate a systemic disease: rashes on the skin and mucous membranes, a burning sensation when emptying the bladder, an increase in body temperature up to 37.5 °C, chills, headaches, weakness, sweating during sleep. These symptoms are also characteristic of infectious arthritis. It can be caused by gonorrhea, tuberculosis, brucellosis.

• Neuropathologist.

  This doctor will provide care to a patient with carpal tunnel syndrome. It often develops in pregnant women and in people who work at a computer. The development of this pathology is indicated by symptoms such as: pain, burning and itching in the wrist, trembling in the fingers (all fingers suffer except the little finger). It is difficult for a person to hold an object in the palm of his hand. The hand may swell, and numbness often occurs in the forearm area. The hand becomes cold and skin sensitivity worsens.

If it is difficult for a person to understand which doctor he needs to see, then first he should visit a therapist.

Types of Arthritis

Depending on the etiology, the following types of disease of the right and left wrist joint are distinguished:

• infectious arthritis
  - is one of the manifestations of such serious diseases as brucellosis, syphilis, tuberculosis, gonorrhea and others;
• nonspecific purulent arthritis
  - develops in situations when the soft tissues surrounding the joint are affected by bacteria brought by blood from other areas of inflammation, for example, from carious lesions, furunculosis, osteomyelitis;
• gouty arthritis
  is one of the consequences of impaired metabolism;
• rheumatoid arthritis of the wrist joint
  is a consequence of autoimmune disorders;
• reactive arthritis
  - a variant of an allergic reaction, for example, to vaccination;
• so-called arthrosis-arthritis
  , combining the symptoms of both diseases.

Diagnostics

After visiting a doctor, the patient will have to undergo diagnostic procedures such as:

• Anamnesis collection.

  The patient must describe the symptoms that bother him as accurately as possible. It is important to clarify the location of the pain, its nature, and area of ​​distribution. If you have previously been injured, you should report this to a specialist.

• Physical
  examination.
  The doctor will examine the affected area, assess the presence of swelling, deformities, hematomas, bone displacement, and inflammation.
• Donating blood for clinical and biochemical analysis.

  This will allow you to assess the severity of inflammation.

• Ultrasound of the joint. This

  The study allows you to diagnose synovitis, arthritis, tendinitis.

• X-ray of the joint.

  With its help, dislocations, fractures, inflammatory processes, synovitis, and carpal syndrome are detected.

• Arthroscopy.

  A microscopic camera is inserted into the joint, as well as instruments to eliminate pathology. This procedure is carried out not only for diagnostic, but also for therapeutic purposes.

• Assessment of electrical activity of nerve trunks

  (electroneurography) and muscles (electromyography).

• CT or MRI.

  These studies make it possible to accurately determine pathological changes in tissues. Using CT and MRI, disorders such as bone necrosis, fractures, arthritis, damage to nerve fibers and soft tissues of the limb, inflammation of tendon sheaths are detected. However, not everyone can undergo an MRI. This examination is not prescribed for patients with a pacemaker, with claustrophobia and pregnant women.

• Scintigraphy.

  A special substance is injected into the tissue. When it accumulates, the doctor examines the affected area using a gamma camera. Scintigraphy makes it possible to diagnose avascular necrosis of bone tissue, arthritis, fractures and synovitis.

• Study of the composition of synovial fluid.

  A special device is inserted into the joint, with the help of which the joint fluid is collected. Then it is examined for pathogenic flora.

How is the disease diagnosed and treated?

If the pain does not go away, you should seek medical help. The doctor will examine the patient, ask about symptoms, evaluate nerve conduction, and prescribe the following tests:

• X-rays, CT scans show the condition of the bones.
• MRI - detects pathologies in soft tissues.
• Arthroscopy - the doctor makes a small incision in the wrist through which a camera is inserted. The image is projected onto the screen, allowing the doctor to assess the condition of the tissues.
• Puncture - the fluid located inside the joint is examined (if osteoarthritis is suspected).

Based on the examination results, the doctor prescribes anti-inflammatory and painkillers. Ointments and antiseptic solutions have a good effect. They penetrate the tissues, relieve inflammation and pain. Surgery may be necessary to eliminate tumors and growths.

Physical therapy will improve blood flow around the wrist, which promotes healing. Exercise therapy will help restore hand mobility during the recovery period.

In a word, take care of your wrist, do not load your hand, and if necessary, immobilize it with a splint or bandage. Change your occupation to an activity that does not require stress on your hand. If this is not possible, take a 10-minute break once an hour while working.

Treatment for wrist pain

A comprehensive therapeutic effect on the body will allow you to achieve a speedy recovery.

Treatment is carried out in the following areas:

• Fixation of the damaged area. The patient may be given a plaster cast, splint, or other fixative.
• Treatment with physiotherapy methods.
• Performing exercise therapy, visiting a massage therapist’s office.
• Taking medications.

Surgery is resorted to in extreme cases.

Drug therapy

There are many drugs that can cope with diseases of the wrist joint. Most of them help against a specific pathology. They should be prescribed by a doctor after he knows the patient’s exact diagnosis.

The main groups of medications that can be used to treat wrist pain:

• Analgesics:

  Ketonal, Ketanov, etc.

• NSAIDs:

  Larfix, Ortofen. They are used in the treatment regimen for arthritis and osteochondrosis.

• Chondroprotectors:

  Artra, Teraflex. They are used to restore the patient's lost range of motion. The drugs can be prescribed either in the form of tablets or ointments.

• Antirheumatic
  drugs:
  Arva, Imuran. They are prescribed in order to prevent dystrophic and degenerative processes in articular tissues.
• Calcium preparations:

  Calcemin. They are prescribed to patients with impaired bone tissue integrity.

• Corticosteroids:

  Prednisolone, Celeston. These drugs are used to relieve pain caused by arthritis and arthrosis.

• Combined drugs.

  This includes Dolobene gel. Its use can reduce tissue swelling, relieve inflammation and pain. You can also use the drug Diclak, which helps reduce body temperature and also has an antirheumatic effect.

Experts prohibit patients from taking any painkillers and anti-inflammatory drugs until a diagnosis is made. Otherwise, it will be difficult to make an accurate diagnosis. If it is impossible to endure the pain, then it is permissible to take a Ketanov tablet and immediately consult a doctor.

Physiotherapy

If the pain in the wrist was caused by an injury, then the doctor may prescribe physiotherapeutic treatment to speed up tissue restoration. These procedures help to enhance nutrition of the affected area, and also enhance the therapeutic effect of the drugs used, for example, ointments or creams. Thanks to physiotherapy, it is possible to remove salt deposits from the joints.

The most prescribed procedures:

• Ultrasound treatment.

  Effects: improved blood and lymph flow, elimination of inflammation, improved permeability of the dermis, effective penetration of ointments and gels into the affected tissues. Thanks to this treatment, recovery is rapid.

• Magnetotherapy.

  Effects: reducing the intensity of the inflammatory process, relieving pain, relieving swelling.

• Electrophoresis.

  This procedure is prescribed for various diseases that are accompanied by inflammatory phenomena.

• Laser treatment. Effects

  : stimulation of metabolic processes, improvement of blood circulation, removal of excess salts, pain relief.

• Applications with paraffin.

  They are prescribed for tendon damage, namely chronic tendinitis.

• Shock wave therapy.

  This procedure is often prescribed to patients who require surgery. Sometimes, thanks to shock wave therapy, surgery can be avoided. This treatment is indicated for patients with trauma.

After completing a full treatment course, a person gets rid of pain. The average number of procedures is six. The duration of one session is 20 minutes. During treatment, you should not engage in sports; it is important to avoid putting stress on the joint.

Physiotherapy

Physical therapy complexes allow you to cope with various joint pathologies. Thanks to well-chosen exercises, it is possible to restore the range of lost movements and strengthen the muscles. Classes must be carried out under medical supervision.

It is important to ensure that the person does not experience pain while performing the exercises. If discomfort occurs, exercise should be stopped. You can perform simple exercises on your own, but they must be recommended by a doctor. You can use a special massage ball. The load on the hand should not be too intense.

Massage

If a person suffers from chronic joint disease, then massage is indicated for him. It promotes normal lymph flow, eliminates pain, and improves tissue nutrition.

Massage can only be performed by a specialist with medical education. If a person has not been trained in professional massage, then it can harm the patient’s health.

Surgical treatment

Surgery is prescribed when conservative methods fail. Sometimes the help of a surgeon is resorted to in order to restore a joint after an injury.

The operation is performed under anesthesia. The altered articular structures are removed, tendon aponeurosis is performed and sutures are applied. Rehabilitation takes up to 3 months. It all depends on the volume and nature of the intervention.

Diet therapy

To keep your joints healthy, you need to include foods rich in vitamin D and calcium in your diet. These include: yogurt, cheese, milk, broccoli, rich green vegetables.

It is beneficial to eat fatty sea fish and nuts, as they are a source of omega-3 fatty acids. During pregnancy, you need to monitor your weight and prevent the formation of edema. To do this, you need to eat right and drink enough water.

Alcoholic drinks are excluded. They negatively affect the condition of joints and bones. Men should not drink more than 2 servings of alcohol per day, and women should not drink more than 1 serving. To reduce the likelihood of developing osteoporosis, you need to give up tobacco. In addition, smoking interferes with normal tissue repair after injury.

Video: Physical Therapy by Jeff Cavaliere. About the causes of wrist pain, hand anatomy and exercises to eliminate pain:

Prevention

To prevent pain in the hands, you must adhere to the following recommendations:

1. Avoid injury to the upper extremities. Before playing sports, you need to warm up well and do not neglect wrist protection during physical activity.
2. Wear mittens or gloves during the cold season. Frequent hypothermia negatively affects the small joints of the hands and can cause the development of arthritis and pain in the hands.
3. Do hand exercises. This is not necessarily a complex of physical therapy. It is enough to make normal rotational movements with your hand and stretch your fingers, hands, and wrist from time to time. Use wrist expanders.
4. Avoid physical overexertion. For example, when working at a computer for a long time, it is recommended to use special pads for your hands, as well as take breaks during monotonous work.
5. Regularly undergo medical examinations and monitor concomitant diseases. Even in the absence of complaints, it is necessary to undergo an examination of the body once a year. Do not wait for complications to develop, but seek medical help at the first symptoms of discomfort.
6. Give up bad habits and eat a balanced diet. Caffeine and cigarettes constrict blood vessels, limiting blood supply to the joint tissues of the extremities. Alcohol increases the risk of developing osteoporosis. A lack of vitamins reduces the body's protective functions.

Following these recommendations does not require much effort and helps maintain mobility of your fingers and hands and overall health. Therapy for any disease in its early stages is easier, and the risk of complications is minimal. With an integrated approach and the support of doctors at the Dr. Bubnovsky Center, you can achieve lasting results in treatment - forget about pain in your hands and restore joint mobility.

Vessels and nerves

The bones, joints, muscles and ligaments of the hands are abundantly supplied with blood . Blood saturates the tissues of the hand with oxygen, ensures high mobility and rapid tissue regeneration.

The ulnar and radial arteries approach from the forearm to the hand , then descend through the wrist joint to the palm and back of the hand, forming deep and superficial arches. On the back side, the vein diverges into four metacarpal arteries, and then each divides into two more digital arteries, which pass through the fingers to the nails. Networks of small capillaries supply blood to the fingers. Abundant branching of blood vessels protects the fingers from excessive blood loss when the hand is injured.

The innervation of the hand occurs thanks to the ulnar, median and radial nerves , which through their mutual action provide motor functions, tactile and pain sensitivity. Many nerve receptors run through the entire hand to the fingertips, contracting and relaxing muscles.

Reference! The nerve endings on the fingers are so sensitive that when the surface layer of the skin is cut with a piece of paper, the receptors react sharply to the entry of air and the person experiences pain more severe than from a cut with a knife.

Damage to the median nerve makes it difficult to flex and extend the hand , and simultaneous injury to the ligaments leads to complete loss of motor function. Compression or injury to the ulnar nerve causes loss of abduction and adduction of the fingers, particularly in the lower palm and little finger. The radial nerve is responsible for sensation in the dorsum of the hand and abduction of the thumb. If the radial nerve is damaged, it is impossible to clench your palm into a fist and unclench your hand.

Muscles

The muscular system of the hand consists of many small muscles that are attached to the bones with the help of tendons and ligaments . The complex work of all muscle fibers ensures precision and coordination of finger movements. Injury to one of the ligaments or muscles entails disruption of the basic functions of the hand.

The musculature of the hand includes three muscle groups:

• middle - lumbrical muscles, palmar and dorsal interosseous muscles. Participate in flexion of the phalanges, adduct and spread the fingers to the sides,
• muscles of the thumb - form the eminence of the thumb on the hand. They are distinguished: abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, and adductor pollicis.
• muscles of the small finger - forms an elevation on the inside of the palm. Palmaris brevis, abductor digiti minimi, flexor pollicis brevis and oppons digiti minimi.