Wrist Pain

WHEN TO SEE YOUR DOCTOR

* Significant wrist pain persists for more than a day.

* There is also weakness or numbness in the hand.

* You've had an accident recently, your wrist looks deformed and you're unable to move it.

* You also hear clicking, popping or grinding noises.

What Your Symptom Is Telling You

You're the neighborhood seamstress, the one person everyone thinks of when they need bridesmaid's dresses. You can do wonders concealing everyone's worst faults—wide hips, big tummy, skinny legs and all.

But lately, you're having trouble concealing one of your own anatomical sore points. It's your aching wrist, accompanied by pins and needles—figuratively speaking, of course—in your fingers. After a day of pinking away at eight bridesmaid's dresses, your wrist and hand feel almost divorced from the rest of your arm.

Inside your wrist is a small compartment, a framework of bone and ligament called the carpal tunnel. The median nerve and tendons pass through this narrow passageway on the way to your hands and fingers. If the tendons of your wrist are abused in any way, perhaps through repeated forceful movements—like bending and twisting as you scissor through a diaphanous mass of tulle—they can become irritated and inflamed, and swell up. In time, the tendons start to close in on the nerve, and before you know it, you feel a tingling, followed by decreased sensation and then numbness in your thumb, index and long fingers. You can lose coordination and strength and may even feel discomfort. This injury is called carpal tunnel syndrome, and it is the bane of anyone who uses their hands to perform the same motion over and over again.

This feeling of pins and needles, often accompanied by pain, is a dead giveaway. "You decide how hard you're gripping something by the pressure you sense in your fingers," explains Scott Barnhart, M.D., director of the Occupational Medicine Clinic at Harborview Medical Center in Seattle. "So if you lose that sensation, your perception may be that you aren't able to grab things as tightly."

Another clue might come your way in the dead of the night. You may be awakened by tingling and burning in your hand. Inflamed tendons retain fluid and can cause nocturnal discomfort. During sleep, when your arm is relaxed, the fluid has difficulty circulating properly and builds up pressure in the area, says Steven Bogard, lead physical therapist for the Mayo Clinic Hand Center in Rochester, Minnesota. "Once awake, if people shake their hands, it feels better," he says. "This relieves the built-up fluid pressure and thus the associated aching sensations." Your wrist is vulnerable to this kind of injury from overuse, but water retention during pregnancy can also cause swollen tissues and carpal tunnel syndrome, Bogard says.

Injuries such as dislocations or broken bones can also cause wrist pain. In fact, it's even possible to break your wrist and not know it at first. The pain and throbbing only later become noticeable, and you may also notice a clicking or grinding sound coming from the joint.

Symptom Relief

Barring serious injury—which, of course, your doctor should tend to immediately—here's how to get a handle on wrist pain.

Do no further harm. Protecting your wrist from further damage is often the first step in healing it. So if you're pretty sure why your wrist is starting to hurt—for example, you've been tapping away at the computer keyboard on an all-nighter—ease up. If you can't stop completely—for example, if typing is your job—some physicians recommend that you alternate the typing with your other work duties. Modify your work habits, if you can. Take frequent breaks, and try to keep your hands and wrists in a straight line, not bent up or down. The doctor may prescribe splints as a gentle reminder, though many people only wear them at night.

Chill out. Using an ice pack on the pain may be helpful, says Bogard. Apply mineral oil to the skin where the pack will be placed. Put a damp towel over the oil and place the ice pack on the towel. Cover the pack with added towels for insulation. Leave the pack in place for 10 to 20 minutes, he advises. Check your skin every 5 to 10 minutes. If the skin turns white or blue (which would indicate a potential for frostbite), remove the ice pack immediately.

Take your shots. In more painful cases, the doctor may inject cortisone directly into the carpal canal to reduce the pain and swelling.

Search for the source. To tell exactly where the injury has occurred and whether there is any nerve damage, your doctor may recommend a procedure called an electromyelogram (EMG). During this test your physician will measure the condition of your muscles in the injured area by inserting needles with electrodes into the muscles and reading the electrical signals. This helps to locate where the nerve is injured and the extent of the damage. This isn't necessary for everybody, but it may be called for if the location of your injury isn't readily apparent.

Consider surgery, when necessary. In more serious carpal tunnel syndrome cases, surgery may be required to relieve the pressure against the nerve and blood vessels. This is outpatient surgery—you're in and out in a day. It usually requires only a local anesthetic, says David Rempel, M.D., an assistant professor of medicine at the University of California, San Francisco, and a biomedical engineer. "The doctor makes an incision into the wrist and palm, and cuts the tight ligament or band that forms the 'roof' of the carpal tunnel. That releases pressure," says Dr. Rempel. "A second version of that surgery is performed with an endoscope—a tube about the thickness of your little finger. A small incision is made in the wrist or palm, and a tiny knife, like a switchblade at the end of the tube, can cut the ligament from inside your wrist. This surgery is surprisingly effective at relieving the symptoms."

See also Joint Inflammation; Joint Pain