“The times they are a changin'”
Wrist pain is a very common problem and the symptoms generally seem to occur on one side of the wrist or the other. In a previous blog I talked about pain on the ulnar side of the wrist, which is the side towards the little finger. In this post I want to discuss pain on the radial side of the wrist which is the side that the thumb is on.
When the doctor listens to the patient describe pain we ask questions to try and pinpoint the source. For instance, if your hand and wrist hurt and this is associated with numbness and tingling in the fingers, and the hand going asleep during activity and waking you up at night with numbness, then the most common cause is carpal tunnel syndrome, which I have discussed in other posts. If the pain is associated with use and activity, then a diagnosis such as arthritis or tendonitis is more common.
On the radial side of the wrist there are specific areas of pain associated with specific areas of arthritis and tendonitis. Since the thumb is so mobile and active, there are problems that actually both people most when they use their thumbs which are actually caused by issues at the wrist. I’ll try to discuss these one at a time.
If the pain doesn’t seem to be affected by thumb movement then by far the most common cause of radial sided wrist pain is arthritis. The wrist consists of eight different bones that connect with each other, and arthritis can occur in very specific areas. The scaphoid bone sits on the radial side of the wrist and this is where the majority of wrist arthritis occurs. The scaphoid can wear out at either end of the bone. What happens is that ligaments stretch out and the cause the scaphoid to move outside of it’s normal range. Over time this can cause the lining of the bone, or cartilage, to wear out. Usually the first problem people have is that their wrist aches and the pain seems to get a little worse with activity. Initially avoiding the aggravating activities and taking over the counter non-steroidals such as Alleve or Advil can take care of the problem. If the arthritis worsens the wrist can start getting stiff and more painful. Cortisone injections can help relieve the pain and sometimes improve wrist motion, at least for a period of time. In some people the pain and stiffness get so severe that surgery is needed. Unlike other joints such as the hip, knee and shoulder, where replacing the joint can be done very successfully, there is no real joint replacement for the wrist. The surgery we usually recommend involves taking out the scaphoid, and either taking out a couple of other bones in the wrist or partially fusing some of the other wrist bones together. These procedures are good at decreasing pain but patients usually only get about 50-60% of their wrist motion and their wrists are never quite as strong as a normal wrist.
Sometimes we find that that the scaphoid bone has broken and has never healed. The injury can be something that happened quite some time ago and never bothered the patient too much. The scaphoid, however, doesn’t have a very good blood supply and often won’t heal if the break wasn’t noticed or treated. This can lead to pain and discomfort in the wrist that usually requires surgery. I’ll discuss scaphoid fracture surgery in another post since that’s a pretty intense and complicated topic.
The other most common cause of radial sided wrist pain is known as DeQuervain’s tendonitis. I’ve discussed DeQuervain’s in another post so you can look back at that post for a more detailed discussion. The main thing that helps the doctor distinguish Dequervain’s from arthritis is that more pain occurs with movement of the thumb rather than the wrist but the pain is still located on the radial side of the wrist. A lot of patients have swelling and some have a popping sensation with thumb movement. The treatment usually involves rest and splinting. Alleve and Advil can help, but some patients need either a cortisone injection or surgery if the problem gets bad enough.
The good news for patients is that most of the problems that cause pain on the radial side of the wrist can be helped and managed with simple treatments such as splinting and over the counter medications. Cortisone shots and surgery can be used when the problems get so bad that they affect the things you do every day.