Doctari wrote:
As practicing Sports Physician, I always teach my athletes the following dictum:
Pain is just a symptom - it is not a disease. If you treat pain only, you are not modifying the underlying pathology. To treat pain successfully, you must investigate the cause....
Now, looking at the question asked for advise here, not enough information is provided. How old is this person, as osteo-degenerative disease (commonly given the misnomer of "Arthritis") is very uncommon in ages less than 30 years. It is only seen in this age group, if it is the result of a disastrous joint injury where cartilage is ripped off the joint surfaces.
Was there any acute trauma in this case, as that may indicate a possible missed scaphoid fracture, scapholunate dissociation, rupture of the triangular fibrocartilage complex or lunate subluxation. These all cause immediate pain and discomfort following the singular traumatic incident. If one extends the thumb to the widest open-hand position, two tendons will pop up on the thumb side over the wrist area - this is called the radial or anatomical snuffbox. The scaphoid bone of the wrist looks like a raw peanut in its shell still - two balls attached to a thinner neck area. This area easily fractures during a fall. The scaphoid bone sits in the bottom of the anatomical snuffbox. Pressure onto this area will illicit pain if the pathology is of scaphoid origin. Sometimes the small ligament between the scaphoid and lunate bones can tear - this leads to instability and when the wrist joint is bent, the lunate pops up, just to slip back again when the wrist is back in neutral position. The triangular fibrocartilage sits on the articular surface of the radius and ulnar bones (the two wide bones of the fore arm at the wrist joint). Sometimes this can tear, leading to instability and pain.
These conditions are usually easily identified - nothing was wrong, something happened, and suddenly all hell of pain breaks loose.....
The other conditions are the slower onset ones, usually to small chronic incidents of trauma, or as we call them "overuse injuries". The most common of these is the de Quervain's tenosynovitis (which in this case I expect to be the cullprit of the complainant's pain). It is the chronic inflammation of those two tendons I described above, forming the edges of the snuffbox. Put the thumb into bent position so that it touches the palm of your hand as far as possible - hold the thumb in that position with your other hand. Now bend the wrist joint as far as possible over to the side of your small finger - if this causes discomfort and pain, the Finkelstein test is positive and you have de Quervain's. This is treated with cortisone injection into the tendon sheaths and this should be done by orthopaedic specialist or sports physician. The other common cause of pain in that area, is what is called Intersection Syndrome. This is a bursitis (inflammation of small fluid-filled pouch) between two common tendons that cross over each other on the thumb side of the wrist. This is common in rowers and for that reason is called the 'oarsmen's wrist'. Another condition which I sometimes see in weightlifters, is a type of impingement syndrome. It is called Scaphoid Impaction Syndrome and is caused when heavy weights are pressed upwards whilst the wrist is bent backwards - such as in bench press. The scaphoid bone then physically presses with great force into the surface of the radius on the thumb side of the wrist. Another cause of pain in this area, can come from small ganglions that develop - these are small fluid-filled "pockets" which develop in thinned-out areas of the joint capsule. The joint fluid (synovia) then thickens to a jelly-like substance and extends into the thinner part of the capsule, blowing out like a small balloon. These are very commonly seen in body builders and similar sports, and develop due to the very high hydraulic pressures placed on the synovia inside the joint capsule.
As far as gout is concerned, this usually starts with the primary (first) attack in the toes, mostly the second toe. The joint becomes warm, red and swollen up - highly irritated and severely painful. Gout can attack any joint - IF that joint has pathology in it due to degenerative disease. Through my 20 years in practice, I still have to cross someone having an acute gout attack of the wrist joint.
So, just to summarize:
There are many causes of pain in the wrist joint. I have only discussed the most common ones - there are a number of other conditions, including nerve conditions and other impingement syndromes (like carpal tunnel syndrome, for instance) that can directly or indirectly through referred pain syndromes, cause pain and discomfort.
My advice in this particular case would be the following:
First obtain simple set of wrist joint X-rays, including stress views. This will indicate whether there is bony pathology, or subluxating/dislocating carpal bones.
If the X-rays are normal, have a sports physician look at the tendinous structures of the wrist. If this examination reveals nothing, consider a bone scan to exclude possible stress fractures surrounding the site of pain.
In the meantime, rest the wrist properly, apply ice compressions for 10-15 minute per session 2-3 times per day, and consider obtaining a semi-rigid wrist splint.
Kind Sir, your problem is probably being caused by some type of over-use injury.
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