The wrist is a complex joint that is made up of eight bones and arranged into two rows with muscles that are shared with the forearm. Being an intricate part of the body that connects with both the forearm and hand, specialized knowledge is required to properly diagnose and treat various conditions and injuries, such as from orthopedic wrist specialists.
What are Orthopedic Wrist Specialists?
An orthopedic physician is a type of doctor who specializes in the musculoskeletal structures in the body, which means the muscles, bones, tissue, and supportive structures in the body. A wrist specialist is a subtype of orthopedic doctors and is usually referred to as an orthopedic hand specialist due to wrist conditions being so tied to the hand.
Common Causes of Wrist Pain: Wrist Conditions
Wrist specialists can diagnose and provide care for a wide range of wrist injuries and conditions, such as:
- Carpal Tunnel Syndrome: Caused by compression of the median nerve as it travels through the carpal tunnel in the wrist. Symptoms include numbness, tingling, and pain in the hand, especially the thumb, index, and middle finger.
- De Quervain's Tenosynovitis: An inflammation of the tendons on the thumb side of the wrist, causing pain and swelling.
- Wrist Tendonitis: Inflammation of the tendons in the wrist, usually due to overuse.
- Wrist Fractures: Such as a distal radius fracture (often referred to as a Colles' fracture) which is a break near the wrist end of the forearm's radius bone.
- Scaphoid Fracture: A break in the small bone on the thumb side of the wrist.
- Wrist Sprain: An injury to the ligaments in the wrist.
- Ganglion Cyst: A fluid-filled lump that forms over a joint or tendon in the wrist.
- Triangular Fibrocartilage Complex (TFCC) Tear: Injury or degeneration of the cartilage and ligaments in the outer part of the wrist.
- Scapholunate Dissociation: A tear or injury to the ligament connecting the scaphoid and lunate bones, two of the small bones in the wrist.
- Wrist Osteoarthritis: Degeneration of the cartilage in the wrist, causing pain and reduced movement.
- Wrist Rheumatoid Arthritis: An autoimmune condition where the lining of the joints becomes inflamed and can lead to joint damage.
- Intersection Syndrome: Inflammation of the tendons of the forearm just above the back of the wrist. It's sometimes called "oarsman's wrist."
- Dupuytren's Contracture: Though it primarily affects the palm and fingers, it can influence wrist movement. It's a thickening and tightening of tissue beneath the skin of the hand.
Common Care and Wrist Surgery Options
An orthopedic wrist doctor can provide both non-surgical care and wrist surgery depending on the type of condition. Unless an injury or condition demands surgery, most doctors will first use conservative methods to try and ease symptoms. Below is a list of common non-surgical treatments that are often recommended before surgery is pursued:
- Rest: Allowing the wrist to heal by avoiding activities that aggravate symptoms.
- Immobilization : Using wrist braces or splints to stabilize the wrist and prevent further injury. This is especially common for fractures, sprains, and tendonitis.
- Ice: Applying cold packs to reduce swelling and pain.
- Compression: Using an elastic bandage to provide support and minimize swelling.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen can help reduce pain and inflammation.
- Steroid Injections: For conditions like carpal tunnel syndrome, de Quervain's tenosynovitis, or wrist osteoarthritis, corticosteroid injections can provide temporary relief from inflammation and pain.
- Physical Therapy: Exercises and modalities designed to strengthen the wrist, improve flexibility, and reduce pain.
- Ergonomic Modifications: For conditions like carpal tunnel syndrome, changing the way you perform repetitive tasks, or modifying your workstation can help alleviate symptoms.
- Activity Modification: Altering or avoiding activities that exacerbate the wrist condition.
- Hand Therapy: Occupational therapists specializing in hand therapy can provide exercises and strategies to improve hand and wrist function.
- Splinting or Bracing: For conditions like carpal tunnel syndrome, wearing a night splint can help alleviate symptoms.
- Pain Relievers: Over-the-counter pain relievers, such as acetaminophen, can help manage pain.
- Topical Analgesics: Creams, gels, or patches that can be applied to the skin over the painful area for relief.
- Platelet-rich plasma (PRP) injections: Though more research is needed, some studies suggest PRP might benefit certain wrist conditions by promoting healing.
Types of Surgery
When non-surgical treatments fail to ease symptoms or resolve the issue, a patient may be recommended to orthopedic surgeons if their wrist doctor isn’t qualified to perform surgery themself. Depending on the condition diagnosed, the following procedures could be performed:
To relieve pressure on the median nerve, the surgeon cuts the transverse carpal ligament. It’s the standard procedure for carpal tunnel syndrome.
A minimally invasive procedure using a small camera (arthroscope) to diagnose and treat various conditions, such as ligament tears or inflammation.
Fusing the bones of the wrist together to eliminate pain, usually performed for severe arthritis.
Replacing a damaged wrist joint with an artificial joint.
Used for certain wrist fractures where the bones are repositioned (reduced) and then secured in place using plates, screws, or pins.
Specifically addresses fractures of the scaphoid bone, one of the carpal bones in the wrist. Depending on the fracture type and location, this might involve screws or pins.
Surgery to alleviate the tightness of the sheath or tunnel that surrounds two tendons in the wrist, relieving the pain.
Surgery to address tears in the TFCC, which acts as a cushion and support between the small bones in the wrist.
Surgical removal of a ganglion cyst, a fluid-filled sac that can develop near a joint or tendon in the wrist.
Addressing torn ligaments in the wrist, such as the scapholunate ligament.
Removal of the first row of carpal bones to treat arthritis or certain types of wrist injuries.
Surgical intervention to repair torn or damaged tendons in the wrist.
A procedure to shorten the ulna bone to relieve pressure on the wrist, usually only used for ulnar impaction syndrome.