How do I get rid of wrist discomfort that had no preceding trigger?
Hi, I'm a 22 year old male. For the last few days, I have experienced a gradual onset of discomfort and tightness in the area of my left wrist closer to the thumb. The range of motion of my left thumb is also affected due to the tightness. There was no obvious trigger, although I do take part in resistance training. TCM treatment has not helped. Looking forward to receiving some advice, thanks!
Thanks for reaching out about your wrist pain. Certainly wrist pain is very common and as Dr Sean mentions De Quervain's tenosynovitis can cause considerable pain.
I have seen it in patients from different walks of life and it can be precipitated by playing badminton, using the computer or even lifting up babies!
There are of course other causes of joint pain that can come on insidiously, such as inflammatory conditions (e.g. gout or arthritis) , stress fractures (with repetitive forces), tendon anthologies or even degenerative changes.
Firstly you could try:
1. Splinting to offload the wrist
4. Activity assessment/modification
If these fail, as Dr Sean mentions, you could see a surgeon for assessment and further investigation is certainly an option. Other options include consulting:
1. A physiotherapist for assessment and functional interventions
2. A Sports/MSK physician for assessment, ultrasound scanning (very useful for superficial areas such as wrists) functional treatments and guided treatments if required.
3. A Hand therapist for assessment, splinting and functional interventions
I hope this adds to what you have perhaps looked into yourself.
There can be several causes of wrist discomfort, including joint, tendon, or ligament problems. If there is no preceeding trigger ( ie. I would presume trauma/ fall/ extreme heavy laods), it would unlikely be a fracture. Pain on the thumb side of the wrist, commonly can be due to a tendon overuse problem, eg De Quervains tenosynovitis.
If the discomfort is persistent and not going away, it would be important for you to seek a consultation with an orthopaedic surgeon. A thorough examination of your hand/ wrist and forearm would need to be done. Radiological investigations may also be potentially warranted. Once the cause of the problem is identified, then we can proceed to treat it. I hope this has been useful.
Dr Sean Ng
Thank you for your email. From your description, it's likely that you are suffering from DeQuervain's tenosynovitis (aka texting thumb), basically it's due to the excessive usage of the thumb (likely from texting!) that is now causing some inflammation in the tendon sheath. (you can try rubbing your palms together forcefully for 1000 times, then you will know how the inflammation feels like).
Of course, there are many other causes of wrists pain that we need to exclude, for example:
1. Fracture of the carpal bones/ distal radius
2. Ligaments tears in the wrists
3. Ganglion/ any other abnormal growth
4. Impingment syndrome
I'd suggest you seek treatment from Orthopaedic Surgeons/ Hand Surgeons, we will take a detailed clinical history, physical examination and imaging (X rays/ MRI) to fully evaluate the cause of your symptoms.
Usually we will treat DeQuervain's tenosynovitis conservatively first - which includes anti-inflammatory medication, protective splint, hand therapy. Only for those severe/ persistent pain, that the patients may benefit from anti-inflammatory injection/ surgery.
I hope it clears some doubt for you.
Dr. Henry Chan