How do I get rid of wrist discomfort that had no preceding trigger?

Doctor's Answers 4

Photo of Dr Aaron Gan
Dr Aaron Gan

Hand Surgeon

The area of the wrist closer to the thumb is called the radial side of the wrist. Pain in this area is termed "radial-sided wrist pain". This is in contrast to the opposite side of the wrist (nearer the little finger side) called the ulnar side of the wrist. Pain in this area is called ulnar-sided wrist pain.

The common causes of radial-sided wrist pain include:

  1. Osteoarthritis of the 1st carpometacarpal joint (thumb basal joint osteoarthritis)
  2. Fractures or fracture non-union of the scaphoid bone
  3. Radial styloiditis or DeQuervain's tendovaginitis
  4. Intersection syndrome (synovitis of the tendons due to repetitive friction between the tendons of the 1st and 2nd dorsal compartments of the wrist

The most common of the above in a young person is DeQuervain's tendovaginitis. In fact, this is also extremely common in new mothers who are nursing an infant. In these cases, this condition is commonly known as "mummy's wrist".

DeQuervain's tendovaginitis is a condition where the thin synovium (covering) of the tendons at the radial side of the wrist (the abductor pollicis longus and extensor pollicis brevis tendons) become swollen and painful. These tendons run within a fitting tunnel called the 1st extensor compartment.

As these tendons become swollen and enlarged, they start causing additional friction against the walls and the edge of this tunnel. This starts a vicious cycle - the now enlarged tendon girth rubs against the tight tunnel walls and this further encourages more swelling and inflammation due to the friction and irritation of the tendon synovium.

This is why the pain always seems to worsen rather than improve with more movement and motion when one tries to "stretch" or "mobilise" the wrist to "loosen the tightness".Treatment Options for Dequervain's Tendovaginitis

Splint and NSAIDS

The first line of treatment is actually the opposite of this. Immobilisation and rest is the initial treatment for early DeQuervain's tendovaginitis. The aim of this is to:

  • break the cycle of repetitive friction and
  • inflammation by resting the tendon.

This allows the body to heal the inflammation naturally. A long thumb spica splint (not a common wrist brace) is the correct implementation to help with thumb and radial wrist immobilisation. A custom-moulded thumb spica splint can be obtained from a trained hand occupational therapist at a hand & wrist surgeon's clinic. Furthermore, oral non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to accelerate the resolution of inflammation and pain.

Corticosteroid Injections

The second line of treatment is corticosteroid injections, also known as H&L (Hydrocortisone & Lignocaine) injections. This injection contains a mixture of a corticosteroid (a very potent anti-inflammatory agent) and xylocaine or lignocaine (a local anaesthetic agent).

A hand & wrist surgeon will be the best person to administer this injection as accurate delivery of the medication mixture into the 1st extensor compartment (containing the inflamed tendons) is key to the success of this procedure. The proper administration of this injection will also reduce the likelihood of adverse effects of such an injection such as:

  • infection,
  • skin hypopigmentation,
  • skin and fat atrophy.

In about 50% of patients who receive this injection, the condition is resolved and does not recur. In the other 50%, however, the condition recurs and repeat treatment is required. The recommendation is no more than 2 injections given to a specific site. If the condition recurs again after 2 injections, surgical intervention is indicated.

Surgery

Surgery for DeQuervain's tendovaginitis involves:

  1. releasing the 1st extensor compartment,
  2. removing all the inflammatory tissue and inflamed synovium surrounding the affected tendons and
  3. reconstruction of the extensor retinaculum by repairing the incised retinaculum with a Z-plasty closure.

This last procedure prevents subluxation, or clicking, of the tendons after release. This operation can be done under local anaesthesia or moderate sedation and is performed as a Day Surgery procedure. Post-operative discomfort usually lasts for about 1 week, after which the surgical wound, which is also usually sutured with absorbable and subcuticular sutures, would have completely healed.

Simple tasks such as typing and texting on the mobile phone can be commenced on the first day after surgery. All discomfort will resolve within a month. This condition rarely recurs after surgery.

In my professional experience, patients do very well with the above 3 options. One can consider seeking effective treatment from a hand & wrist specialist.

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

2. Anti-inflammatories

3. Icing

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.

BW
Dr Dinesh

Photo of Dr Sean Ng
Dr Sean Ng

Orthopaedic Surgeon

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.

Best regards,

Dr Sean Ng

Photo of Dr Henry Chan
Dr Henry Chan

Orthopaedic Surgeon

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.

Cheers,

Dr. Henry Chan

Similar Questions

TCM

Is TCM a good form of medical treatment?

It would be useful (as Dr Israr as suggested) to get an MRI done, come to a diagnosis before continuing treatment. TCM by itself is not particularly cheap and a clear-cut diagnosis and management plan suggested by the orthopedics would avail you much less angst.

Photo of Dr Winston  Lee

Answered By

Dr Winston Lee

Aesthetic

What should I do next if my wrist has not recovered completely after a fall?

A Fall On an OutStretched Hand (FOOSH) can cause significant injury to the wrist. These injuries can cause radial-sided (the side nearer the thumb) and/or ulnar-sided (the side nearer the little finger) wrist pain.

Photo of Dr Aaron Gan

Answered By

Dr Aaron Gan

Hand Surgeon

Ask any health question for free

I’m not so sure about a procedure...

Ask Icon Ask a Question

Join Human

Sign up now for a free Human account to get answers from specialists in Singapore.

Sign Up

Get The Pill

Be healthier with our Bite-sized health news straight in your inbox