How should I investigate the cause of persistent wrist pain on lifting objects?

This is quite a common presentation of chronic wrist pain which I see in my clinic. Often times, the pain is preceded by one or several bouts of injury. One may or may not recall these episodes as very frequently, the injuries may have been deemed as minor ones or just "a sprain".

However, putting off these injuries is also the most common cause of one developing chronic wrist pain. The wrist is built to withstand forces required to lift, push, pull, twist and hold objects on a daily basis. Pain whilst doing these actions is abnormal, especially when one compares doing the same actions with the normal hand.

One should seek a consultation with a hand & wrist specialist to obtain an accurate diagnosis. Through a detailed clinical examination, the specialist will be able to zoom in on the problem.

Imaging modalities may be required to further investigate the cause of pain. Example of imaging modalities includes:

• X-rays,
• CT scans or
• MRI scans

In my practice, the most common causes of chronic wrist pain which only occurs on exertion are:

1. Sprains or tears of the triangular fibrocartilaginous complex (TFCC)
2. Sprains or tears of the scapholunate ligament
3. Undiagnosed fracture non-union of the scaphoid

In general, once the above conditions have been neglected for extended periods of time and are still symptomatic, surgical intervention to reconstruct and restore normal anatomy of the injured location is indicated. Coupled with immediate post-operative hand occupational therapy, one may then finally be on the road to recovery by regaining strength and function in the limb.

Thank you for your question - it is certainly a common problem that I see in the clinical setting, particularly amongst younger patients.

Broadly speaking, pain in the wrist can be from a structural or functional issue. When I mean "structural", this can be from the bones, joint, ligaments, tendons, nerves or skin that make up the wrist joint. If there has been an anatomical insult/injury to any of these, it can cause pain symptoms. Often, a thorough clinical examination is required to localise the pain and investigations/treatments can be targeted accordingly. In the clinic, I tend to perform MSK ultrasound examinations, particularly as the wrist is quite a superficial area.

When I refer to "functional", this might be due to a relative weakness of a certain muscle groups, it might be from catching of certain structures or compression of others around the wrist joint. Again, a thorough clinical assessment and early investigations might be helpful.

In terms of treatment, this might include rehabilitation with hand therapists, physiotherapists or guided injections - depending on what the problem might be. If it seems like a surgical approach is needed, then an opinion can also be sought to this effect.

Listening to your symptoms, and the duration, it might be more functional. Nevertheless I would recommend being assessed by a hand therapist or a Sports/MSK Physician.

Hope this helps.

BW

Dr Dinesh