When Should You Worry About Wrist Pain?

Wrist pain is the great equalizer. Whether we're construction or agricultural workers or office dwellers clicking away on a mouse, most of us work with our hands. But few of us probably think about the vast range of precise, powerful and delicate hand movements our wrists enable us to make until pain strikes there.

The truth is, wrist pain — typically the result of either injury or constant use that quietly stresses — can upend both work and play. To find out more about what causes it and what to do about it, we spoke with Dr. Chia Wu, an orthopedic hand surgeon at Houston Methodist.

The most common causes of wrist pain

Dr. Wu says that most wrist pain falls into two broad buckets: traumatic and degenerative/overuse.

"The first category is pain from trauma, usually from accidents or falls, that oftentimes will result in a torn ligament, wrist sprain or broken bone," Dr. Wu says. "Category number two is what I call degenerative or overuse, so that usually has more to do with repetitive tasks, and as a result, can end up with inflammation."

Two of the most common overuse wrist injuries are De Quervain tenosynovitis and triangular fibrocartilage complex (TFCC) injury.

"The most common source of pain on the thumb side of the wrist is De Quervain tenosynovitis, where the tendon attaching the thumb is inflamed," Dr. Wu says. "You can also get pain on the pinky side of the wrist, and that usually is from a small structure called the TFCC. I usually see TFCC tears more in athletic populations than office workers, but you certainly can get both, and there is overlap."

Dr. Wu says that sometimes orthopedic symptoms such as wrist pain can signal underlying, systemic disease. In the early stages of rheumatoid arthritis (RA), pain will usually first appear in the small bones of the hands and wrists on both sides of the body. RA is most commonly diagnosed in middle age.

"I think there is a tendency for people to say, 'Oh, it's just aches and pains,'" Dr. Wu says. "But I would say, if it persists for more than a week or two, you should probably come into be seen, because a lot of times it could be manifestation of underlying disease. Intervention earlier on in the disease process could also be more effective."

Who is most at-risk for wrist pain?

While we're all at-risk for collecting joint pain with each passing birthday, some of us are more at-risk for wrist pain.

"Office professionals develop pain from typing on a computer, which can be a side effect of poor ergonomics. They are more at risk for tendon inflammation," Dr. Wu says. "Professionals in trades like construction, pluming or oil-field work are more likely to develop arthritis because of force applied on their joints day after day, year after year, through work."

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Athletes can be at risk, as well. It used to be that young adults would play sports seasonally. Now athletes specialize in a single sport year-round, raising the risk of overuse injuries in the wrist at younger ages.

"It doesn't give the muscles and joints as much time to rest, because you're performing the same action and loading the same structures over and over again," Dr. Wu says. "I do think it that has led to increasing wrist injuries in athletes, more so than I used to see even just 10 years ago."

I have wrist pain. What should I do?

First things first: Is your pain the result of an accident or specific injury, such as a fall, cut or burn? If so, get care as soon as you can. But if you can't pinpoint the cause of your pain, and it is non-specific, Dr. Wu says it's reasonable to try at-home treatments to see if the pain subsides and improves.

"If the pain is very specific, especially after a specific episode or injury, come in right away," Dr. Wu says. "If it's more general pain without trauma, try a brace and over‑the‑counter medication for a week or two. If it doesn't get better, it makes sense to come in."

To evaluate wrist pain, doctors will conduct a careful history and physical exam, followed by X‑rays in the office when needed. Depending on what's suspected, your doctor may order advanced imaging (such as a CT or MRI) to see bones, cartilage and soft tissues in more detail. If nerve involvement is likely, you may be referred for a nerve conduction study (often called a "nerve test") to measure how well signals travel through the nerves to assess their function. These steps help distinguish inflammation from tears and guide the least invasive treatment.

Wrist pain treatments

Treatment plans for wrist pain will vary depending on the cause and diagnosis. For many, over-the-counter options and minimally invasive medicines can offer relief, but Dr. Wu emphasizes chronic pain or significant injuries may require surgery.

Activity modification and rest

Activity modification and rest may be required to fully heal from injury or lessen chronic wrist pain. This can mean adjusting how you perform tasks with repetitive motions, switching hands to perform tasks when possible, or sharing the load with coworkers or family to reduce repetitive stress.

"As far as overuse is concerned, by changing your posture, changing the way you perform certain aggravating activities, perhaps with a tool or using the other hand, or even asking for your coworkers help is enough to mitigate this, especially for mild or even some moderate versions of tendinitis," Dr. Wu says. "It is best to be thoughtful about how to design your work to the extent that your employers are willing to work with you."

Topical anti-inflammatory gel

A topical over-the-counter gel can relieve pain almost immediately. Dr. Wu often recommends applying diclofenac (Voltaren) gel to the painful area.

"The hands and wrists are basically skin on bone," Dr. Wu says. "Topical ointments can be particularly effective with the wrist because medication doesn't have to penetrate very deep for it to reach the intended target."

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Over-the-counter painkillers such as ibuprofen or naproxen (a group of medicines called nonsteroidal anti-inflammatory drugs or NSAIDs) can also help with wrist pain. Talk with your doctor about using anti-inflammatory medications if you are on a blood thinner or have kidney, liver or gastrointestinal issues.

Always follow label directions, especially the "not to exceed" and duration instructions, since these medicines shouldn't be taken for chronic pain. Using NSAIDs long-term can lead to impaired kidney function, gastritis and gastrointestinal bleeding.

Dr. Wu emphasizes that NSAIDs are not a long-term solution to wrist pain. If your pain doesn't resolve in a few weeks, talk to your doctor.

Bracing

Keeping the wrist straight and stable with a brace can support the joint while inflammation settles. Wrist braces are available at most pharmacies and even grocery stores. If you're a person who experiences off-and-on pain in both wrists, there are adjustable wrist braces that can be worn on either the left or right wrist.

Injections

Corticosteroid injections can offer quick relief to jumpstart recovery for certain wrist conditions and buy time without surgery.

"I generally have a low threshold to offer injections, because that's something that works fairly quickly," Dr. Wu says. "It typically gives quick relief without having to redesign patients' entire lives around the injury, though it does involve a needle stick."

Surgery

If nonoperative options don't provide enough relief — or the demands of your sport or job make change unrealistic — surgery may be appropriate.

That decision is personal and depends on your stage of life, your support system at home or work and how strongly the wrist issue interferes with what matters to you.

"It's hard to do a one-size-fits-all approach," Dr. Wu says. "I could have one patient who says, 'It only hurts when I play golf,' and stopping golf was all that was needed, and that problem goes away. The other person will say, 'This is my passion; I don't want to change my life. I want to keep playing.' Then it may make sense to invest in surgery so they can continue living their life how they want to."

Managing wrist pain can require some introspection, according to Dr. Wu. For some, their identity may be tied to their hands through work or hobbies — surgeons, woodworkers, concert pianists, baseball pitchers and many others — which can make it extremely distressing when confronted with limitations such as pain.

"The tendency most of us have is that we take our hands for granted. Whatever you want to do with your hands, often you just do," Dr. Wu says. "There is a psychological aspect to it as well, because you might have to ask for more help at home or work and that can be incredibly hard for some emotionally. I think if you are able to do that, treatment will be easier."