The wrist is an unusual joint because stiffness or even fusion causes relatively little difficulty, while if it is wobbly and unstable there can't be real problems. The wrist provides the platform from which the fine motions of the fingers operate. It is essential that this platform be stable. The eight wrist bones form a rather crude joint that is very limited in motion compared with, for example, the shoulder, but which is strong, and stable. Almost no regular human activities require the wrist to be bent all the way back or all the way forward, and the fingers don't operate as well as when the wrist is fully flexed or fully extended.
The wrist platform works best when the wrist is bent upward just a little. When the wrist is in proper position, you can pull or push most efficiently. To illustrate this position, make a fist and put your thumb in the middle of the wrist. Looking down your arm, the thumb should be on an imaginary horizontal line going straight down the middle of your forearm.
The wrist is very frequently involved in rheumatoid arthritis, and the side of the wrist by the thumb is very commonly involved in osteoarthritis.
The "carpal tunnel syndrome" can cause pain at the wrist. In this syndrome, the median nerve is trapped and squeezed as it passes through the fibrous carpal tunnel in the front of the wrist. Usually the squeezing results from too much inflammatory tissue. The cause can be tennis playing, a blow to the front of the wrist, canoe paddling, rheumatoid arthritis, or many other activities that repeatedly flex and extend the wrist. In addition to wrist pain, this syndrome can cause pains to shoot down into the fingers or up into the forearm; usually there is a numb feeling in the fingers, as if they were asleep.
You can diagnose this syndrome pretty well yourself. The numbness in the fingers will not involve the little finger and often will not involve the half of the ring finger nearest the little finger. If you tap with a finger on the front of the wrist, you may get a sudden tingling in the fingers similar to the feeling of hitting your funny bone. Tingling and pain in the carpal tunnel syndrome may be worse at right or when the wrists are bent down.
The key to management of wrist pain is splinting. Since stability is essential and loss of motion is not as serious in the wrist as in other joints, the treatment strategy is a little different. Exercises to stretch the joint are not very important. The strategy is to rest the joint in the position of best function. Wrist splints are available at hospital supply stores and some drugstores. Any that fit you are probably all right. The splint will be of plastic or aluminum and the hand rest will cock your wrist back just a bit. You can put a cloth sleeve around the splint to make it more comfortable against your skin and wrap the splint on your arm gently with an elastic bandage to keep it in place. That's all there is to it. Wear it all the time for a few days, then just at night for a few weeks. This simple treatment is all that is required for most wrist flare-ups. Even the carpal tunnel syndrome is initially treated by splinting. But since nerve damage is potentially serious, give your doctor a call if you seem to have the carpal tunnel syndrome.
No major pain medication should be necessary. Aspirin and similar-strength medications are all right but probably won't help very much. If you are taking a prescribed anti-inflammatory drug be certain that you are taking it just as directed; sometimes a flare-up is simply due to inadequate medication. If you know what triggered the pain, work out a way to avoid that activity. Common sense means listen to the pain message.
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