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The wrist is a complex structure, composed of eight small bones in two rows, between the bones in the forearm and the bones in the hand. Bands of ligaments connect the wrist bones to each other, and to the forearm and hand bones. Tendons attach the muscles to the bones. Diagram of components of the wrist

There are many conditions which can give rise to pain in the wrist. These include injury, a long term condition such as arthritis, carpel tunnel syndrome, tendonitis, tenosynovitis, repetitive stress, from playing a musical instrument for example, or gout. An injury may result in strain or sprain, or more seriously, a fracture. Typically, a fractured wrist would be painful, swollen with possibly misaligned bones. If a fracture is suspected, advice should be sought at the A & E Department at hospital. Minor strains and sprains will often resolve with rest, ice and/or the application of heat.

Carpel Tunnel Syndrome occurs when the median nerve becomes pinched. It is one of three major nerves which run down the forearm. There is a narrow passage running through the wrist made of small bones and a tough band of tissue which levers the tendons which bend the fingers. The nerve can become compressed as it passes through the passage. It runs on the palm side of the hand, and the condition can give rise to symptoms in the thumb, index finger, middle finger and part of the ring finger. One or both hands may be affected. The excessive pressure being put upon the nerve can result in pain (usually a dull ache), swelling, numbness, tingling and weakness on the thumb side of the hand. Causes include repetitive hand movements, such as typing, being overweight, a family history pregnancy, menopause, and conditions such as diabetes, arthritis or an underactive thyroid. More women than men are known to suffer from the condition.

Diagram showing compression of the median nerve

Tendonitis is a condition when the tendons become inflamed, giving symptoms of pain and tenderness. Several tendons pass between the hand and forearm through the wrist. They allow the muscles of the forearm to flex, extend and move from side to side. If the hand is used without proper muscle coordination, the muscles and tendons are over worked. The body’s repair systems are unable to keep pace and inflammation is the result. Swelling occurs between the tendon and the synovium which covers it. As the wrist tapers, there is very little space for fluid to escape. As a consequence, it builds up, making wrist movements painful and stiff. Tenosynovitis is a relatively rare condition, when inflammation and pain arises in the sheath that surrounds the tendon. It may be caused by repeated small tears which lead to pain and a reduction in strength and movement.

Arthritis is a common condition which involves wrist pain, and is characterised by swelling and stiffness in the joints. It arises from wear and tear, aging or overworking of joints. Symptoms can include swollen fingers, numbness or pins and needles, pain which is often worse at night, and swelling, redness and heat around joints. Treating arthritis with acupuncture results in changing the pain sensation which is sent from the tissues to the brain. It also stimulates the release of the pain- relieving hormones endorphins and encephalin. Physiotherapy would help sufferers manage their condition, and provide advice and support. Goals would be set, and therapy designed to relieve pain by appropriate use of therapies such as exercise, TENS (Transcutaneous electrical nerve stimulation), use of splints and taping, manipulation and massage. Massage therapy would help to move the muscles and soft tissues to reduce muscle tension and increase the circulation of blood and lymph. It also helps to reduce the associated anxiety and stress associated with dealing with a long-term painful condition.

Photo of arthritic wrist and hand

If the tendons and sheath on the thumb side of the wrist swell, the condition is known as Dequervains disease. As part of their condition, diabetes sufferers can experience a reduced blood flow and suffer nerve damage in the wrist. Lupus is an auto- immune condition which affects the joints and sufferers can have associated pain. Gout can result in wrist pain amongst other joints. There is a build -up of uric acid which is deposited in the joints.

Acupuncture can help with wrist pain. A consultation will be aimed at finding the root cause for the pain and addressing it as well as the symptoms. Fine needles are inserted at pre-determined points on the body. The procedure should not be painful, and can lead to a feeling of relaxation. Using acupuncture to treat carpel tunnel syndrome encourages the compressed space in the wrist to open, and inflammation to disperse. Herbal soaks may also be used to allow the healing qualities of the herbs to target the affected area. This also encourages the circulation of oxygen and blood to improve, which encourages self-healing and a decrease in pain.

An acupuncture practitioner will be looking for a ‘pattern of disharmony’ based upon your symptoms and their observations. Both the local and systemic cause for the problem will be treated to help prevent reoccurrence. A wrist problem may be as a result of aggravated muscles in the forearm, postural stresses or from neck or back problems. The neuromuscular effects of acupuncture would help to disperse the pain by treating any associated areas. It is a safe therapy to use for carpel tunnel syndrome in pregnancy. Needling of wrist

A chiropractic treatment is safe and effective, using no medication or surgery. A consultation would involve examining the medical history, symptoms, a physical examination and x rays or scans as necessary. The root cause would be established, and techniques such as adjustments to restore functionality, immobilization (splints), cold and heat used. The spine and the joints leading down to the wrist would be examined, and therapy given as required. Tendonitis may require ultrasound therapy, which has shown clinically important improvement in the treatment of calcific tendonitis1. Physiotherapy would complement treatment with ‘eccentric loading exercises’ designed to gradually increase the load put upon muscles, rehabilitation and strengthening exercises, gentle stretching and close monitoring. Rest from the causative activity may be required, or a supportive brace. Ultrasound therapy being administered

Often, an issue with the wrist will result in other areas of the body compensating. An osteopath would examine these areas and target treatment to the root cause. Soft tissue and joint mobilisation are amongst the techniques which would be used. With a condition such as carpel tunnel syndrome, the nerve responses would be tested. If there is restriction in the joints of the upper spine, the part of the nervous system controlling the diameter of the arteries and lymphatic channels is affected. Less drainage can occur, fluid collect in the arm and wrist and more pressure be put upon the median nerve. The upper back would be treated in order to free up the restriction, normalise the nervous system and improve drainage from the arm and hand. Osteopathic treatment for carpel tunnel syndrome has been shown to assist in relieving pressure on the carpel tunnel, stretching soft tissue and increasing the range of movement and strength2.

Adopting a holistic view of the issue enables that elements of any of the available therapies may be used in your tailor-made treatment plan. The aim is to resolve your health issue and prevent its reoccurrence whenever possible. Please call us on 0207 526 4925 if you would like some help resolving your wrist pain.

References
  1. Pfefer M et al ‘Chiropractic Management of Tendinopathy: A Literature Synthesis’. Journal of Manipulative and Physiological Therapeutics 2009 Vol 32 (1) 41-52.
  2. Siu G ‘Osteopathic Manipulative Medicine for Carpel Tunnel Syndrome’ The Journal of American Osteopathic Association 2012 Vol 112 127-139.
  3. www.acupuncture.org