Musculoskeletal problems of the wrist and hand

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The wrist is made up of eight small bones known as carpals. They support a tube that runs through your wrist. That tube, called the carpal tunnel, has tendons and a nerve inside. It is covered by a ligament, which holds it in place.

Wrist pain is common. Repetitive motion can damage your wrist. Everyday activities like typing, racquet sports or sewing can cause pain, or even carpal tunnel syndrome. Wrist pain with bruising and swelling can be a sign of injury. The signs of a possible fracture include misshapen joints and an inability to move the wrist. Some wrist fractures are a result of osteoporosis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• 
  Right Human Posterior Distal Radius, Ulna, Carpals
• 
  Right Human Anterior Distal Radius, Ulna, Carpals
• 
  Carpus

• 
  Ligaments of wrist. Anterior view
• 
  Ligaments of wrist. Posterior view.

• Distal Radius

  • Styloid process adds medial stability

• Distal Ulna

  • Styloid process adds lateral stability

• Proximal Carpal Row

  • Scaphoid (navicular), lunate, triquetrum, pisiform
  • Scaphoid provides stabilizing articulation between proximal and distal carpals

• Distal Carpal Row

  • Trapezium, trapezoid, capitate, hamate
  • Articulate with metacarpals

• Joint Capsules

  • Seven non-communicating compartments of the wrist
  • Negative findings in one compartment do not rule out pathology in another

• Flexor Tendons

  • Majority traverse palmar surface via carpal tunnel
  • Lie between carpal bones dorsally and flexor retinaculum ventrally

• Extensor Tendons

  • Cross the wrist covered by fascia along the dorsal surface

• Insertions

  • Major wrist flexors/extensors insert at base of metacarpals, not onto carpal bones

• Median Nerve

  • Runs through carpal tunnel

• Ulnar Nerve

  • Follows ulnar artery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

• Fracture
  • Immediate severe pain and swelling
  • Colle’s fracture
    • Fracture of distal radius; most common, easily seen on X-ray
  • Scaphoid Fracture
    • May require special X-ray views to visualize
• Ligament Rupture or Tear
• Tendon Injury

• Inflammatory Arthritis
  • Septic, crystal-induced, rheumatoid arthritis (RA)
  • Pain with movement of wrist through its range of motion
  • Synovitis with swelling in setting of inflammatory entities
• Osteoarthritis
  • Rarely involves wrist except for carpometacarpal (CMC) joint at base of thumb
• Osteonecrosis (avascular)
  • Localized pain interfering with hand/wrist function
• Entrapment Syndromes
  • Wrist pain radiating into hand or forearm, +/- sensory or motor deficits
  • Carpal tunnel syndrome
  • Ulnar or interosseous nerve entrapment
• Tenosynovitis
• Ganglion Cyst
• Referred Pain from Cervical-Spine/Shoulder
  • Pain in absence of local findings
  • Symptoms worsened by neck/shoulder movement

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