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The wrist is made of many small joints, which enables us to make precise movements. The wrist, unfortunately, is exposed to overload and injuries as well as pain caused by rheumatic and degenerative diseases, inflammations and diseases of tendons, muscles and nerves. What is carpal tunnel syndrome?
Wrist – what is it?
While the function and structure of the wrist is among the most complex in our body, the purpose of our wrists is to support a wide range of motion. The wrist is made up of many joints, bones, ligaments, and tendons that work together to allow the wrist to move sideways, back and forth, up and down, rotate, and bend.
The wrist (wrist joint) is made up of approximately 8 smaller bones in the wrist. It is a complex joint formation that connects to the ulna and radial bones of the forearm and to the five metacarpal bones of the phalanges. Occasionally, doctors may need to surgically intervene in this complex structure with minimally invasive procedures such as wrist arthroscopy.
The wrist is used to transfer power from shoulder to hand. Without a wrist, our hands would be neither flexible nor strong. These details are made possible by the convergence of bones, joints, tendons, ligaments, nerves, and blood vessels.
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Wrist – construction
The eight bones that make up the wrist are canoe-shaped, lunate, triangular, pea-shaped, triangular larger, smaller quadrilateral, capitate, hook-shaped. The most commonly damaged wrist bone is the navicular bone, located near the base of the thumb. A unique cluster of small bones of various shapes and sizes gives the wrist strength and flexibility. If you look at your hand as you move your fingers and wrist, you will notice how flexible your hand and wrist are. If your hand consisted of 3 or 4 larger bones, your hand and wrist would not function the same.
The two long bones of the forearm that run from the elbow to the wrist are the ulna and the radius. The ulna does not form a direct joint with the bones of the wrist, but the radius does. The end of the ulna, closest to the smallest finger, is covered with a piece of cartilage that acts as a pillow between the bones of the wrist and forearm. The radius, closest to the thumb, is in direct contact with the crescent and scaphoid bones, which are considered part of the proximal wrist. The row of carpal bones closest to the forearm is known as the proximal row of carpal bones, while the row of carpal bones closer to the fingers is known as the distal row of carpal bones.
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Joints and wrist movement
Although there are several joints in the wrist, the joints are different in type and each supports separate movements. Wrist fractures often occur on joint surfaces.
The radiocarpal joint is the largest and main joint in the wrist, also known as the condylar joint, which allows you to combine movements in multiple planes. The radiocarpal joint is located at the proximal parts of the wrist (where the forearm meets the wrist).
The distal radioulnar joint is located between the radius and ulna bone and is one of the two joints between the bones of the forearm. The second joint between the two bones is the proximal radioulnar joint, which allows the wrist to rotate forward and backward.
The carpal joint connects the ulna with the lunar bone and the tricuspid bone inside the wrist. Due to the location of this joint, it is known to be a common area of wrist dislocation. This joint also serves as part of the forearm rotation.
Most wrist fractures result from a radial fracture at the radiocarpal joint known as a distal radius fracture.
While there are more joints connecting the distal, middle, and proximal phalanges, let’s focus on the five joints between the distal wrists of the wrist and the metacarpals of the fingers. These five joints are known as metacarpal joints, and each serves a different purpose. The carpal-metacarpal joint of the thumb is the saddle joint that allows the thumb to move forward, backward, and side to side.
The carpal-metacarpal joints of the other four fingers are sliding joints, allowing up and down movements and from side to side. The synovium lines the joints and fills up with a lubricating fluid called synovial fluid. Joints with a synovial membrane can form balloon cysts called ganglion cysts that may need to be surgically removed.
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Wrist – ligaments
Ligaments are permanent bands of connective tissue that connect bones and support them to keep them in place. The wrist consists of several ligaments that make up several functions of the hand and wrist.
The elbow and radioulnar ligaments are two sets of ligaments that provide the main support for the wrist. The interosseous scapulo-sacral ligament and the luno-tricuspid ligament ensure the stability of the proximal wrist. This ligament can be divided into three parts: dorsal, proximal and stellate ligaments.
The palmar and dorsal ligaments support each side of the wrist. The radial-carpal ligaments support the inside of the wrist, while the radial-carpal ligaments support the back of the wrist.
The radial and ulnar collateral ligaments are a pair of ligaments that work together to secure the bones of the wrist and keep it stable.
Collateral ligaments are strong ligaments on both sides of the joints of the fingers and thumb. These ligaments prevent lateral movement of the joint to prevent injury. Ligament injuries are called sprains. The ligaments and tendons inside the wrist play an important role in our daily activities, and overloading them can result in hand aches such as tendinitis, and even fractures in extreme cases.
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Wrist – tendons
Hand and wrist movements are controlled by tendons, which are cords of connective tissue (like a rope) that connect muscles to bones. The tendons that control movement in the hands and wrists start in the forearm and enter the bones of the hand. No tendons go into the wrist bones themselves.
There are superficial tendons that pass through the inside of the wrist and hand and attach at the base of the middle phalanges, and deep tendons that function similarly but attach at the base of the distal phalanges.
The extensor tendons attach to the middle and distal phalanges, which work together to bend the wrist and straighten the wrist. The tendons are known as the wrist radial extensor, the long wrist radial extensors, and the elbow wrist extensors.
The flexor tendons are nine long tendons that pass from the forearm through the carpal tunnel, also allowing the wrist to flex. They separate in the palm of your hand and attach to your fingers and thumb. These tendons are called the radial wrist flexor (which is attached to the distal parts of the wrists of the second and third metacarpals) and the ulnar flexor of the wrist (which is attached to the pea and fifth metacarpal bones).
Tendons connect muscles to give strength to joints and bones, providing movement. Tendons and ligaments allow you to perform simple hand and wrist movements, such as opening and closing your hands and flexing your fingers. Wrist tendon injuries can include tendon damage, which can lead to tendinitis. The appendages on the tendon sheath may fill with synovial fluid, forming a ganglion cyst.
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Wrist injuries and causes of pain
Wrist pain is an ailment that happens regardless of age, it affects both sports youth and the elderly. This is due to the complex anatomy of the wrist. It is a very important joint, where there are nerves, tendons and vessels that are responsible for the work of the entire arm. If your wrist hurts, it affects the performance of your entire arm. Causes of wrist pain:
- overload of muscles and tendons as a result of many hours of computer work or constant manual work,
- permanent injuries,
- wrist fracture – deformation of the shape, wrist thickening and limitation of wrist efficiency,
- degenerative changes caused by the destruction of cartilage, bone growths, pain, limited joint movement and morning wrist stiffness,
- rheumatic disease, changes in bones, soft tissue and joints occur, there is pain and chronic inflammation,
- wrist instability, it can occur either as a result of an injury or due to muscle laxity, it is also associated with pain, weakening of the joint.
See: Rheumatic profile, i.e. what tests will help detect rheumatic diseases
Carpal tunnel syndrome – characteristics
Carpal tunnel syndrome (CTS) is a compression neuropathy caused by compression of the median nerve as it travels through the carpal tunnel. It is the most common nerve entrapment neuropathy, accounting for 90% of all neuropathies. Early symptoms of carpal tunnel syndrome include pain, numbness, and paraesthesia. These symptoms usually occur, with some variation, in the thumb, index finger, middle finger, and the radial (thumb side) of the ring finger. Pain may also radiate to the affected arm. Hand weakness, decreased coordination, clumsiness, and disappearance of the withers may occur with further progress.
In the early stages of the disease, symptoms most often appear at night while lying down and disappear during the day. As the disease continues to progress, symptoms will also appear throughout the day, especially with certain repetitive activities such as drawing, typing, or playing video games. In more advanced disease, symptoms may appear constantly.
Common occupations for people with carpal tunnel syndrome include long-term computer users, people using vibrating equipment, such as construction workers, and any other occupation that requires frequent, repetitive movement.
Carpal tunnel syndrome is the result of increased pressure in the carpal tunnel followed by compression of the median nerve. The most common causes of carpal tunnel syndrome include a genetic predisposition, a history of repetitive wrist movements such as typing or machine work, as well as obesity, autoimmune disorders such as rheumatoid arthritis, and pregnancy.
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Carpal tunnel syndrome – symptoms
Symptoms of carpal tunnel syndrome can include:
- numbness, tingling, burning and pain – mainly in the thumb and index, middle and ring fingers (nocturnal symptoms)
- occasional paralysis-like sensations that radiate to the thumb and index, middle and ring fingers
- pain or tingling that may travel up your forearm towards your shoulder
- weakness and clumsiness of the hand – this can make it difficult to perform delicate movements such as fastening clothes,
- dropping things – due to weakness, numbness of the hands.
In most cases, the symptoms of carpal tunnel syndrome develop gradually without any specific injury. Many people find their symptoms come and go at first. However, as the condition worsens, the symptoms may appear more often or they may persist for a long time.
Nocturnal symptoms are very common. Since many people sleep with their wrists flexed, symptoms can cause them to wake up from sleep. During the day, symptoms often occur when you hold something for a long time with your wrist bent forward or backward, such as when using a phone, driving a car, or reading a book.
Tennis wrist – causes and symptoms
There is no such disease as “tennis wrist”. It is just a common name confused with tennis elbow, pain syndrome on the outer surface of the elbow joint, the pain causes overloading of the muscle tendons, the patient feels pain in the lateral epicondyle on the outer side of the elbow, because this is where the muscles that are responsible for straightening the fingers and wrist are attached.
Unfortunately, the area of the elbows is small in relation to the amount of stress and strain during intense muscle work. Tennis elbow is caused by many overloads and microtraumas, as well as due to coexisting inflammation. The disease most often occurs in people between the ages of 30 and 60. People whose professional work or hobby requires the same wrist movements are particularly vulnerable. Interestingly, tennis elbow affects only 10% of all people who play tennis. Tennis elbow can be treated as an occupational disease by dentists, orthopedists, masseurs, as well as electricians and locksmiths.
As a prophylaxis, you can use a gel wrist guard with magnets to support the treatment of a sore wrist. You can buy it at a favorable price on Medonet Market.
Wrist – X-ray and other tests
Wrist pain can be associated with a variety of conditions, such as carpal tunnel syndrome, finger flexor tenosynovitis, psoriatic arthritis, ganglion, Dupuytren’s contracture, and others. Diagnosing the causes of wrist pain requires tests such as:
- Wrist X-ray – thanks to the X-ray image, you can see post-traumatic changes and recognize joint diseases and degenerative diseases.
- Wrist ultrasound – you can check the presence of pathological conditions in the area of the hand;
- Wrist EMG – a test performed to diagnose carpal tunnel syndrome.
Wrist diseases often result from acquired causes, i.e. multiple hand movements, as is the case, for example, when working at a computer or practicing drumming.
To support the proper functioning of the wrist, use the OS1st WS6 compression wristband, black or nude. In case of pain, it is worth reaching for the Visiomed KINECARE VM-GB8 compress for ankle, wrist, elbows, the shape of which adapts perfectly to the body.