If you've wrist pain plus swelling, are your fingers also swollen?
Rheumatoid arthritis causes smooth swelling of the middle of the fingers. The joints here are tender to squeeze. You are likely to be stiff for an hour or so first thing in the morning. Both hands are usually involved.
Osteoarthritis causes bumpy, knobbly swelling particularly at the sides, where the fingernail starts. These swellings are hard and only tender for the first few months.
Gout Also can cause dramatically knobbly fingers, due to collections of urate crystals. It can cause polyarthritis and include the wrists.
Psoriatic arthropathy can cause sausage-like swelling of an entire finger, and fingernail changes such as pitting..
If your fingers are not involved, there are other possibilities as well. These will be on one side only.
Old scaphoid bone fracture may have been missed when it was injured, or the fracture may have caused avascular necrosis due to interruption of blood supply.
This is the commonest fracture, at nearly all ages.
It is pretty obvious if it is bent abnormally - called the "dinner fork deformity."
In small children this is unlikely, and there may be little swelling either. If you gently rub on all three sides of the bone just above the thumb side of the wrist, all will be tender at about the same level.
This is the radius bone of your forearm, and in children the fracture is often through the plate of metaphyseal gristle here, where the bone grows. If the bone itself is broken, it will often be a greenstick fracture, with just a tiny kink in the bone on X-ray.
At the other end of life, wrist fractures are commonest until after 75 when hips take over.
Research from the University of Melbourne in Australia, just published in the Lancet (Vol 375 May 15, 2010) found bone densiometry underestimates the cortical bone loss at the wrist, which accounts for 2/3 of the loss.
All bones have a solid outer shell (cortex) and softer, spongy inner supporting framework of cancellous or trabecular bone. The bone marrow fills the spaces in this.
The researchers pointed out that most people with fractures do not have osteoporosis and most with osteoporosis do not sustain fractures.
They found bone mineral density was poorly associated with intracortical porosity - the cortex becoming more spongy, so weaker.
Early diagnosis if it is not obvious, may require more than a plain X-ray. If the bone fragments are sitting together, the crack between them may be hard to see. A nuclear medicine bone scan will become positive within 72 hours, or an MRI may show the bone bruising accompanying the fracture. A repeat plain X-ray a week later would otherwise be needed, once the fracture line had widened enough to see.
Acute injury effects can be ameliorated by immediate vitamin E megadose.
My personal experience was skiing for a weekend, about 7 hours each day, with absolutely no preparation. At the end of the Sunday's skiing I could hardly put one foot in front of the other, but I had no pain.
Three offspring and I had consumed a bottle of vitamin E between us, over the two days.
A heavy chap fell about twenty feet off a roof, onto a garden bed fortunately. He didn't break anything, but when he woke up the next morning he couldn't move for the pain. He had 25,000 IU of vitamin E that day and we were both surprised at how rapidly he recovered.
The worst one is likely to suffer from this treatment is a bit of upset tummy.
It is only useful if started immediately, and only needed for one day. 1000 IU of natural vitamin E every 2 hours is an average adults dose.
The other thing I've found useful is a single dose of calcium intravenously two weeks after the fracture. This inhibits parathyroid hormone secretion temporarily, and so bone breakdown. Two weeks after a fracture, the cleaning up of devitalized bone along the fracture line, should be more or less complete.
These two measures helped a friend's fractured collarbone heal rapidly enough to surprise his orthopaedic surgeon.
The force which fractures the wrist bones is partly transmitted up the arm to the shoulder girdle and axial skeleton.
Damage at these further sites may be overlooked as the wrist is the focus of attention and site of the worst pain.
It is quite common for someone to put their neck out at the same time as they break their wrist, so the cervical joints should be checked as soon as possible.
See the note on treatment of chronic pain syndrome.
To sprain any joint needs an obvious, memorable injury.
Without a history of recent trauma, best to look for another explanation for wrist pain.
Place a thumb across the back of the wrist and bend the hand back and forth and side to side.
Hopefully you can feel the wrist bones moving on the end of your forearm bones (which remain still.)
The wrist joint line is a narrow furrow across between forearm and hand, felt most easily when the hand is bent back. It is in line with the lower end of the obvious bump on the little finger side.
Tenderness of the joint line is consistent with a sprain.
Wrist injuries can also include the joint between the two bones of the forearm, just above the wrist.
The same bump on the little finger side of the back of the wrist, is the landmark for this joint, on its inner side.
To feel this joint line, press your thumb here, alongside the bump, as you rotate your hand.
Is the joint line tender?
Rest (with or without splinting) and anti inflammatory treatment, (preferably applied to the skin) are in order.
A study of MRI in people with wrist injury and normal X-ray, has just been published in 2012.¹
The researchers examined 155 people with MRI and found abnormalities in 125,two per person. They found 54 fractures, 56 bone bruises and 73 soft tissue injuries.
If your doctor has considered an X-ray appropriate at the time of the injury and it is not much better a fortnight later, they suggest an MRI at that stage could be useful.
Arthritis in the last joint mentioned can cause the bump on distal ulna to slip back and become more prominent, but most times when people point this out to me it hasn't.
One just doesn't notice the bump until pain in the wrist draws it to one's attention.
When it is so, there may also be crackling when one's hand is rotated (palm up and down,) which involves the Ulna bone rotating on the lower end of the other (Radius) bone.
Rheumatoid arthritis in the wrist can cause ulnar deviation of the hand, when it is permanently tipped to the little finger side.
It is really important to get onto rheumatoid disease quickly, to avoid this sort of thing.
Polyarthritis is a condition where multiple joints are inflamed.
Necrosis is death of tissue.
Avascular means death by loss of blood supply, when the fracture line goes through an artery supplying half the scaphoid bone.
Aseptic means not caused by infection, probably avascular as well.
The metaphysis separates the main shaft of the bone from the end at the wrist. This is the plate of residual gristle from the original cartilaginous anlage, where bone is added during growth.
Osteoporosis means thinning of bones. It is conventionally defined by DEXA scan T score more than 2.5 standard deviations below the mean value for a young adult, measured at the hip and lumbar spine.
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The obvious bump on the back of the wrist, little finger side, is the lower (distal) end of the ulna bone.