Wrist: Overuse & Degenerative Conditions

See also Hand: Overuse & Degenerative Conditions for the digital/finger equivalents of these conditions.

De Quervain’s tenosynovitis

Stenosing tenosynovitis of the first dorsal wrist compartment (abductor pollicis longus and extensor pollicis brevis). Common in women 40–50 and postpartum/new parents (repetitive lifting).

• Symptoms: gradual-onset pain at the radial border of the wrist, worse with pinching, grasping, and thumb/wrist movement; can be disabling.
• Examination: positive Finkelstein’s test (pain over the radial styloid when the thumb is clasped and the wrist deviated ulnarly).
• Management: relative rest and activity modification; a thumb spica splint; corticosteroid injection (effective first-line); surgical release if symptoms persist beyond ~6 months.

Carpal tunnel syndrome

The most common compressive neuropathy — median nerve compression at the wrist.

• Risk factors: female, obesity, pregnancy, hypothyroidism, rheumatoid arthritis, CKD, diabetes, and repetitive/vibratory hand use.
• Symptoms: tingling ± pain in the median distribution (thumb, index, middle, radial half of ring finger), classically waking the patient at night and relieved by shaking the hand (“flick sign”); may radiate proximally. Late: thenar wasting and weakness.
• Examination: Phalen’s and Tinel’s tests (both low sensitivity).
• Investigations: nerve conduction studies if diagnosis is uncertain or before surgery.
• Management:
  • Night splinting (neutral wrist) — good for night-predominant symptoms; activity modification; treat contributing conditions.
  • Corticosteroid injection — ~20% remain symptom-free at 1 year; poor response predicts poor surgical response.
  • Carpal tunnel release — for persistent symptoms or any motor deficit/ thenar wasting (don’t delay if motor involvement).

Ganglion cyst (dorsal/volar wrist)

Fluid-filled cysts arising from a joint capsule or tendon sheath, containing gelatinous fluid. Most commonly the dorsal wrist (~70%), then volar wrist — the digital/finger form is covered on the Hand page. Peak in the 2nd–4th decades, slight female predominance. Two groups: young people with lax ligaments and older patients with arthritic joints (where the cyst signals underlying OA — removing it won’t relieve the joint pain).

• Features: a firm, smooth, rubbery, well-circumscribed lump fixed to deep tissue (not skin); occasionally tender or causing nerve impingement.
• Diagnosis: clinical; transilluminates (differentiates from a solid mass); ultrasound confirms and excludes a vascular lesion. Consider MRI for occult wrist pain.
• Red flags for a neoplastic mass: rapid growth, pain at rest, functional impairment, or an atypical location → consider biopsy.

Management:

• Reassure and observe — over half resolve spontaneously. (The old “hit it with a Bible” is discouraged.)
• Aspiration has a high recurrence rate (~50% within a year, being continuous with the joint) and a small septic-arthritis risk — limited benefit over leaving it alone.
• Surgical excision for persistent pain or functional limitation (not for cosmesis — it trades a lump for a scar); ~10% recur.