Wrist Pain: Causes by Location, Treatment and When to See a Doctor

Wrist pain causes by location

Point to the spot that hurts most. The wrist is crowded with small bones, ligaments, tendons and nerves, and each area has its own usual suspects.

Thumb side of the wrist

Pain on the thumb side when you grip, pinch, wring out a cloth or lift a baby is typical of De Quervain's tenosynovitis, inflammation of the two tendons that run along the edge of the wrist to the thumb. A deep ache at the very base of the thumb, worse with pinching and opening jars, is more often thumb base (basal joint) arthritis, common after age 50. After a fall, tenderness in the small hollow at the base of the thumb means a scaphoid fracture until proven otherwise.

Pinky side of the wrist

Pain on the outer, pinky side that flares when you turn a key, use a screwdriver or push up from a chair often comes from a tear of the triangular fibrocartilage complex (TFCC), the cartilage cushion between the forearm bone and the small wrist bones. Clicking is common. Tendinitis of the extensor carpi ulnaris tendon causes pain along the outer edge with certain movements, and in some people a slightly long ulna bone presses on the wrist bones (ulnar impaction). Gout and inflammatory arthritis also often start on this side.

Top of the wrist

Pain on the back of the wrist is common in people who do push-ups, yoga, gymnastics or heavy lifting with the wrist bent back. A small, firm lump that gets bigger with activity is usually a ganglion cyst. Gradual pain and stiffness in the middle of the back of the wrist, especially in young adults doing manual work, can be Kienböck's disease. A sprain of the scapholunate ligament after a fall also causes pain here.

Inside of the wrist (palm side)

Pain on the palm side with tingling or numbness in the thumb, index and middle fingers, worse at night, points to carpal tunnel syndrome. Pain along a tendon when you bend the wrist or fingers suggests flexor tendinitis. A smooth lump near the base of the thumb on the palm side is often a volar ganglion.

When the wrist is swollen as well as painful

Swelling means fluid, blood or inflammation in or around the joint, and its pattern adds clues: fast swelling after a fall suggests a fracture, a hot red wrist suggests gout or infection, and both wrists swelling at once suggests inflammatory arthritis. Our guide to a swollen wrist and its causes covers swelling with and without injury and when it is an emergency.

Wrist pain after a fall

Wrist fracture

A fall onto an outstretched hand is the most common cause of a wrist fracture. The distal radius (forearm bone at the wrist) is the most commonly broken bone in the arm. Expect immediate pain, swelling, bruising and sometimes a deformity. In older adults, it can be a sign of osteoporosis.

Scaphoid fracture

The scaphoid is a small bone on the thumb side of the wrist. A scaphoid fracture may cause only mild swelling, so people often assume it is a sprain. Tenderness in the "anatomical snuffbox" (the hollow at the base of the thumb when you extend it) is the key sign. It may not show on the first X-ray. Because its blood supply is poor, a missed scaphoid fracture can fail to heal. Suspected cases are splinted and re-imaged or scanned with MRI.

Sprain

A wrist sprain is a stretched or torn ligament. Mild sprains heal in 2 to 6 weeks. A severe tear of the scapholunate ligament can cause long-term instability and needs specialist assessment.

Wrist pain without injury

• Carpal tunnel syndrome: compression of the median nerve causes numbness, tingling and pain in the thumb, index, middle and half of the ring finger, often worse at night or when holding a phone or steering wheel. Shaking the hand often relieves it.
• De Quervain's tenosynovitis: inflammation of two thumb tendons, causing pain on the thumb side of the wrist when gripping, pinching or lifting. It is common in new parents and with repetitive thumb use.
• Ganglion cyst: a smooth, fluid-filled lump, usually on the back of the wrist, which may ache, especially with wrist extension.
• Tendinitis: overuse from typing, gaming, racquet sports or manual work.
• TFCC tear: damage to the cartilage on the pinky side, from injury or wear, causing pain and clicking with twisting movements.
• Osteoarthritis: most often at the base of the thumb, causing aching with pinching and gripping.
• Rheumatoid arthritis: swelling and stiffness in both wrists and the small joints of the hands, with morning stiffness over an hour.
• Gout and pseudogout: sudden, hot, swollen wrist.
• Kienböck's disease: loss of blood supply to the lunate bone, causing gradual pain and stiffness in the middle of the wrist.

How doctors find the cause

A clinician will ask how the pain started, about falls, sports, work and hobbies, and whether there is numbness, clicking or swelling. They will examine the wrist for tenderness, swelling and range of movement, and do special tests such as:

• Finkelstein test: bending the thumb into the palm and the wrist toward the pinky, which causes pain in De Quervain's
• Tinel's and Phalen's tests: tapping the nerve or bending the wrist, which reproduce tingling in carpal tunnel syndrome
• Snuffbox tenderness for scaphoid fracture

Tests include X-rays for fractures and arthritis, MRI for scaphoid fractures, ligament and TFCC tears, ultrasound for tendons and cysts, nerve conduction studies for carpal tunnel syndrome, and blood tests for inflammatory arthritis or gout.

Treatment and home care

For mild sprains and overuse

• Rest from the activity that causes pain.
• Ice for 15 to 20 minutes every 2 to 3 hours for the first 2 days, wrapped in a cloth.
• Compression and elevation to reduce swelling.
• A wrist splint to rest the joint, especially at night for carpal tunnel syndrome. Use a thumb spica splint for De Quervain's.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose, or a topical NSAID gel.
• Ergonomics: keep wrists straight when typing, use a supportive keyboard and mouse, and take regular breaks.
• Gentle stretches once acute pain settles.

Medical treatment

• Fractures: a cast or splint, or surgery with plates or screws for displaced fractures.
• Steroid injections for De Quervain's, carpal tunnel syndrome and some arthritis.
• Hand therapy for strengthening and recovery of movement.
• Ganglion cysts: often left alone, as many go away. Aspiration or surgical removal if painful.
• Surgery: carpal tunnel release, tendon release, ligament repair, or TFCC repair when other treatment fails.
• Medicines for inflammatory arthritis and gout.

Frequently asked questions

What causes wrist pain without injury?

Common causes are carpal tunnel syndrome, De Quervain's tenosynovitis, other tendinitis from repetitive use, ganglion cysts, osteoarthritis at the base of the thumb, rheumatoid arthritis and gout. Numbness in the fingers points to carpal tunnel syndrome, and pain on the thumb side when gripping points to De Quervain's.

What does pain in both wrists mean?

Pain in both wrists at once is unusual for injury or overuse and usually points to the joints themselves. Common causes include rheumatoid arthritis, viral arthritis, psoriatic arthritis, pseudogout and lupus. Morning stiffness lasting over an hour and swelling of the finger joints support inflammation. See a doctor within days for blood tests.

What causes wrist pain on the thumb side?

The most common causes are De Quervain's tenosynovitis, thumb base arthritis and, after a fall, a scaphoid fracture. De Quervain's causes pain when gripping or lifting, especially in new parents. Tenderness at the base of the thumb after a fall needs an X-ray, even if you can move your wrist.

What causes wrist pain on the pinky side?

Pinky-side pain usually comes from a tear of the triangular fibrocartilage complex (TFCC), tendinitis of the tendon on that side, or the ulna bone pressing on the wrist bones. Pain with twisting, such as turning a key or doorknob, and clicking are common. An MRI may be needed.

How do I know if my wrist is broken or sprained?

You cannot reliably tell without an X-ray. Severe pain, swelling, deformity, inability to use the hand, or tenderness at the base of the thumb suggest a fracture. Any significant wrist injury from a fall should be X-rayed, because scaphoid fractures can look like sprains.

What causes pain on top of the wrist?

Pain on the back of the wrist is most often from a ganglion cyst, a sprain, or strain from weight-bearing on a bent-back wrist during push-ups, yoga or lifting. Gradual, deep pain with stiffness can be Kienböck's disease. Pain after a fall that does not settle within a week needs an X-ray.