Swollen Wrist: Causes and When to Worry

Why is my wrist swollen?

Your wrist is a busy joint. Eight small carpal bones sit between the ends of the two forearm bones (the radius and ulna) and the hand, held together by dozens of ligaments. Tendons that move the fingers and thumb run over the top and underside of the wrist in slippery sheaths. Swelling happens when any of these structures is injured or inflamed, or when fluid collects in or around the joint.

The two quickest clues to the cause are:

1. Was there an injury? A fall onto an outstretched hand points to a sprain or fracture.
2. Where exactly is the swelling, and what does it look like? A smooth, round bump is usually a cyst. Diffuse puffiness over the whole joint suggests arthritis, gout or infection. Swelling along the thumb side suggests tendon inflammation.

If your wrist hurts but is not visibly swollen, the location of the pain is the better guide: see wrist pain by location for thumb-side, pinky-side, top and inside-of-wrist causes.

Swollen wrist after an injury

Wrist sprain

A wrist sprain is a stretched or torn ligament, usually from a fall or a twist. Swelling and bruising appear within hours. Pain is worst when you move or bear weight on the hand. Mild sprains settle in 1 to 3 weeks. A severe tear of the scapholunate ligament can leave the wrist weak and clicking, so a sprain that does not improve deserves a check.

Wrist fracture

A wrist fracture often follows a fall onto an outstretched hand, especially in children and in adults with weaker bones. The most common is a break at the end of the radius (a distal radius fracture). Clues are rapid swelling, a deformed or "dinner fork" shape, severe pain and being unable to use the hand.

A scaphoid fracture is easy to miss. The swelling can be mild, and you may still move the wrist, but there is tenderness in the hollow at the base of the thumb. Early X-rays are sometimes normal. Because the scaphoid has a fragile blood supply, an untreated break can fail to heal, so doctors splint the wrist and repeat imaging if they suspect one.

Tendon and soft-tissue injury

Cuts, crush injuries and heavy lifting can injure tendons or bruise soft tissue. A cut on the palm side of the wrist that leaves you unable to bend a finger needs urgent repair.

Swollen wrist with no injury

Tendinitis and tenosynovitis

Repetitive gripping, typing, lifting a baby or racquet sports can inflame the tendons and their sheaths. De Quervain's tenosynovitis causes swelling and pain on the thumb side of the wrist that is worse when you make a fist with the thumb tucked inside. It is common in new parents. Swelling is usually mild and runs along the line of the tendon.

Ganglion cyst

A ganglion cyst is a smooth, rubbery, fluid-filled lump that grows from a joint or tendon sheath. It is the most common lump on the wrist, usually on the back of the wrist, and can come and go or change size with activity. Most are painless. Some ache or press on a nerve. They are harmless and about half disappear on their own.

Arthritis

• Osteoarthritis: wear-related arthritis at the base of the thumb or in the wrist after an old injury. It causes bony swelling, stiffness and aching with use.
• Rheumatoid arthritis: an autoimmune disease that typically swells both wrists and the knuckles of the hands at the same time. Morning stiffness lasting more than 30 minutes is a classic clue. Early treatment prevents joint damage.
• Psoriatic arthritis and lupus: these can also inflame the wrists, often with skin or nail changes.

Gout and pseudogout

Crystals in the joint cause sudden, severe attacks. The wrist becomes hot, red, shiny and exquisitely tender within hours, often overnight. Gout more often hits the big toe first but can affect the wrist. Pseudogout (calcium pyrophosphate crystals) has a particular liking for the wrist and knee in older adults.

Infection

• Septic arthritis: bacteria inside the joint, from the bloodstream or a wound. The wrist is hot, red, swollen and too painful to move, usually with a fever. This is an emergency that needs drainage and antibiotics.
• Cellulitis: infection of the skin and tissues under it, with spreading redness and warmth, often after a cut, bite or insect sting.
• Tendon sheath infection: spreading pain and swelling after a puncture wound to the hand or wrist.

Fluid retention (wrist edema)

Puffiness that affects both wrists and hands, and often the ankles, is usually fluid retention rather than a joint problem. Common causes are hot weather, pregnancy, salty meals, long flights and some medicines (such as calcium channel blockers, steroids and NSAIDs). Less often it signals heart, kidney or liver disease. Swelling of one whole arm, including the wrist, can come from lymphedema after breast cancer treatment or from a clot in an arm vein.

Carpal tunnel syndrome

Carpal tunnel syndrome itself rarely makes the wrist look swollen, but many people describe their hands as feeling puffy. Tingling and numbness in the thumb, index and middle fingers, worse at night, are the main signs. Fluid retention in pregnancy and wrist arthritis both raise the risk.

Swollen wrist causes compared

Swollen arms and wrists together

When both arms and wrists swell at once, the cause is usually body-wide rather than in the joint itself. Think of fluid retention from heat, pregnancy or medicines, an allergic reaction (angioedema), or kidney, heart or thyroid problems. Inflammatory arthritis can also affect both wrists, but the swelling then sits at the joints, not along the whole forearm. See a doctor if swelling in both arms is new and lasts more than a few days, or if you also notice breathlessness, weight gain or reduced urine.

Wrist swelling: when to worry

Get same-day medical care if your swollen wrist:

• followed a fall and you have pain at the base of the thumb, deformity or cannot grip
• is red, hot and too painful to move, or you have a fever
• has red streaks spreading from a wound
• comes with numbness, coldness or color change in the hand

Book a routine appointment if swelling lasts more than 1 to 2 weeks, keeps coming back, affects both wrists with stiffness, or is a lump that is growing.

How doctors find the cause

A doctor will ask how and when the swelling started, whether there was an injury, what makes it worse, whether other joints are involved, and about fever, skin rashes and your medicines. They will look at the shape of the wrist, press on specific points (such as the anatomical snuffbox), and test movement, grip and sensation.

Tests depend on what they find:

• X-ray: for suspected fractures, arthritis and calcium deposits.
• Ultrasound: shows cysts, fluid in the joint and inflamed tendons.
• MRI: finds hidden scaphoid fractures and ligament tears.
• Joint aspiration: fluid drawn from the joint with a needle is checked for crystals and bacteria. This is essential if infection or gout is possible.
• Blood tests: inflammation markers (CRP, ESR), uric acid, rheumatoid factor and anti-CCP antibodies, and kidney function.

Treatment and home care for a swollen wrist

First steps for minor swelling

• Rest: avoid the movement that hurts for a few days. A wrist splint from a pharmacy helps.
• Ice: apply an ice pack wrapped in a cloth for 15 to 20 minutes, several times a day for the first 48 hours.
• Elevate: keep the hand above the level of the heart, for example on pillows.
• Remove rings and bracelets early, before swelling makes this impossible.
• Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose. Avoid NSAIDs such as ibuprofen if you have kidney disease, stomach ulcers or take blood thinners, unless a doctor says otherwise.
• Gentle movement: once pain eases, move the fingers and wrist through their range to prevent stiffness.

Treatment of specific causes

• Fractures: a cast or splint, and sometimes surgery with plates or pins.
• Sprains: a splint for a short period, then strengthening exercises.
• Tendinitis: a thumb or wrist splint, activity changes, and sometimes a steroid injection.
• Ganglion cysts: often left alone. Draining with a needle or surgical removal is possible, though they can come back. Do not try to burst a cyst by hitting it.
• Gout and pseudogout: anti-inflammatory medicines, colchicine or steroids for attacks, and urate-lowering treatment for recurrent gout.
• Rheumatoid arthritis: disease-modifying medicines from a rheumatologist, started as early as possible.
• Septic arthritis: hospital treatment with joint washout and intravenous antibiotics.

Frequently asked questions

Why is my wrist swollen with no injury?

The commonest causes are tendon inflammation from overuse, a ganglion cyst, osteoarthritis, rheumatoid arthritis and gout or pseudogout. Fluid retention from heat, pregnancy or medicines can make both wrists puffy. A red, hot, painful wrist with fever may be an infection and needs prompt medical care.

When should I worry about wrist swelling?

Worry if the wrist is deformed, you cannot grip or move it, the hand is numb or cold, or the wrist is red and hot with a fever. Pain at the base of the thumb after a fall can mean a scaphoid fracture even if you can move the wrist. Swelling lasting over two weeks also needs a check.

How long does a swollen wrist take to go down?

Swelling from a mild sprain usually improves within a few days and settles in 1 to 3 weeks. Fractures can stay puffy for several weeks after the cast comes off. Gout attacks settle in about a week with treatment. Swelling that is not improving after two weeks of rest should be examined.

Can a swollen wrist be broken if I can still move it?

Yes. Scaphoid fractures in particular often allow movement and cause only mild swelling. The key sign is tenderness in the hollow at the base of the thumb. If you fell on an outstretched hand and that spot hurts, get an X-ray and keep the wrist splinted until a fracture is ruled out.

What causes a red, swollen wrist?

Redness and heat point to inflammation or infection. Gout and pseudogout cause sudden attacks with intense pain. Septic arthritis and cellulitis cause redness with fever or a nearby wound. Insect bites and allergic reactions can also cause a red, puffy wrist. Any red, hot joint with fever needs same-day assessment.

Should I use heat or ice on a swollen wrist?

Use ice in the first 48 hours after an injury or during a flare of swelling, for 15 to 20 minutes at a time. Heat suits stiffness from long-standing arthritis once swelling has settled. Never put heat on a wrist that is red, hot or possibly infected.