Tuesday 12 November 2019

Dear Dr Nina: Why is my wrist hurting so much?

Carpal tunnel is more common in pregnancy
Carpal tunnel is more common in pregnancy

Nina Byrnes

Q Ever since I went back to work after my last child, I have a very bad pain in my wrist. When I bend my hand down, there appears to be a small lump. I don’t think that it’s repetitive strain, as I have it whether I have spent a lot of time using a mouse or not. What could this be and is it connected to having a baby?

Dr Nina replies: The wrist is a complex structure containing many bones, tendons and ligaments. The carpal tunnel is a tube-like structure located on the palm side of the wrist. Nerves and tendons pass through this onto the hand. Injury to any part of the wrist or its structures can lead to wrist pain.

Poor posture or repeated small movements of the hand, wrist and arm make repetitive strain more likely. Pain that persists over a prolonged period of time is most likely due to chronic inflammation or repetitive strain.

Carpal tunnel syndrome commonly causes pain radiating from the palm of the hand to the middle three fingers. The pain may be described as tingling or burning. Carpal tunnel is more common in pregnancy, but it does not cause a lump or swelling.

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It sounds like you might have a ganglion. These are fluid-filled lumps that occur near tendons. Tendons are tough bands of tissue that connect muscles to bone. These in turn are protected by lubricating synovial fluid which assists in their function. Ganglions grow on these membranes. These lumps are not dangerous but usually cause little, if any, pain or discomfort unless their size or shape causes them to press on a nearby nerve.

These lumps occur most commonly on the back of the hand but can also occur on the feet, knees and ankles. They occur most commonly in women aged between 20 and 40.

Ganglions are usually very smooth and round and, although firm, are not bony-hard to touch. The cause is unknown.

It may somehow be linked to a leakage of synovial fluid from joints and membranes. Ganglions form within a thick fibrous capsule. In the majority of cases no treatment is required. They often resolve themselves although this may take many months.

If a ganglion is large or causing discomfort, the more definitive surgical treatment involves removing the fluid, the capsule and a small amount of the surrounding fibrous tissue. This is usually undertaken using a local anaesthetic and you will be awake during the procedure.

De Quervain’s tenosynovitis causes pain at the base of the thumb that is typically worse when turning the wrist, grabbing things or making a fist. If pain is reproduced by bending your thumb across your hand, flexing the fingers over it and flexing the wrist towards your little finger (Finkelstein’s test), then this is the likely cause.

Physiotherapy is always a good place to start with wrist pain. If despite this attention the pain is no better, a visit to the doctor may help.

⬤ If you have any queries, email askthedoctor@independent.ie

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