Charles V. Toman, MD - 4/12/2009

Question
QUESTION: Can a wrist be sprained badly or fractured without having an injury?  I don't rember doing anything, but mid-day Fri. while applying hand lotion, I got a pain in my left wrist.  I looked at the wrist bone and it was pink.  It has gotten progressively more swollen and painful.  How can this be?  I am using a cold pack and a sling and can't see an available doctor until Tues.  What to do?  How could this happen without incident?

ANSWER: Lynn,

First of all I am sorry that your wrist is bothering you.  It is very unlikely that you fractured your wrist or sprained it by putting on hand lotion.  Typically, when a patient has an all of a sudden type pain my differential diagnosis typically includes infection and inflammation.  With an infection, you typically would have redness around the joint, swelling, and extreme pain with motion of the joint.  Also patients usually feel sick, ie. fever,chills, sweats, generalized malaise.  If you have these symptoms you should proceed directly to the ER.

More often than not, an acute swelling and pain in the wrist is due to over exertion the days before the symptoms began or from a chronic overuse activity.

Typically, for inflammation the treatment of choice involves ice, elevation, anti-inflammatory medications, and a period of rest or activity modification.  

This should help with your discomfort until you see your physician.

It is unlikely that you sprained or fractured a bone in your wrist from merely applying the lotion.  Other things to think of are an inflammatory arthritis like rheumatoid arthritis and similar diseases that usually present with multiple joint involvement.

Hopefully this has been helpful, but be sure to see your physician or the ER if this progresses before you can see your physician on Tuesday.  Feel free to contact me again if I have missed a point you wanted answered or if you want me to elaborate on a different point.



---------- FOLLOW-UP ----------

QUESTION: Thank you for your input.  I do have the redness around the joint, swelling and extreme pain on movement.  I do not feel sick, just anxious and jittery.  The ice pack had to be discontinued because the pressure made it worse.  Just a few minutes ago, I tried a warm soak and it made my fingers tingle.  So much for that.  Should I be worried about a disease you mentioned?
Lynn

Answer
Lynn,
It seems that you are not improving. I doubt that you have any type of autoimmune arthritis, but it is possible.  If it is getting worse you should have it evaluated in the ER.  If you were my patient and i received this type of call I would send you there.  I am conservative.  It may cost you some time in the ER, but it would give you peace of mind.  It is impossible for me to evaluate you over the internet, but my advise is go to the ER.