Question
Hello. I am a 25 yr old waitress who has spent a lot of time on computers during college, and I have held several positions in which I am continuously using my hands. My wrist is unable to bear any weight at all. This is a constant symptom. There is moderate pain on the underside of the bone side of my wrist that at times radiates up my arm to my elbow. There is no tingling,numbness, or pain in my hand, thumb, or fingers. There have been episodes in which I am unable to open or close my hand. When I rptate my wrist, there are severe cracking, snapping, and popping noises. I carry everything lefthanded, and the pain is in my right wrist. My dr diagnosed tendonitis after stating she really had no idea what it could be. She gave me a splint that I wear while working. It does not seem to help. Thank you for your time.  Any advice is appreciated. Also there is very little swelling.

Answer
Dear Jamie,

The wrist is a very complicated area. There are many joints and bones.  It is so complicated, in fact, that some orthopedic doctors specialize in only treating the wrist and hand.

Here are some ideas. Please keep in mind that they are simply ideas and that you should consult a local doctor for evaluation and treatment.

First of all, I have to assume that you have not had any trauma to the wrist any time during your life.  If you have, it changes the picture significantly. Past trauma could lead to some significant degenerative problems in the wrist.  There are some bones, for example, in the wrist that will actually decay and die at times when broken.  This can be very serious.

If, however, there is no history of trauma, we have to "look for horses and not zebras", which means, consider the more common issues.  These might include the following:

1) Tendinitis. Yes, your MD could be right on with her diagnosis. If I were you, I would continue to use the splint whenever possible, such as at work and also at night. The goal is to take all stress off the tendon so that it can settle down and heal. It will take weeks to months.

2) Carpal Tunnel Syndrome.  This typically includes some pain in the thumb and first two fingers, as well as pain up the forearm, and at times up to the shoulder area.  This can be difficult to diagnose, and at times requires a nerve conduction velocity test by a neurologist. This is an over-use syndrome.  Often it is first treatment with... you guessed it... a wrist brace at night and whenever possible.  Severe cases require surgery.

3) Cysts on the tendons.  These are synovial cysts or "bible cysts". They can cause locking or pain in the wrist with movement of the wrist, and often will prevent the patient from placing pressure on the wrist and hand.  Sometimes these are surgically removed, although often they rupture on their own. The problem is that they are quite persistent and often will re-develop.  They were called "bible cysts" because some people use a large book, like a bible, to slam down on the cyst, causing it to rupture and providing some relief.

4) Elbow Nerve Entrapment syndromes.  Sometimes the ulnar or radial nerve can get caught or pinched at the elbow. this can cause pain in the wrist. I doubt that this is going on because you are getting popping and clicking in the wrist.

5) Arthritis conditions of the hand and wrist. There are some types of arthritis that can affect the joints of even young people like yourself. A rheumatologist MD would help to rule these in or out as possible issues. This would involve some lab blood testing.

If I were you, I would give the wrist brace treatment a nice long trial period. If I did not get any relief, I would then find for myself an orthopedic doctor that specializes in hands.  He/she would be able to do an evaluation and get a more definitive diagnosis for what is going on.

Good Luck Jamie. I hope that you feel better soon and that you get some answers.

Keith Biggs, DC
http://www.eastmesachiropractor.com
http://www.biggschiropractic.blogspot.com