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Wrist – Anatomy, Conditions and Treatment

The wrist connects the hand to the forearm and allows a wide range of movements. It consists of several bones, ligaments, and tendons working together.

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The wrist connects the hand to the forearm and allows a wide range of movements. It consists of several bones, ligaments, and tendons working together.

What is the Wrist?

The wrist (Latin: Articulatio radiocarpalis) is a complex joint that connects the hand to the forearm. It is made up of multiple small bones, ligaments, tendons, and cartilage structures that work together to enable a wide variety of movements essential for everyday tasks such as writing, gripping, and lifting.

Anatomy of the Wrist

The wrist consists of two main functional units:

Proximal wrist joint (radiocarpal joint): The connection between the radius (forearm bone) and the proximal row of carpal bones (scaphoid, lunate, triquetrum).
Distal wrist joint (midcarpal joint): The connection between the proximal and distal rows of carpal bones.

In total, the wrist contains eight small carpal bones arranged in two rows. The joint is stabilized by numerous ligaments, and the tendons of the forearm muscles pass through the carpal tunnel to reach the hand.

Movements of the Wrist

The wrist allows the following main movements:

Dorsiflexion (extension): Bending the hand upward toward the back of the hand
Palmar flexion: Bending the hand downward toward the palm
Radial deviation: Moving the hand sideways toward the thumb
Ulnar deviation: Moving the hand sideways toward the little finger
Circumduction: Circular movement of the hand

Common Wrist Conditions and Injuries

Sprain and Ligament Tear

Wrist sprains most commonly occur from falls onto an outstretched hand. Ligaments may be overstretched or torn. Symptoms include pain, swelling, and limited range of motion.

Wrist Fracture

The most common wrist fracture is a distal radius fracture. It typically results from a fall and is treated conservatively with a cast or splint, or surgically depending on the severity.

Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve is compressed within the carpal tunnel. Typical symptoms include tingling, numbness, and pain in the thumb, index, and middle fingers, especially at night.

Tendon Sheath Inflammation (Tenosynovitis)

Irritation or inflammation of the tendon sheaths around the wrist can be caused by overuse, repetitive movements, or infection. Those affected experience pain and a grating sensation during movement.

Wrist Osteoarthritis

Wrist osteoarthritis involves the gradual breakdown of joint cartilage, leading to chronic pain, stiffness, and reduced load-bearing capacity. It can develop with age or following a previous injury.

Ganglion Cyst

A ganglion cyst is a benign, fluid-filled cyst that commonly appears on the back or front of the wrist. It is usually harmless but can cause pressure and discomfort.

Diagnosis

Various diagnostic methods are used to evaluate wrist complaints:

Physical examination: Inspection, palpation, and assessment of range of motion
X-ray: To detect fractures or signs of osteoarthritis
Ultrasound: Assessment of tendons, ligaments, and cysts
MRI (Magnetic Resonance Imaging): Detailed visualization of soft tissues, ligaments, and cartilage
Nerve conduction study (NCS): Used when carpal tunnel syndrome is suspected

Treatment

Treatment for wrist problems depends on the underlying cause:

Conservative therapy: Immobilization, splints, physical therapy, anti-inflammatory medications (e.g., ibuprofen)
Physiotherapy: Strengthening and stretching exercises to restore function
Injection therapy: Corticosteroid or hyaluronic acid injections for inflammation or osteoarthritis
Surgical treatment: For severe injuries, carpal tunnel syndrome, or advanced osteoarthritis

References

Platzer, W. - Color Atlas of Human Anatomy, Vol. 1: Locomotor System. 7th Edition, Thieme Publishers, Stuttgart 2014.
Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd Edition, Elsevier, 2020.
American Academy of Orthopaedic Surgeons (AAOS) - Wrist Injuries and Disorders. www.orthoinfo.aaos.org, accessed 2024.

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