Wrist pain.
What is causing your wrist pain?
The wrist is a complex joint — eight carpal bones, multiple articulations, the distal radioulnar joint, a rich network of tendons crossing from the forearm, and the median, ulnar and radial nerves all passing through or immediately adjacent to it. This complexity means that wrist pain can arise from a wide range of structures, and accurate diagnosis is essential because the management of a wrist sprain is quite different from that of a median nerve entrapment, a De Quervain's tenosynovitis or a scaphoid fracture.
Wrist pain can cause significant discomfort and impact quality of life, ability to perform daily activities, and can lead to time off work — particularly for people in manual trades, healthcare, keyboard-based work and sport.
Common causes of wrist pain
Wrist sprains — the most common acute wrist injury — occur from a fall onto an outstretched hand or a sudden forced movement that overstretches the wrist ligaments. The scapholunate ligament is the most commonly injured and clinically significant wrist ligament — partial or complete tears produce wrist instability and chronic pain if not adequately managed. Mild sprains present with localised pain, swelling and bruising, and respond well to physiotherapy including joint mobilisation, stability training and progressive loading. More significant sprains with instability require careful assessment to identify the degree of ligamentous disruption and whether surgical intervention is warranted.
Carpal tunnel syndrome — compression of the median nerve as it passes through the carpal tunnel — produces pain, numbness, tingling and weakness in the thumb and first three fingers, typically worse at night and with sustained wrist flexion. It is the most common peripheral nerve entrapment and responds well to conservative physiotherapy in many cases. For post-surgical management, see our carpal tunnel release page.
De Quervain's tenosynovitis — inflammation of the tendon sheath around the extensor pollicis brevis and abductor pollicis longus tendons at the radial side of the wrist — produces pain and swelling over the radial styloid, particularly with thumb movements and gripping. It is common in new parents from repetitive infant lifting and in occupations requiring repetitive gripping and wrist deviation.
Triangular fibrocartilage complex (TFCC) injuries — tears or degeneration of the cartilage and ligament complex on the ulnar side of the wrist — produce ulnar-sided wrist pain aggravated by forearm rotation and power grip. TFCC injuries are common in racquet sports, gymnastics and manual occupations, and can be acute (from a fall or twisting injury) or degenerative.
Scaphoid fractures — the most frequently missed fracture in the wrist — produce anatomical snuffbox tenderness and pain with axial loading after a fall. They are frequently not visible on initial X-ray and require CT or MRI for definitive diagnosis. Missed scaphoid fractures that are inadequately treated can progress to avascular necrosis and non-union — making early diagnosis critical. For post-surgical scaphoid fracture fixation rehabilitation, see our dedicated page.
Wrist osteoarthritis — most commonly affecting the scaphotrapeziotrapezoid (STT) joint and the radioscaphoid joint — produces progressive wrist pain and stiffness, particularly with loading and extremes of motion. It is common following previous wrist injury or fracture.
Ganglion cysts — fluid-filled cysts arising from the wrist joint capsule or tendon sheaths — produce a visible or palpable lump on the dorsal or volar wrist, sometimes with aching pain. Many resolve spontaneously. Physiotherapy addresses the associated joint or tendon dysfunction contributing to cyst formation.
Ulnar nerve entrapment at Guyon's canal — the ulnar equivalent of carpal tunnel syndrome — produces numbness and tingling in the ring and little fingers with grip weakness. It is common in cyclists from handlebar pressure and in manual occupations.
Wrist tenosynovitis from repetitive occupational or sporting demands — affecting the extensor or flexor tendon sheaths — produces localised pain and crepitus with tendon movement.
How is wrist pain diagnosed?
A physiotherapy assessment involves a detailed history of the mechanism and onset, palpation of the specific structures in and around the wrist, stress testing of the relevant ligaments, and neurological assessment to identify nerve involvement. The pattern of pain location, aggravating activities and associated symptoms guides the differential diagnosis. X-ray identifies bony injuries and arthritis. Ultrasound visualises tendon and soft tissue pathology. MRI provides comprehensive assessment of ligamentous, cartilaginous and neural structures.
How can physiotherapy help?
The physiotherapy approach is specific to the underlying cause. For acute injuries, initial management focuses on swelling control, pain management and protected movement within comfortable limits. Manual therapy — joint mobilisation of the wrist, radiocarpal, midcarpal and distal radioulnar joints — restores normal joint mechanics and reduces pain. Neural mobilisation addresses nerve sensitisation in carpal tunnel and Guyon's canal presentations. Progressive strengthening of the wrist flexors, extensors and grip muscles rebuilds the functional capacity needed for work and sport.
Dry needling assists with forearm and wrist muscle tension management. Real time ultrasound can monitor tendon and ligament healing. Splinting and bracing provide support during healing phases for specific conditions. Ergonomic advice — workstation setup, tool grip modification, repetitive task management — addresses the occupational contributors that will perpetuate the problem if not modified.
For patients whose wrist condition developed in a workplace context, WorkCover funded physiotherapy is available.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
The wrist is a complex joint — eight carpal bones, multiple articulations, the distal radioulnar joint, a rich network of tendons crossing from the forearm, and the median, ulnar and radial nerves all passing through or immediately adjacent to it. This complexity means that wrist pain can arise from a wide range of structures, and accurate diagnosis is essential because the management of a wrist sprain is quite different from that of a median nerve entrapment, a De Quervain's tenosynovitis or a scaphoid fracture.
Wrist pain can cause significant discomfort and impact quality of life, ability to perform daily activities, and can lead to time off work — particularly for people in manual trades, healthcare, keyboard-based work and sport.
Common causes of wrist pain
Wrist sprains — the most common acute wrist injury — occur from a fall onto an outstretched hand or a sudden forced movement that overstretches the wrist ligaments. The scapholunate ligament is the most commonly injured and clinically significant wrist ligament — partial or complete tears produce wrist instability and chronic pain if not adequately managed. Mild sprains present with localised pain, swelling and bruising, and respond well to physiotherapy including joint mobilisation, stability training and progressive loading. More significant sprains with instability require careful assessment to identify the degree of ligamentous disruption and whether surgical intervention is warranted.
Carpal tunnel syndrome — compression of the median nerve as it passes through the carpal tunnel — produces pain, numbness, tingling and weakness in the thumb and first three fingers, typically worse at night and with sustained wrist flexion. It is the most common peripheral nerve entrapment and responds well to conservative physiotherapy in many cases. For post-surgical management, see our carpal tunnel release page.
De Quervain's tenosynovitis — inflammation of the tendon sheath around the extensor pollicis brevis and abductor pollicis longus tendons at the radial side of the wrist — produces pain and swelling over the radial styloid, particularly with thumb movements and gripping. It is common in new parents from repetitive infant lifting and in occupations requiring repetitive gripping and wrist deviation.
Triangular fibrocartilage complex (TFCC) injuries — tears or degeneration of the cartilage and ligament complex on the ulnar side of the wrist — produce ulnar-sided wrist pain aggravated by forearm rotation and power grip. TFCC injuries are common in racquet sports, gymnastics and manual occupations, and can be acute (from a fall or twisting injury) or degenerative.
Scaphoid fractures — the most frequently missed fracture in the wrist — produce anatomical snuffbox tenderness and pain with axial loading after a fall. They are frequently not visible on initial X-ray and require CT or MRI for definitive diagnosis. Missed scaphoid fractures that are inadequately treated can progress to avascular necrosis and non-union — making early diagnosis critical. For post-surgical scaphoid fracture fixation rehabilitation, see our dedicated page.
Wrist osteoarthritis — most commonly affecting the scaphotrapeziotrapezoid (STT) joint and the radioscaphoid joint — produces progressive wrist pain and stiffness, particularly with loading and extremes of motion. It is common following previous wrist injury or fracture.
Ganglion cysts — fluid-filled cysts arising from the wrist joint capsule or tendon sheaths — produce a visible or palpable lump on the dorsal or volar wrist, sometimes with aching pain. Many resolve spontaneously. Physiotherapy addresses the associated joint or tendon dysfunction contributing to cyst formation.
Ulnar nerve entrapment at Guyon's canal — the ulnar equivalent of carpal tunnel syndrome — produces numbness and tingling in the ring and little fingers with grip weakness. It is common in cyclists from handlebar pressure and in manual occupations.
Wrist tenosynovitis from repetitive occupational or sporting demands — affecting the extensor or flexor tendon sheaths — produces localised pain and crepitus with tendon movement.
How is wrist pain diagnosed?
A physiotherapy assessment involves a detailed history of the mechanism and onset, palpation of the specific structures in and around the wrist, stress testing of the relevant ligaments, and neurological assessment to identify nerve involvement. The pattern of pain location, aggravating activities and associated symptoms guides the differential diagnosis. X-ray identifies bony injuries and arthritis. Ultrasound visualises tendon and soft tissue pathology. MRI provides comprehensive assessment of ligamentous, cartilaginous and neural structures.
How can physiotherapy help?
The physiotherapy approach is specific to the underlying cause. For acute injuries, initial management focuses on swelling control, pain management and protected movement within comfortable limits. Manual therapy — joint mobilisation of the wrist, radiocarpal, midcarpal and distal radioulnar joints — restores normal joint mechanics and reduces pain. Neural mobilisation addresses nerve sensitisation in carpal tunnel and Guyon's canal presentations. Progressive strengthening of the wrist flexors, extensors and grip muscles rebuilds the functional capacity needed for work and sport.
Dry needling assists with forearm and wrist muscle tension management. Real time ultrasound can monitor tendon and ligament healing. Splinting and bracing provide support during healing phases for specific conditions. Ergonomic advice — workstation setup, tool grip modification, repetitive task management — addresses the occupational contributors that will perpetuate the problem if not modified.
For patients whose wrist condition developed in a workplace context, WorkCover funded physiotherapy is available.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
