Causes of Wrist Pain a Throbbing Mystery

A hand typing.

Is the wrist built to handle the tasks of modern life? IStockPhoto hide caption

itoggle caption IStockPhoto

A year and a half ago, my wrists exploded.

OK, my wrists didn't really "explode"– but it sure felt that way. I'm a newspaper journalist, and whenever I tried to type up a story, I would feel a piercing pain.

Typing just a few words was enough to set off the pain. My wrists tingled and throbbed for hours. And the pain never went away completely.

I couldn't stop writing altogether, since I earn my living at the keyboard. So, I tried anti-inflammatory medicines, painkillers and, finally, rest. No luck.

I began using a voice recognition program that translates spoken word into text. It works, but you have to speak slowly and robotically, which feels silly. And. Slows. Down. Writing.

Looking for help, I began visiting doctors. One hand specialist said I had carpal tunnel syndrome, an injury to a nerve that runs through my wrist and supplies electricity to my finger muscles.

Another expert disagreed. He didn't know what I had, but said it was definitely not carpal tunnel.

A third diagnosed the pain as inflamed tendons in my wrists. She tried injecting cortisone — an anti-inflammatory — directly into the tendons. It made no difference.

Yet another doctor did an MRI and said my wrists looked completely normal.

But they didn't feel normal. In desperation, I began doing research on my own.

I discovered that millions of Americans have chronic wrist pain. One study found that as many as five percent of the population may suffer from carpal tunnel syndrome. Every year, between 200,000 and 400,000 of us undergo carpal tunnel surgery. And surgery works in the vast majority of cases.

Even so, doctors don't have a good handle on what's actually happening inside all these aching wrists. To me, that's the most amazing part. There are almost half a million surgeries a year, but no one can really explain the underlying problem.

One of the experts I talked to, Mayo Clinic hand expert Peter Amadio, says he thinks the human wrist isn't designed for modern life.

"We're taking an anatomy that has evolved over hundreds of millions of years," Amadio says, "but not necessarily for the purposes we're putting it to at the moment. The human hand is doing lots of different things, using lots of different positions, and lifting heavy things, doing fine manipulations, a variety of different activities, and so these tissues need to adapt. And it's not unreasonable that the adaptations might fail in certain cases.

Amadio also thinks that many wrist problems start with overly sticky tendons. The wrist contains nine tendons, six bones, two bursa, two nerves and a mass of grisly connective tissue binding it all together. That's a whole lot of moving parts in a tight space.

"The tendons all have a lining, and normally, under the microscope, this lining kind of looks like puff pastry, you know, with all those different layers of dough that you can see, like in a baklava," Amadio says. "And each of those layers slides on the layer below it as the fingers move, that's the normal arrangement. In patients with carpel tunnel syndrome, all those layers are basically fused, or glued together."

Amadio says once tendons are gummed up, they become thick and scarred. That creates pressure on the nerve, and causes tingling, throbbing and pain.

Maybe that's my problem: layers of tendon are scraping together too much.

But I'm still going to explore another possibility. Some experts think pain in your wrists and fingers may not have anything to do with your wrists and fingers. One doctor says wrist pain is often referred from the elbow, the neck, the shoulder — even the back.

I have an appointment to find out more next month. Until, then I will just have to speak. Slowly. And. Enunciate.

David Kohn, a medical reporter for the Baltimore Sun, is currently on a Nieman Fellowship at Harvard.

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