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Causes of Wrist Pain a Throbbing Mystery

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Causes of Wrist Pain a Throbbing Mystery

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Causes of Wrist Pain a Throbbing Mystery

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DEBORAH AMOS, host:

Newspaper journalist David Kohn would have been happy to find any medicine for a wrist that started to bother him a year and a half ago. Kohn says whenever he tried to type a story, his wrist exploded with pain.

Mr. DAVID KOHN (Newspaper Journalist): Okay. My wrists didn't really explode but it sure felt that way. 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 stopped writing altogether since I earned 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 wrists and supplies electricity to my finger muscles. But another expert disagreed. He didn't know what I had but said it was definitely not carpel tunnel.

A third diagnosed the pain as inflamed tendons in my wrists. She tried injecting cortisone, another anti-inflammatory, directly into the tendons. It made no difference. Yet another doctor did an MRI and said my wrists looked completely normal.

But since 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 5 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 most of the time.

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. 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 surgeon Peter Amadio, says he things the human wrist isn't designed for modern life.

Dr. PETER AMADIO (Mayo Clinic Hand Surgeon): What we don't know is what causes the pressure to build up. Usually there's not any obvious reason, like a disease that makes the tendons or nerves swell, or severe arthritis that causes a deformity in the bones that surround the carpal tunnel.

Mr. KOHN: 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 gristly connective tissue binding it all together. That's a whole lot of moving parts in a tight space.

Dr. AMADIO: The tendons all have a lining. And normally this lining, under the microscope, it kind of looks like puff pastry, you know, with all of those different layers of dough that you can see like in a baklava or something. And each of those layers slides on the layer below it as the fingers move. That's the normal arrangement.

And patients with carpal tunnel syndrome, all those layers are basically fused or glued together.

Mr. KOHN: Amadio says once it's gummed up, the tendons become thick and scarred. That's creates pressure on the nerve and causes the 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 the pain in your wrist and fingers may not have anything to do with your wrist 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.

For NPR News, I'm David Kohn.

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