The Wrist

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> The Invaluable Wrist

> Basic Wrist Anatomy

> Basic Wrist Function

> Types of Wrist Conditions

> Home Care of the Wrist

> Best Patient Resources

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> The Wrist

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Nerves

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This page has everything you need to get started understanding the wrist. I’ll get you up to speed on the important anatomy, the types of conditions that affect the wrist, and what to do at home for your own wrists. This is a starting point of understanding so you can build from here. My goal is for us to share enough understanding that we can then make important decisions about your wrist health together, if and when the time comes.

At the bottom of this page, please find a complete list of all the articles I’ve written on the wrist and the various conditions that affect it.

The Invaluable Wrist

Before we get too far, I think it’s important to define what exactly we are talking about when we say “The Wrist.”

In strict anatomical terms, the wrist is comprised of eight bones that we call the carpal bones. But for the sake of being complete, it is also reasonable to include the forearm bones, the radius and the ulna. The end of the radius and ulna meet together with the 8 carpal bones to comprise the functional unit that most of us think of as the wrist. In fact, a broken wrist, in layman's terms, typically means a broken radius near where it joins up with the carpal bones.

If you’ve read my page on The Hand, you’ll understand its importance as it relates to our evolution as a species. But without a highly mobile wrist that functions to place the hand in the perfect position, many of these advances would be useless. As I take you through wrist anatomy and function, you will develop an appreciation for just how many planes of motion the wrist can move through, resulting in an amplification of the inherited genius that is our hand.

Basic Wrist Anatomy

Bones

The human wrist is made of 8 carpal bones, joining together with two forearm bones (radius and ulna). The 8 carpal bone are arranged neatly in two rows, one stacked on top of the other. A critical carpal bone known as the scaphoid is the only bone that bridges the two rows, thus providing a structural anchor to the entire wrist.

Ligaments

Ligaments are stout soft tissue structures that exist between bones. Think of them as the stabilizing links that hold the bones in line and force them to rotate in the way they were designed for optimal function. The wrist is packed with important ligaments, interlocking and supporting the eight small carpal bones described above. Additionally, a massive ligament complex known as the triangular fibrocartilage complex (TFCC) exists between the carpal bones and the radius/ulna bones. In this location, it serves both as a shock absorber during grip and a stabilizer of the wrist during rotation. Wrist ligament injuries are a nagging nuisance at best and lead to devastating progressive degeneration of the wrist at worst.

Tendons

While there are certainly several important tendons of the wrist itself (tendons that exert an effect to extend or flex the wrist), the wrist is largely a ‘pass-through’ zone, an intricate network of the hand and finger tendons that cross back and forth across the wrist on the way to their functional destination. The most famous of all is the carpal tunnel, a narrow wrist tunnel through which nine different finger tendons pass (along with the median nerve - hint: carpal tunnel syndrome). But did you know there are also six additional ‘carpal tunnel’ passageways on the back side of your wrist? We commonly refer to these tunnels as ‘dorsal extensor compartments,’ and they play a huge role in various wrist conditions I treat.

Read more: De Quervain’s Tenosynovitis

Nerves

Similar to the story with the tendons, the wrist is largely a ‘pass-through’ zone for the nerves of the upper extremity. But that doesn’t mean our bodies escape nerve issues at the wrist. In fact, carpal tunnel syndrome is the most common nerve pathology of the upper extremity and it occurs as a result of what happens as the median nerve passes through the wrist. I have numerous sources on this site detailing carpal tunnel syndrome and all of its nuances.

Blood Vessels

All of the structures above require nutrition and waste disposal to work at their best and heal from injury. The circulatory system is responsible for this exchange, whether in the wrist or elsewhere in the body. Just as in the hand, the blood supply of the wrist has evolved to provide a dual supply to (nearly - ahem, the scaphoid) every component of the wrist.

Basic Wrist Function

The wrist is a beautiful machine. To support the complex movements of the hand, it allows for six different planes of motion, provides strength to the crossing tendons of the fingers, and provides cushioning to all of the activities of the upper extremity.

Motion

The wrist joints all combine to provide six different planes of motion. 1. Flexion, 2. Extension, 3. Radial deviation, 4. Ulnar deviation, 5. Pronation, 6. Supination.

The combination of these planes will allow us to put our hand in space, essentially however we please. The ability to do this relies on careful coordination of well-aligned bones, smoothly gliding joints, and the tendons/muscles that power these movements in concert with one another. Unfortunately, you can imagine how just one thing wrong with the wrist, whether from injury or degeneration, can throw off the entire working balance.

Strength

An underrated component of the wrist’s function is its architecture. The wrist has evolved to be a certain length to provide the internal strut on which to power finger flexion (grip) and extension. The muscles and tendons that contract to power the hand all of their own optimal tension. You can imagine a bad wrist fracture or degenerative arthritis over time can shorten the wrist relative to its normal anatomy. This shortening will take tension off the crossing tendons, thus significantly diminishing the contractile power they possess. Many patients note prolonged hand weakness after a trauma or degenerative change to the wrist.

Shock-Absorption

A final important category of wrist function is that of shock absorption. As we manipulate our hands in space, grip, or bear weight through the hands, notable forces are transmitted across the hands back up into the body. Transmitting that force from the hand to the forearm passes through the same stout ligament complex I mentioned above, the TFCC. The central component of this complex is a padded disc that cushions and absorbs forces between the hand and forearm. This is particularly important in activities of weightbearing (think push-ups), throwing, or (hopefully not) fighting.

Types of Wrist Conditions

Tunnel Pathologies

As mentioned in my section about “The Hand”, tunnels are a common theme in hand and upper extremity surgery. Whether it’s your tendons or nerves, many of these tubular structures pass through narrow tissue planes or ‘tunnels’ as they traverse the wrist between the hand and forearm. The most common of all is the ‘carpal tunnel.’

Degenerative

As time passes, the wrist will accumulate wear and tear that it cannot always heal. The whole of this process is referred to as degenerative disease. It can affect the bones (arthritis) but also the soft tissue ligaments and tendons of the wrist.

Wrist Lumps and Bumps

Masses and cysts are extremely common in the wrist. Many may be familiar with a ‘ganglion cyst,’ most frequently seen as a bubble-like mass on the back of the wrist. These often pop up overnight and can feel quite alarming when they come out of nowhere.

While these happen throughout the body, including the hand, the most common location is the back of the wrist. I often hear these referred to as “Bible cysts” – in medieval times, the treatment was to smash them with something heavy…oftentimes the heaviest thing within reach was the Bible! Fortunately, our treatment methods have improved since then.

Injury

Unfortunately, due to its complex structure, injury to the wrist is quite common. Whether bracing yourself as you land from a fall or experiencing a twisting injury, the wrist is at risk of frequent injury. The vast majority of wrist injuries could be categorized into either fractures or ligament injuries (scapholunate ligament tear or TFCC tear).

While any of the wrist bones can break, the most common by far is the distal radius fracture. If you fall and land on your wrist, more times than not this is the bone you will break. Many of these can be treated nonoperatively but there is a sizeable portion that will do better with surgical fixation.

Perhaps the most dreaded wrist fracture is a break of the scaphoid bone. This bone has naturally poor blood supply and makes healing of any fracture a challenge. Failure to heal will lead to a very predictable pattern of wrist pain and arthritis over the ensuing years. Take home message? Don’t ignore wrist pain after an injury! These are hard to diagnose, can be subtly not that painful, and require expert care.

Home Care of the Wrist

While there’s no way to describe here all that may go into caring for the wrist, here are a few basics to get you started.

If It Hurts, Don’t Do It

I mention this in my section on the hand as well, and I realize it may sound obvious. But it’s true.

If your wrist is injured or hurt to the point that you’re considering seeing a specialist, then it’s time to make some changes. If a particular activity hurts, either stop doing it or modify it in a way to prevent it from hurting. A brace can be a great tool for this

When In Doubt, Brace Temporarily

In contrast to the hand and fingers, the wrist readily responds to bracing. Any standard wrist brace from the pharmacy will usually get the job done. If you’re hurting and modifying your lifestyle here and there hasn’t worked, there’s a good chance a couple of weeks in a wrist brace will help. This is especially true for the tendinitis conditions we see of the wrist. Don’t brace full-time for more than 2 or 3 weeks without specialist care, or you will start to get stiff.

Never Ignore Wrist Injuries

If you find yourself using the above bracing advice following an injury, please consider seeing a specialist first. There are two or three subtle ligament injuries or fractures of the wrist that initially seem a bit sore, will then feel like they improve, but in reality will set your wrist on a path towards painful arthritis with few treatment options. Do not try to self-treat wrist injuries!! We see it too often and the results can be disastrous.

RICE Therapy

If there’s one thing you learn about caring for your wrists (or arms or legs or anything else musculoskeletal), let it be this.

If you have sustained an injury, there are several at-home treatments to start right away before you can get in to see a doctor. Let’s walk through how to treat yourself with what is commonly known as R.I.C.E. therapy.

R - Rest. If your wrist hurts following an injury, try to stop using it as much as possible. Even better, obtain a standard Velcro brace from your local pharmacy or a friend. This will immobilize the joints of your wrist and allow your injury to rest. While this may not be enough to definitively treat your injury, it will help with the initial stages of pain and inflammation.

I - Ice. It can be very helpful to use ice on the injured wrist. Be sure you have a protective layer between the ice and your skin (eg, dish towel, clothing). Do not ice the area for more than 20 minutes at a time. I typically recommend icing in a “20 minutes on, 20 minutes off” pattern.

C - Compression. Of all the stages of R.I.C.E., be the most careful with compression. Some find that some gentle compression feels good after an injury for extra stabilization. In general, we would recommend accomplishing this by using an elastic wrap bandage (Brand example: ACE wrap). However, it is crucial that you don’t stretch the elastic wrap bandage while you wrap. This will provide too much compression, and if your wrist swells, you can develop a painful or even permanently damaging condition. If you are interested in using compression, be sure to gently apply the bandage and re-evaluate frequently to ensure it is not becoming too tight with your wrist swelling. Never apply compression before going to sleep for the night.

E - Elevation. This is the most important one. I wish this were first in the mnemonic, but then it would spell E-R-I-C. Anyways, elevate, elevate, elevate. The higher the better. When you can, keep the wrist above the level of the heart. When that’s not possible, keep your hand above your elbow. Gravity is your friend! The more you elevate your injured wrist, the less swelling you will experience. The less swelling you experience, the less pain you will have. This is particularly crucial in the first few days after an injury.