Carpal tunnel syndrome is a common cause of wrist pain. You may feel aching, burning, numbness, or tingling in your palm, wrist, thumb, or fingers. The thumb muscle can become weak, making it difficult to grasp things. Pain may extend up to your elbow.

Carpal tunnel syndrome occurs when an important nerve (called the median nerve) gets compressed at the wrist because of swelling. Such swelling can occur if you:

• Do a repetitive motion with your wrist like typing on a computer keyboard, using a computer mouse, playing racquetball or handball, sewing, painting, writing, or using a vibrating tool.
• Are pregnant, menopausal, or overweight.
• Have diabetes, premenstrual syndrome, an underactive thyroid, or rheumatoid arthritis.

Wrist pain with bruising and swelling is often a sign of an injury. The signs of a possible broken bone include misshapen joints and inability to move the wrist, hand, or a finger. Other common injuries include sprain, strain, tendinitis, and bursitis.

Arthritis is another common cause of wrist pain, swelling, and stiffness. There are many types of arthritis. Osteoarthritis occurs with age and overuse. Rheumatoid arthritis generally affects both wrists. Psoriatic arthritis accompanies psoriasis.

Infectious arthritis is a medical emergency. The signs of an infection include redness and warmth of the wrist, fever above 100°F, and recent illness.

Other common causes of wrist pain include:

• Gout -- this occurs when you produce too much uric acid, a waste product. It forms crystals in joints, rather than being excreted in the urine.
• Pseudogout -- this is when calcium deposits in your joints (usually the wrists or knees), causing pain, redness, and swelling.

For carpal tunnel syndrome, you may need to make adjustments to your work habits and environment:

• Make sure that your keyboard is low enough that your wrists aren't bending upwards while you type.
• Take plenty of breaks from activities that aggravate the pain. When typing, stop often to rest the hands, if only for a moment. Rest your hands on their sides, not the wrists.
• An occupational therapist can show you ways to ease pain and swelling and stop the syndrome from coming back.
• Over-the-counter pain medications like ibuprofen or naproxen can relieve pain and swelling.
• Various mousepads, typing pads, split keyboards, and wrist splints (braces) are designed to relieve wrist pain. Some people find these devices help their symptoms. You may wish to try a few different kinds to see if any help.
• You may only need to wear a wrist splint at night while you sleep. This helps reduce the swelling. If that alone is not working, wear the splints during the day and apply hot or cold compresses periodically.

For a recent injury:

• Rest your wrist. Keep it elevated.
• Apply ice to the tender and swollen area.
• Take over-the-counter pain medication, like ibuprofen or acetaminophen.
• Wear a splint for several days. Wrist splints can be purchased at many drugstores and medical supply stores.

For non-infectious arthritis:

• Do flexibility and strengthening exercises every day. Work with a physical therapist to learn the best and safest exercises for your wrist.
• Try the exercises after a hot bath or shower so that your wrist is warmed up and less stiff.
• DO NOT perform exercises when your wrist is actively inflamed.
• Make sure that you also rest the joint adequately. Both rest and exercise are important when you have arthritis.

Get emergency care if:

• You are unable to move your wrist, hand or a finger.
• Your wrist, hand, or fingers are misshapen.
• You are bleeding significantly.

Call your doctor right away if:

• You have a fever over 100°F.
• You have a rash.
• You have swelling and redness of your wrist and you have had a recent illness (like a virus or other infection).

Call your doctor for an appointment if:

• You have swelling, redness or stiffness in one or both wrists.
• You have numbness, tingling, or weakness in the wrist, hand, or fingers with pain.
• You have lost any muscle mass in the wrist, hand, or fingers.
• You have been following self-care treatments for two weeks but still have pain.

Your doctor will perform a physical examination, which may include an examination of the wrists and hands, and ask questions such as the following:

• When did the wrist pain begin?
• Did it occur suddenly and severely or gradually and mildly?
• Is the pain constant, or does it come and go?
• Is the pain worse in the morning or at night?
• Does it go away without self care?
• Is the pain sharp, throbbing, or burning? Is there numbness or tingling in any of your fingers?
• Where exactly is the pain? Is it in both wrists? Does it extend into the fingers?
• Does the pain occur only with certain movements or positions?
• Does the pain prevent normal use of the wrist, hand, or arm?
• Is the pain worse with movement?
• What helps it? Is it better with immobilization to prevent movement? Does splinting the wrist or applying heat help?
• Do any medications help?
• Is there joint pain elsewhere?
• Is there pain elsewhere, such as the neck?
• What medications are you taking?
• Have you had any recent injuries or illnesses?
• Are you involved in activities requiring repetitious hand and wrist movements, such as sewing, knitting, computer keyboard use?

Diagnostic tests that may be performed include an x-ray. If your doctor suspects that you have an infection, gout, or pseudogout, he or she may draw fluid from from the joint to examine under a microscope.

Anti-inflammatory drugs may be prescribed. Injection with a steroid medication may be performed. Surgery or medications may be needed to treat some conditions.

To prevent carpal tunnel syndrome:

• Adjust your keyboard so that you do not have to bend your wrist upward while typing.
• Take frequent breaks from activities that require wrist movement.
• Work with an occupational therapist.

To prevent gout attacks:

• Limit alcohol.
• Lose weight if you are overweight.
• Drink plenty of water.
• Eat lower amounts of liver, anchovies, sardines, and herring.
• Your doctor may prescribe medication.

Viera AJ. Management of carpal tunnel syndrome. Am Fam Physician. 2003; 68(2): 265-272.

Padua L. Carpal tunnel syndrome in pregnancy: Multiperspective follow-up of untreated cases. Neurology. 2002; 59(10): 1643-1646.

American Academy of Orthopaedic Surgeons (AAOS). AAOS clinical guideline on wrist pain - phase I. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2002.