Wrist Bursitis

A wrist consists of eight little bones and several ligaments, tendons and a couple of bursae. A wrist constantly performs movements all over the day. Normal regular activities like tying shoes, opening a door, getting dressed, preparing food, and for athletes performing their regular sports activities could become a very big issue when there is pain in most important part of the body such as the wrist.

The distinct synovial sheaths consist of the two main bursae of the hand, which include radial bursa and ulnar bursa. The radial bursa surrounds the thumb and continues to the crease of the wrist where as the ulnar bursa surrounds the tendons of the ring, middle, and index fingers. The infection caused to ulnar bursa and radial bursa is termed as horseshoe abscess.

Bursitis^[1] could be explained as an inflammation of a bursa that is a sac filled with fluid adjacent to the joints that acts like a cushion for the joint.

A bursa is a sac that is filled with lubricating fluid situated between tissues like muscles, tendons, skin, and bone that lessens irritation and friction between the tissues. The bursa causes pain in the wrist when subjected to continual trauma resulting in swelling and inflammation. This could strongly affect athletes such as the cyclists who frequently put the entire weight of their body on their hands.

• Irritation or inflammation is caused when there is a direct blow to the bursa.
• Wrist bursitis is a condition which is easily caused in the elderly people.
• Wrist bursitis may be caused when falling down putting weight on the bursa or the wrist.
• Wrist bursitis may also cause pressure on the bursa while using the wrist.
• Sports activities like badminton, throwing or pitching, biking, skiing, baseball, golf, raking and tennis may also cause wrist bursitis.
• Repetitive activities such as shoveling, gardening and painting could also be a major cause for developing the condition of wrist bursitis.
• Wrist bursitis may also occur to individuals having medical history of certain diseases such as thyroid disease, gout, rheumatoid arthritis and lupus.

• Tenderness over the tendons of wrist.
• Swelling in the wrist.
• Redness over the area of the wrist.
• Pain is felt while performing certain activities that put pressure on the bursa such as writing and typing.
• Pain is felt while performing activity that pressurizes the tendons that are lubricated by the bursa.
• Stiffness in the joints of the wrist.
• Pain in the hand could also be experienced.
• Pain becomes worse during movements of the wrist.
• Warmth over the area of the wrist.
• Development of a little lump in the top part of the wrist could be noticed which may be tender to touch.
• Pain may be experienced while bending the wrist backward and applying weight on the wrist.

• Rest.
• Cold therapy for pain.
• Use of compression bandage to help reduce the swelling.
• Anti-inflammatory medications such as ibuprofen and Naproxen.

Physical Therapy: PT for wrist bursitis is important in speeding up the healing process. Physical therapy also decreases the likelihood of recurrences in the future. Physical therapy for Wrist Bursitis may include:

• Application of heat and ice.
• Electrotherapy like ultrasound.
• Exercises to improve strength and flexibility.
• Activity modification and training.
• Appropriate plan for return to activity.

• Fine needle aspiration of bursa.
• Corticosteroid injections where the medication is injected into the bursa.

Of note, repeated injections can result in weakening of the wrist tendons.

Wrist Flexion: This exercise is performed by holding a hammer handle or soup can in the hand with palm facing the ceiling. Then bend the wrist in the upward direction. Gradually decrease the weight and come back to the starting posture. Perform 3 sets of 10. Slowly increase the weight of the object.

Wrist Extension: This exercise is performed by holding a hammer handle or soup can in the hand with palm facing downward. Slowly bend the wrist in the upward direction. Gradually decrease the weight coming back to the starting posture. Perform 3 sets of 10. Slowly increase the weight of the object.

Grip Strengthening: This exercise involves holding a tennis ball in the hand and squeezing it as hard as possible ensuring comfort without pain. Hold for 5 seconds and release. Perform 3 sets of 10 ensuring there is no exacerbation of symptoms.

Generally a complete subjective and physical examination is performed to diagnose wrist bursitis and to find out the possible affected structures. Few additional tests such as x-rays may be recommended to evaluate for other possible causes.

References:

Also Read:

• Bursitis: Hip, Ankle, Pes Anserine, Shoulder Joint