Houston Methodist. Leading Medicine

Wrist FAQ

Question:

My husband works as a cement engineer (mixer and layer). Every night he comes home and complains of wrist pain, swelling, and tenderness. In the last few months, he hasn't even been able to hold the trowel because of weakness. He refuses to see a doctor. I'm looking for answers as to what might be wrong. What do you think could be causing his symptoms?

Answer:

Any manual laborer involved in repetitive tasks who reports wrist pain, tenderness, swelling, and/or weakness could be suffering the effects of joint damage, ligament tears, leasions of the cartilage, and/or any combination of these problems. The problem could be something as simple as tendinitis (inflammation of the tendon). Another possibility is something called osteochondritis dissecans (OCD). OCD is a problem that usually affects the knee, but can also occur in other joints such as the elbow, ankle, and wrist. It's a localized problem, meaning it only affects one bone and doesn't spread. The primary area involved is the joint articular surface (cartilage lining the joint surface). A piece of the articular cartilage detaches or separates from the underlying layer called the subchondral bone. Basically, OCD is a separation of the joint lining from the first layer of bone underneath. When the subchondral bone just under the cartilage surface is injured, there is also damage of the blood vessels to the bone. Without blood flow, the area of damaged bone actually dies. This area of dead bone can be seen on an X-ray and is sometimes referred to as the osteochondritis lesion. A joint surface damaged by OCD doesn't heal naturally. Treatment involves surgery to replace the damaged bone with a healthy bone graft. One of the newer surgical approaches is the osteochondral autograft transplantation (OATS). The surgeon takes out the damaged area, harvests a piece of donor bone (from the patient), and replaces the damaged bone with the graft. The piece of bone graft is held in place with a wire until full healing takes place. The patient is placed in a protective splint to limit motion that might disrupt the graft. Studies show that manual laborers who have this particular problem and procedure are able to return to work. They are able to perform the job tasks once again without discomfort and with full return of wrist motion and strength. However, with continued repetitive motion, there is an increased risk for another episode of this problem. All of these potential problems are just guesses at what might be causing your husband's symptoms based on the history and symptoms you described. A clinical examination is really required before making any real diagnosis. Early treatment for problems like this often yield good results (better than waiting until the problem has progressed too far). Young-Keun Lee, MD, PhD, et al. Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Scaphoid: Case Report. In The Journal of Hand Surgery. May 2011. Vol. 36A. No. 5. Pp. 820-823.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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