What are the signs and symptoms of wrist swelling?

Signs and Symptoms of Wrist Swelling

The most important signs and symptoms of wrist swelling include visible enlargement, pain, limited range of motion, and warmth or redness over the affected area, which should prompt appropriate diagnostic imaging starting with radiographs. 1

Clinical Presentation of Wrist Swelling

Visual and Physical Signs

• Visible enlargement or puffiness around the wrist joint
• Asymmetry when compared to the unaffected wrist
• Skin changes including:
  • Redness (erythema)
  • Warmth to touch
  • Shiny or stretched appearance of skin
• Palpable abnormalities:
  • Fluid fluctuation
  • Nodular masses (in cases of ganglion cysts)
  • Tenderness to touch 2

Functional Symptoms

• Limited range of motion in the wrist joint
• Pain that may:
  • Worsen with movement
  • Be present at rest
  • Increase with specific activities
• Stiffness, especially in the morning or after periods of inactivity
• Decreased grip strength 1, 3
• Mechanical symptoms such as clicking, catching, or locking 1

Diagnostic Algorithm for Wrist Swelling

Step 1: Initial Assessment

• Radiographs are the most appropriate first imaging study for evaluating wrist swelling 1, 2
  • Standard 3-view examination (posteroanterior, lateral, and oblique views)
  • Can identify arthritis, fractures, bone tumors, and soft tissue swelling

Step 2: Based on Radiograph Findings

• Normal or nonspecific radiographs:

  • For persistent symptoms, proceed to MRI without contrast (preferred) or ultrasound 1, 2
  • MRI is particularly valuable for detecting ligamentous injuries, triangular fibrocartilage complex tears, and occult fractures 1
  • Ultrasound is useful for evaluating soft tissue swelling, tendon pathology, and ganglion cysts 1, 4

• Abnormal radiographs:

  • For suspected fracture with displacement >1mm: consider surgical fixation 2
  • For suspected infection: proceed to aspiration 1
  • For suspected arthritis: consider inflammatory markers and additional views 1

Common Causes of Wrist Swelling by Presentation Pattern

Acute Traumatic Swelling

• Fractures (particularly scaphoid and distal radius)
• Ligament tears (especially scapholunate)
• Triangular fibrocartilage complex (TFCC) injuries 2, 5

Chronic or Recurrent Swelling

• Inflammatory arthritis (e.g., rheumatoid arthritis)
• Osteoarthritis
• Ganglion cysts
• Tenosynovitis (including de Quervain's) 6, 7, 4

Swelling with Specific Characteristics

• Localized nodular swelling: Often indicates ganglion cyst 4
• Diffuse swelling with warmth/redness: Suggests inflammatory process or infection 1, 6
• Swelling with mechanical symptoms: May indicate internal derangement 1

Clinical Pearls and Pitfalls

Important Considerations

• Persistent wrist swelling for more than 2 months despite conservative treatment warrants advanced imaging 2
• Early and continuous suppression of inflammatory activity in conditions like rheumatoid arthritis is crucial to prevent erosive damage 6
• Anatomical variations (such as anomalous muscles) can cause swelling and may require ultrasound for diagnosis 7

Common Pitfalls

• Failing to obtain proper radiographic views, which can miss fractures (especially scaphoid)
• Overlooking inflammatory causes when trauma is reported
• Mistaking ganglion cysts for more serious conditions or vice versa
• Delaying diagnosis of infections, which require prompt intervention 1, 3

By systematically evaluating these signs and symptoms and following an appropriate diagnostic algorithm, clinicians can effectively identify the cause of wrist swelling and implement appropriate treatment to improve outcomes related to morbidity, mortality, and quality of life.