What treatment options are available for a patient with wrist pain after repetitive movement?

Treatment of Wrist Pain After Repetitive Movement

For wrist pain from repetitive movement, begin with rest, NSAIDs or acetaminophen, and activity modification, followed by progressive rehabilitation exercises once acute symptoms improve. 1, 2, 3

Initial Management

Immediate Interventions

• Rest and activity modification: Stop or significantly reduce the repetitive activity causing pain 4, 5
• Immobilization: Use a wrist splint to protect the affected joint during the acute inflammatory phase 4
• Pharmacologic pain control:
  • Ibuprofen 400 mg every 4-6 hours as needed (maximum 3200 mg daily) 2
  • Alternatively, acetaminophen 650 mg for pain relief 1, 3
  • NSAIDs are preferred over acetaminophen for their anti-inflammatory properties in tendinopathy 6
• Ice application: Apply ice to reduce acute inflammation 6

Diagnostic Considerations

• Obtain standard radiographs (posterior-anterior, lateral, and oblique views) to rule out fractures, arthritis, or bone pathology 1, 7
• Identify the specific anatomical location of pain to narrow the differential:
  • Radial-sided pain: Consider de Quervain tenosynovitis 1, 8
  • Ulnar-sided pain: Consider distal radioulnar joint pathology or ulnar neuropathy 1, 8
  • Central wrist pain: Consider ganglion cysts or Kienböck disease 1
  • Dorsal wrist pain with palpation tenderness: Consider extensor tendonitis 9

Progressive Rehabilitation Phase

Active Finger Motion (Immediate)

• Begin active finger range of motion exercises immediately to prevent finger stiffness, which is one of the most functionally disabling complications 6
• Instruct patients to move fingers regularly through complete range of motion from the first encounter 6
• This intervention is cost-effective and does not adversely affect wrist healing 6

Wrist Rehabilitation (After Acute Phase)

• Delay wrist motion exercises until pain and inflammation are controlled; early wrist motion is not necessary for stable injuries 6
• Progress to eccentric exercises once acute symptoms resolve to reduce pain, increase strength, and promote tendon healing 6
• Incorporate varied repetitive task practice using functional activities rather than isolated movements 6

Workplace and Activity Modifications

Ergonomic Interventions

• Reduce hand force requirements, as force is the strongest risk factor for hand-wrist pain and tendonitis (OR 1.7 for pain, OR 1.9 for tendonitis) 9
• Minimize repetitive wrist movements where possible, as repetition increases risk of incident hand-wrist pain (OR 1.6) 9
• Provide patient education about proper technique and load management 4
• Implement sporting or workplace adaptations to reduce repetitive stress 4

Advanced Treatment Options

If Conservative Management Fails After 6-8 Weeks

• Consider corticosteroid injection for acute phase symptom relief, though this does not change long-term outcomes 6
• Order MRI without IV contrast if radiographs are normal but symptoms persist, to evaluate soft tissue pathology including tendons, ligaments, TFCC, and neurovascular structures 1, 7
• Consider ultrasound for suspected tendon pathology (tendonitis, tenosynovitis) or ganglion cysts 1, 7

Surgical Referral

• Refer to orthopedic surgery if pain persists despite well-managed conservative treatment trial of at least 6-8 weeks 6
• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis 6

Common Pitfalls to Avoid

• Do not use splinting long-term, as prolonged immobilization leads to muscle deconditioning, learned non-use, and potentially worsening symptoms 6
• Do not allow finger stiffness to develop, as this is extremely difficult to treat after fracture healing and may require multiple therapy visits or additional surgery 6
• Do not rely on corticosteroid injections alone, as they provide only short-term benefit without improving long-term outcomes 6
• Do not ignore force requirements in the patient's work or activities, as force is more consistently associated with wrist disorders than repetition or position 9

Multidisciplinary Team Involvement

• Engage physical or occupational therapy early for supervised rehabilitation and ergonomic assessment 4
• Consider referral to rheumatology if inflammatory arthritis is suspected based on morning stiffness, bilateral symptoms, or systemic features 1