University of Oklahoma Health Sciences Center

Radial Sided Wrist Pain: First Line Diagnostic Approach and Management of Selected Common Pathologies

Author/s:

Harris, Philipe, René Wittmer, Valois Emilie, Patrick G.

Abstract
Objective To provide a clinical overview of selected common pathologies causing radial-sided wrist pain and to guide primary care physicians in the diagnostic approach and initial management of these conditions.

Sources of information A literature review was conducted using the PubMed MEDLINE database, supplemented by reference musculoskeletal clinical textbooks.

Main message Radial-sided wrist pain has a wide differential diagnosis due to the complex anatomy of the wrist. A thorough clinical evaluation—including detailed history, physical examination, and appropriate imaging—is essential for accurate diagnosis. Several common conditions are presented with diagnostic features, relevant physical examination tests, and an overview of treatment options.

Conclusion Radial-sided wrist pain requires careful clinical assessment to differentiate among multiple pathologies originating from anatomic causes. Primary care physicians can effectively manage many of these conditions with appropriate diagnostic strategies and conservative treatments. Early recognition and targeted interventions can prevent complications and improve patient outcomes.

Musculoskeletal concerns account for about one-fifth to one-quarter of all primary care visits.1,2 Among those, hand and wrist concerns account for 47 to 60 cases per 1000 patients per year.3 Given the large number of anatomic structures in the relatively small volume of the wrist, radial-sided wrist pain can present a diagnostic challenge. We provide a clinical review of selected common hand and wrist pathologies affecting the radial side of the wrist, defined as the region from the distal radius to the mid-first volar and dorsal metacarpal to a line between the radius and ulna to the base of the second metacarpal.

Keywords

Wrist Pain primary care Diagnostic Approaach

Unilateral Strength Training Leads to Muscle-Specific Sparing Effects During Opposite Homologous Limb Immobilization

Author/s:

Andrushko, Justin W., Lanovaz, Joel L., Björkman, Kelsey M., Kontulainen, Saija A., Farthing, Jonathan P.

Cross education (CE) occurs after unilateral training whereby performance of the untrained contralateral limb is enhanced. A few studies have shown that CE can preserve or “spare” strength and size of an opposite immobilized limb, but the specificity (i.e., trained homologous muscle and contraction type) of these effects is unknown. The purpose was to investigate specificity of CE “sparing” effects with immobilization. The nondominant forearm of 16 participants was immobilized with a cast, and participants were randomly assigned to a resistance training (eccentric wrist flexion, 3 times/week) or control group for 4 weeks. Pre- and posttesting involved wrist flexors and extensors eccentric, concentric and isometric maximal voluntary contractions (via dynamometer), muscle thickness (via ultrasound), and forearm muscle cross-sectional area (MCSA; via peripheral quantitative computed tomography). Only the training group showed strength preservation across all contractions in the wrist flexors of the immobilized limb (training: −2.4% vs. control: −21.6%; P = 0.04), and increased wrist flexors strength of the nonimmobilized limb (training: 30.8% vs. control: −7.4%; P = 0.04). Immobilized arm MCSA was preserved for the training group only (training: 1.3% vs. control: −2.3%; P = 0.01). Muscle thickness differed between groups for the immobilized (training: 2.8% vs. control: −3.2%; P = 0.01) and nonimmobilized wrist flexors (training: 7.1% vs. control: −3.7%; P = 0.02). Strength preservation was nonspecific to contraction type (P = 0.69, ηp2 = 0.03) yet specific to the trained flexors muscle. These findings suggest that eccentric training of the nonimmobilized limb can preserve size of the immobilized contralateral homologous muscle and strength across multiple contraction types.

NEW & NOTEWORTHY Unilateral strength training preserves strength, muscle thickness, and muscle cross-sectional area in an opposite immobilized limb. The preservation of size and strength was confined to the trained homologous muscle group. However, strength was preserved across multiple contraction types.

Keywords

strength training resistance training