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Causes of chronic wrist pain in children and adolescents

D Scott Upton, MD
Joseph Chorley, MD
Section Editors
Albert C Hergenroeder, MD
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


Injuries to the wrist are common in children, adolescents, and young adults. A thorough understanding of the anatomy of the growing wrist, common wrist injuries, and other causes of wrist pain are essential to accurate diagnosis and appropriate treatment.

Causes of chronic wrist pain in children and adolescents include acute injuries that have failed to heal, overuse syndromes, and pain unrelated to trauma. Traumatic and nontraumatic causes of chronic wrist pain in children and adolescents will be presented here. Acute wrist injuries, wrist anatomy, and the evaluation of wrist pain in children and adolescents are discussed separately. (See "Overview of acute wrist injuries in children and adolescents" and "Evaluation of wrist pain and injury in children and adolescents".)


Overuse injuries, which include tendonitis, distal radius physeal stress reaction, Kienböck's disease, chronic distal radioulnar joint (DRUJ) and triangular fibrocartilage complex (TFCC) injury, neuropathy, and impaction syndromes, are more common among adolescents than younger children (table 1). Overuse injuries have insidious symptoms; they frequently are identified when an acute injury is superimposed at the site of previous microtrauma [1]. Risk factors for overuse injuries in children and adolescents include rapid intensification of training, muscle-tendon imbalance, poor conditioning before training, deficient nutrition, associated chronic disease, and periods of rapid growth [1,2].

Tendon injuries — Tendonitis involves inflammation of the tendon or its synovial sheath. Tendonitis is caused by repetitive motion or impact stress (eg, in gymnastics, racquet sports). Clinical features include pain that is exacerbated by activity and can be reproduced by passive stretching of the affected tendon or active contraction of the associated muscle [3]. Radiographs are not usually necessary in the evaluation of patients with tendonitis but may be helpful in excluding other injuries or conditions.

Treatment strategies for tendonitis include rest, bracing, antiinflammatory agents, glucocorticoid injections, and correcting the training error or biomechanical etiology. Sports activity can be gradually resumed once symptoms have resolved.

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Literature review current through: Nov 2017. | This topic last updated: Nov 08, 2016.
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  1. Gill TJ 4th, Micheli LJ. The immature athlete. Common injuries and overuse syndromes of the elbow and wrist. Clin Sports Med 1996; 15:401.
  2. O'Neill DB, Micheli LJ. Overuse injuries in the young athlete. Clin Sports Med 1988; 7:591.
  3. Mastey RD, Weiss AP, Akelman E. Primary care of hand and wrist athletic injuries. Clin Sports Med 1997; 16:705.
  4. Werner SL, Plancher KD. Biomechanics of wrist injuries in sports. Clin Sports Med 1998; 17:407.
  5. Rettig AC. Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med 2004; 32:262.
  6. Nguyen DT, McCue FC 3rd, Urch SE. Evaluation of the injured wrist on the field and in the office. Clin Sports Med 1998; 17:421.
  7. Garcia-Moral CA, Green NE, Fox JA.. Hand and wrist. In: Care of the Young Athlete, Sullivan JA, Anderson SJ (Eds), American Academy of Orthopedic Surgeons and American Academy of Pediatrics, 2000. p.349.
  8. Parmelee-Peters K, Eathorne SW. The wrist: common injuries and management. Prim Care 2005; 32:35.
  9. Rettig AC. Wrist and hand overuse syndromes. Clin Sports Med 2001; 20:591.
  10. Gabel GT. Gymnastic wrist injuries. Clin Sports Med 1998; 17:611.
  11. Kramer RC, Lichtman DM. Kienbock's disease. In: The Wrist, Lippincott Williams & Wilkins, Philadelphia 2001. p.395.
  12. Howse C. Wrist injuries in sport. Sports Med 1994; 17:163.
  13. Simmons BP, Lovallo JL. Hand and wrist injuries in children. Clin Sports Med 1988; 7:495.
  14. Rettig AC. Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist. Am J Sports Med 2003; 31:1038.
  15. Geissler WB. Carpal fractures in athletes. Clin Sports Med 2001; 20:167.
  16. Linscheid RL, Dobyns JH. Athletic injuries of the wrist. Clin Orthop Relat Res 1985; :141.
  17. Dell PC. Traumatic disorders of the distal radioulnar joint. Clin Sports Med 1992; 11:141.
  18. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg Am 1981; 6:153.
  19. Cober SR, Trumble TE. Arthroscopic repair of triangular fibrocartilage complex injuries. Orthop Clin North Am 2001; 32:279.
  20. Wood MB, Dobyns JH. Sports-related extraarticular wrist syndromes. Clin Orthop Relat Res 1986; :93.
  21. Frontera WR. Cyclist's palsy: clinical and electrodiagnostic findings. Br J Sports Med 1983; 17:91.
  22. Osterman AL, Moskow L, Low DW. Soft-tissue injuries of the hand and wrist in racquet sports. Clin Sports Med 1988; 7:329.
  23. Plancher KD, Peterson RK, Steichen JB. Compressive neuropathies and tendinopathies in the athletic elbow and wrist. Clin Sports Med 1996; 15:331.
  24. Nuber GW, Assenmacher J, Bowen MK. Neurovascular problems in the forearm, wrist, and hand. Clin Sports Med 1998; 17:585.
  25. Rettig AC, Patel DV. Epidemiology of elbow, forearm, and wrist injuries in the athlete. Clin Sports Med 1995; 14:289.
  26. Le TB, Hentz VR. Hand and wrist injuries in young athletes. Hand Clin 2000; 16:597.
  27. Rao SB, Crawford AH. Traumatic and acquired wrist disorders in children. In: The Wrist and Its Disorders, Lichtman A (Ed), WB Saunders, St. Louis 1999.
  28. Tachdijan MO. The neck and upper limb. In: Clinical Pediatric Orthopedics: The Art of Diagnosis and Principles of Management, Appleton and Lange, Stamford 1997. p.263.
  29. Waters PM. The upper limb. In: Lovell and Winter's Pediatric Orthopaedics, 6th, Morrissy RT, Weinstein SL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.921.