After shoulder pain, wrist complaints are among the most common reasons patients seek chiropractic care for upper limb issues. Before treatment begins, the likely cause of the patient’s wrist symptoms must be identified. Let’s review the most common causes of wrist pain and the key features that help differentiate them:

• If a patient presents with fever (suggesting possible septic arthritis), severe pain out of proportion to the injury or sudden neurologic changes (raising concern for acute compartment syndrome), or significant trauma (like a suspected scaphoid fracture), immediate referral to the emergency room is warranted.
• Carpal tunnel syndrome is the most common peripheral neuropathy and is characterized by numbness and tingling in the median nerve distribution (thumb, index, middle, and radial half of the ring finger). Positive findings on physical examinations that involve compression of the wrist strongly support this diagnosis.
• De Quervain’s tenosynovitis causes pain on the thumb side of the wrist and most commonly affects women ages 30–50, especially postpartum. A positive Finkelstein test (thumb in fist, bend wrist toward pinky—pain on thumb side is positive) supports this diagnosis.
  Osteoarthritis of the wrist or carpometacarpal joint can cause pain and stiffness during gripping, pinching, and other hand-intensive activities. It may lead to visible deformity and is typically confirmed with X-ray imaging.
• A fall on an outstretched hand can result in a wrist sprain or ligament injury. Pain is typically localized and reproduced with palpation and range-of-motion testing. Mild-to-moderate swelling, no visible deformity, no neurovascular deficits, and preserved (though painful) range of motion help differentiate this from more serious trauma.
• Triangular fibrocartilage complex injury presents with pain on the ulnar (pinky) side of the wrist, often following trauma or repetitive axial loading (motions like pushing up off a chair or performing a push-up that direct force through the wrist into the forearm). Tenderness over the ulnar fovea and pain or clicking with forceful wrist rotation are suggestive findings.
• Flexor or extensor tendinopathy results from overuse of the forearm and wrist musculature, presenting as localized pain along the affected tendon(s), often aggravated by resisted movement.

Once the likely source of wrist pain is identified, treatment typically involves a combination of manual therapy and targeted exercises to reduce stress on affected tissues and restore normal joint function. Patients who do not respond as expected may be referred for further evaluation or advanced imaging.