Bending back under load moves the pressure to the back of the wristEmerging evidence
Push-ups, planks, downward dog, crawling and pushing up from a chair all put body weight through a wrist bent back towards a right angle: in 10 trained practitioners, a sun salutation took the wrist to about 85 degrees. In 8 donated wrists, a push-up with the wrist bent back raised the peak pressure at the joint between the radius and the scaphoid, compared with a straight-wrist knuckle push-up, and moved the pressure towards the back of the wrist. In 14 volunteers, force travelled further towards the back and the little-finger side of a bent-back wrist.
Raising the hands, or doing push-ups from the knees, puts less force through them than standard push-ups, and feet-raised push-ups put more, in two lab studies of 23 adults and 28 trained men. These are lab studies of load, not trials in people with pain, but they explain why changing the hand position usually helps.
Sources 1, 2, 3, 4, 5
Common where hands bear weightEmerging evidence
Pooled across 25 studies, about half of adolescent artistic gymnasts (53%) reported wrist pain, on low to very low certainty evidence. In an online survey of 321 adults who practise handstands, 56.7% had long-lasting wrist pain. In 270 CrossFit athletes, 20.4% had had a hand or wrist injury, most often at the wrist, and 72.8% were back to full training within a month. These are surveys of people who chose to answer, so they show the problem is common, not exactly how common.
Sources 6, 7, 8
The back of the wrist pinched, or a hidden ganglion: real but thinly studiedMixed evidence
Pain in the middle of the back of the wrist, worse with full bending back under load, can come from the soft joint lining being pinched (dorsal capsular impingement), a review for athletes' doctors says; the starting injury may be minor and X-rays are normal. The only systematic review found 6 small retrospective studies of 231 operated patients, aged 27 to 42 on average: 77% had pain brought on by bending the wrist back, and MRI matched what surgeons found poorly. No study gives how common it is.
A small ganglion you can't see or feel (an occult ganglion) can also ache when the wrist bends back. In 25 people whose back-of-wrist pain came on in push-ups, planks or yoga and who had a magnetic resonance imaging (MRI) scan, MRI showed a possible cause in 21, most often a hidden ganglion (16 people), then partial ligament tears. But ganglions showed on MRI in 53 of 103 wrists without any symptoms, and in 20 patients MRI ruled hidden ganglions out correctly only half the time (a specificity of 50%). So these are recognised patterns, but the evidence is small numbers and expert opinion, and a scan finding doesn't prove the cause.
Sources 9, 10, 11, 12, 13, 14, 15
Lumps and bumps on the back of the wristStrong evidence
Ganglions are "the commonest type of swelling in the hand and wrist", and they "are harmless and can safely be left alone", UK hand surgeons say; 60% to 70% are on the back of the wrist. They are most common between 15 and 40 and in women, "common among gymnasts", and "In many cases, they grow larger with more activity. With rest, the lump usually becomes smaller", the American Academy of Orthopaedic Surgeons (AAOS) says. The NHS says they're "usually painless but can be painful during or after moving the affected joint".
A hard, fixed bump at the base of the index and middle finger bones can be a carpal boss, sore when the wrist is forced back, most often in people who load the wrist bent back, as in gymnastics, golf and racquet sports. Some bony prominence there is normal: it showed on 82.2% of 129 wrist computed tomography (CT) scans.
Sources 16, 17, 18, 19, 20, 21
After a fall onto the hand: the scaphoid and the scapholunate ligamentStrong evidence
A fall onto an outstretched hand bends the wrist back. The scaphoid, a small bone at the base of the thumb, breaks in a "forced hyperextension injury to the wrist (fall on outstretched hand, football save), punching injury or major wrist trauma", UK hand surgeons say. In Edinburgh, about 29 adults per 100,000 broke it each year, mostly young men, often in a simple fall from standing; it is about 70% of broken wrist bones. It "may be mistaken for a wrist sprain", AAOS says, and "Pain in your wrist that does not go away within a day of injury may be a sign of a fracture".
The same fall can tear the ligament between the scaphoid and the lunate (the scapholunate ligament), the commonest kind of wrist bone instability. It causes pain in the middle of the back of the wrist, a weaker grip, swelling and sometimes a painful click, and "is often missed because of difficulties in the clinical diagnosis and initial normal plain radiographs". "Even a wrist injury that seems mild with minimal swelling could still involve a torn ligament", AAOS says. No study we found gives how often it is missed.
Sources 22, 23, 24, 25, 26, 27, 28
Rarer causes, and how rare they areEmerging evidence
Kienböck's disease, a problem with the blood supply of the lunate bone, is rare: about 1 in 100,000 people a year in Finland, most often at 50 to 59. In 51,071 people having wrist imaging at one US hospital, it was found with symptoms in 0.17% and by chance in 0.10%. It hurts most bending back under load, as in push-ups, and early X-rays can look normal.
Pain on the little-finger side when leaning on the hand often comes from the TFCC or the ulna pressing on the wrist bones. Later in life, arthritis after an old ligament tear or a scaphoid that never joined is the commonest pattern of wrist arthritis. Several swollen, stiff joints with long morning stiffness point to inflammatory arthritis, which the National Institute for Health and Care Excellence (NICE) asks GPs to refer urgently. Tumours are rare: of 631 bone tumours of the hand in a German registry over 30 years, 5.6% were in the wrist bones and most were harmless.
Sources 29, 30, 31, 32, 33, 34, 35, 36
When a scan helpsStrong evidence
After a fall, if a scaphoid fracture is suspected, UK hand surgeons ask for at least 4 X-ray views. A normal first X-ray doesn't rule it out: in 8 UK centres, 12.9% of 1,989 people with normal X-rays had a hidden fracture on MRI. NICE says consider MRI first for a suspected scaphoid fracture, and UK hand surgeons want a splint and a plan within 2 weeks. Most such wrists turn out not to be broken.
A scapholunate tear may not show on X-ray for months, so an MRI is used if the X-rays are unclear; a full tear is best repaired within 4 to 6 weeks. For a pinched joint lining or a hidden ganglion, X-rays are normal and MRI often doesn't match what surgeons find, so a scan matters mainly if an injection or surgery is being considered. Most wrist pain without an injury needs no scan: the NHS sends a wrist that hasn't improved in 2 weeks to a GP.
Sources 22, 37, 38, 39, 27, 10, 40
How it usually goesEmerging evidence
New wrist pain "should begin to settle within 6 weeks" in many cases, NHS inform says, and an NHS trust leaflet says most soft tissue injuries improve a lot within 6 weeks, "although some injuries may take up to 3 months or longer". A pinched joint lining usually settles over 2 to 3 months once the load is changed, in one expert review's experience, and can come back with heavy loading. A ganglion can take "from several months up to a year" to go, the NHS says; in a UK study followed for about 6 years, roughly 4 to 6 in 10 untreated back-of-wrist ganglions went (the abstract's figures don't quite agree). No one can promise a date.
Sources 41, 42, 9, 18, 43
