Usually an injury: a fall, sport or a punchStrong evidence
In one Swedish register of 31,233 broken wrists in adults, men broke the end of the forearm bone more often than women only from about 17 to 29 (295 against 134 per 100,000 a year at 17 to 19, and 128 against 94 at 20 to 29). From 30 to 49 the rates were about equal, and from 50 women's rate climbed steeply (349 against 140 in men at 50 to 59). In the UK, among adults 35 and over, "in men the incidence remained low until later life". In young adults, sport and car accidents are among the commonest causes, and 72% of snowboarding and skateboarding fractures in a Swedish study were in men, most often of the forearm.
Sprains are most common in the wrists, ankles, thumbs and knees, the NHS says, though no study we found gives wrist sprains by sex. A torn ligament between two wrist bones can lead to arthritis years later: in one clinic, 80% of 61 people with severe arthritis of this kind were men, most had injured the wrist before, and about half did manual work.
Sources 1, 2, 3, 4, 5, 6
The scaphoid: mostly young men, and easy to mistake for a sprainStrong evidence
The scaphoid is the small wrist bone at the base of the thumb. Between 70% and 88% of scaphoid fractures were in men in studies from Edinburgh, Bergen, Leicester and a UK-wide trial, mostly from the mid-teens to 30: in Leicester the average age was 22, and the rate was highest in males aged 15 to 19. In Edinburgh, men were "significantly more likely to sustain their fracture after a high-energy injury".
The British Society for Surgery of the Hand (BSSH) says scaphoid fractures "commonly occur in young men, although they can occur at any age and in either sex", after a fall on an outstretched hand, a football save, a punch or major wrist trauma. A broken scaphoid "may be mistaken for a wrist sprain", and "Pain in your wrist that does not go away within a day of injury may be a sign of a fracture", the American Academy of Orthopaedic Surgeons (AAOS) says.
Sources 7, 8, 9, 10, 11, 12
Moving it doesn't mean it isn't brokenStrong evidence
"It can be hard to tell if a wrist is broken, dislocated or badly sprained. You'll probably need an X-ray", the NHS says. No examination finding on its own confirms a scaphoid fracture; only the absence of tenderness in the hollow at the base of the thumb makes one much less likely. In one cohort of 223 people with a suspected scaphoid injury, being male, a sports injury, and pain in that hollow when the wrist was bent towards the little finger each predicted a fracture.
After a suspected scaphoid fracture with a normal first X-ray, about 1 in 4 or 5 (20% to 25%) turn out to be broken on later scans. So most such wrists aren't broken, but they need follow-up. A missed one can fail to join: breaks at the forearm end of the bone treated without surgery failed to join in 34%, and of 278 people with a scaphoid fracture that hadn't joined (88% of them men), scanned on average 3.3 years after the injury, 62% already had arthritis in the wrist.
Sources 13, 14, 15, 16, 17, 18, 19
Lifting and the gym: men aren't clearly more at riskMixed evidence
Injury rates in the weight-training sports are relatively low, but the wrist and hand are among the commoner sites. In a survey of 270 CrossFit athletes (about half men), 20.4% had had a hand or wrist injury, and only 15 saw a doctor. Men reported more, about twice the odds (an odds ratio of 2.10), but that analysis didn't allow for other differences between them. In 245 competitive powerlifters, women had more hand and wrist injuries. So "men's wrists get hurt more in the gym" is unproven.
Holding a load with the wrist bent back, as in the bench press, the front rack and push-ups, is the usual trigger: in a cadaver study, a push-up with the wrist bent back raised the pressure inside the wrist joint. Our wrist pain when lifting guide covers each lift.
Sources 20, 21, 22, 23
Work, tools and vibrationStrong evidence
The NHS lists "using vibrating tools for work" among the activities to cut down when the wrist hurts. In a national survey from the late 1990s, about 4.2 million men and 667,000 women in Great Britain used vibrating tools at work in a week, with the highest doses in bricklayers, gardeners and groundsmen, carpenters, electricians and builders.
"You could be risking damage to nerves, blood vessels and joints of the hand, wrist and arm if you work regularly with hand-held or hand-guided power tools for more than a few hours each day", the Health and Safety Executive (HSE) says. Early signs are tingling and numbness in the fingers, losing feeling and strength, and fingertips that go white, then red, in the cold and wet. Across 37 studies, carpal tunnel syndrome confirmed by nerve tests went with vibration (odds ratio 5.4), forceful gripping (4.2) and repetition (2.3). These are associations, not proof of cause in any one person.
Sources 24, 25, 26, 27
Carpal tunnel syndrome: less common in men, and later in lifeStrong evidence
In UK general practice, carpal tunnel syndrome was diagnosed in about 88 men and 193 women per 100,000 a year, most often in women at 45 to 54 but in men at 75 to 84. The gap has narrowed: the ratio of women to men fell from 2.74 to 1.93 between 1993 and 2013, and men's median age at diagnosis rose to 59. It causes tingling, numbness or pain in the thumb and first fingers, often at night.
Tingling can also come from the neck, NHS inform says: "This can happen even when you don't feel pain in your neck". Numb ring and little fingers point to a different nerve, the ulnar nerve.
Sources 28, 29, 30, 31
A hot, swollen wrist: gout, infection or crystalsStrong evidence
Gout affects about 4% of UK men against 1% of women (3.97% against 1.05%), and at 35 to 39 men are 11 times as likely to have it. "Gout is about four times more common in men than women", Arthritis UK says. It is "usually your big toe, but it can be in other joints in your feet, ankles, hands, wrists, elbows or knees", the NHS says. The National Institute for Health and Care Excellence (NICE) asks doctors to consider gout with rapid, often overnight, severe pain, redness or swelling in joints such as the wrist, and to think of infection and calcium crystals too. In rheumatology clinics, a wrist was tender in 15% of 509 people with gout confirmed by crystals.
A joint infection is rare, about 16 per 100,000 adults a year in France, but 65% of cases were in men, at an average age of 62. The NHS lists a high temperature among the signs, "although not everyone has one". Calcium crystal arthritis (pseudogout) affects "men and women in equal numbers, but it's rare for it to affect people under the age of 60", Arthritis UK says. Only a sample of fluid from the joint can tell them apart.
Sources 32, 33, 34, 35, 36, 37, 38, 39
A lump: usually a ganglionEmerging 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. They are commoner in women, but not rare in men: in US military and civilian health records, women were diagnosed about 2 to 2.6 times as often, and men in the military had palm-side ganglions at about the same rate as civilian women. Most (60% to 70%) are on the back of the wrist, and about half go on their own, though this "can take from several months up to a year", the NHS says.
Sources 40, 41, 42, 43, 44
Kienböck's disease: rare, and only a little commoner in menEmerging evidence
Kienböck's disease, a problem with the blood supply of one of the small wrist bones, is rare: in Finland, about 1 in 100,000 people a year (10.4 per million men and 8.8 per million women), most often at 50 to 59. Of 51,071 people having wrist imaging at one US hospital, 0.17% had it with symptoms and 0.10% had it found by chance. It is often blamed on manual work, but a review of 152 articles found no evidence that vibrating tools cause it. Early on it can feel like a sprain and the X-ray "may still appear normal", AAOS says; a scan shows it better.
Sources 45, 46, 47, 48
Rheumatoid and psoriatic arthritisEmerging evidence
Rheumatoid arthritis is less common in men (0.40% of UK men against 0.93% of women). Psoriatic arthritis is about as common in men as in women: 9.3 against 7.7 new cases per 100,000 a year in one US county. Several swollen joints, often in both hands, with long morning stiffness need a GP, as the warning signs say.
Sources 49, 50
When a scan or test helpsStrong evidence
After an injury, "You'll probably need an X-ray", the NHS says. If a scaphoid fracture is suspected, UK hand surgeons ask for at least 4 X-ray views; if those look normal, a splint, and a plan within 2 weeks that includes a magnetic resonance imaging (MRI) or computed tomography (CT) scan. MRI is their recommended scan, and NICE suggests considering it first. Once a fracture is seen, CT measures how far it has moved.
A hot, swollen joint needs a sample of fluid, and a uric acid (urate) blood test of 360 micromol/litre or more supports gout; if it is lower during a flare, NICE asks for it to be repeated at least 2 weeks after the flare settles. Carpal tunnel is usually diagnosed from the symptoms, with nerve tests if the diagnosis is unclear. Kienböck's disease may need an MRI when the X-ray is normal.
Sources 13, 11, 51, 35, 30, 48
How it usually goesEmerging evidence
New wrist pain "should begin to settle within 6 weeks" in many cases, NHS inform says. "After 2 weeks, most sprains and strains will feel better", but severe ones "can take months to get back to normal", the NHS says, and most soft tissue injuries improve a lot within 6 weeks, "although some injuries may take up to 3 months or longer", an NHS physiotherapy leaflet says. A gout attack "usually lasts 1 to 2 weeks if left untreated". After a scaphoid fracture treated in a cast, healing is checked with an X-ray or CT by 6 to 8 weeks, and in small studies athletes went back to sport after about 7 weeks on average with surgery and 10 without. No one can promise a timescale.
Sources 31, 5, 52, 34, 11, 53
