Ankle and wrist pain are common complaints that most often arise from repetitive injuries or everyday wear and tear. However, sometimes the source of this nagging pain can be traced back to rarer conditions that require a more discerning diagnosis. Let’s explore some of the uncommon afflictions that can cause ankle and wrist discomfort.
Osteochondritis Dissecans
OsteochondritisDissecans is an unusual condition that occurs when bone underneath the cartilage of joints starts to die due to reduced blood flow. It typically develops in young adults and adolescents who participate in sports that involve repetitive compressive motions like gymnastics, weightlifting or basketball.
In the ankle, osteochondritis dissecans usually impacts the talus bone causing deep ankle pain, swelling and limited mobility. The same condition can strike the wrist at the end of the radius bone near the wrist joint leading to similar symptoms. Sometimes fragments of cartilage and bone will break loose creating a painful loose body inside the joint. Diagnosis often involves MRI scans and possible arthroscopic surgery. Rest, immobilization, physical therapy or surgery are treatment options.
Sarcoid Arthritis
Sarcoidarthritis develops when areas of inflammation called granulomas develop in body tissues from the autoimmune disease sarcoidosis. Although any joint can be affected, the ankles, wrists and knees are most commonly impacted. Some symptoms distinct from general arthritis include redness, nodules under the skin,pitting and swelling of the ankles.
Along with joint discomfort, those with sarcoid arthritis often experience fatigue, skin issues, cough and eye problems. Diagnosis involves blood tests, imaging tests and sometimes biopsy of inflamed tissue. Steroids, NSAIDs, DMARDs and immunosuppressants help treat the inflammation and joint pain.
Cystic Lesions in the Wrist
Ganglion and synovial cysts can emerge near the wrist joint causing pain, swelling and, sometimes, wrist locking or catching. Ganglion cysts form from joint fluid leaking into surrounding tissue, often near the scaphoid bone of the wrist. Synovial cysts grow from the wrist joint lining and contain clear, lubricating fluid. While cysts frequently disappear on their own, options include aspiration, cortisone injection or surgery for more troublesome cases.
Septic Arthritis
While rare, infectious septic or bacterial arthritis can occur in any joint. When bacteria spreads through the blood stream, the microbes can settle in a joint, multiply and provoke severe inflammation. The wrists, knees and ankles are frequent targets. High fever, excruciating pain, swelling and warmth in the joint area signal a potential infection. Septic arthritis requires urgent medical care. Doctors will drain the toxic joint fluid, prescribe IV antibiotics and immobilize the joint to bring quick relief.
Charcot Neuroarthropathy
Charcot Neuroarthropathy is a degenerative ankle condition related to severe diabetic neuropathy. Nerve damage means normal pain sensations are not felt. So even when the ankle bones fracture or dislocate, it does not hurt. However, because the fractures go unfelt, massive ankle deformation occurs. Dramatic redness, swelling, changes in shape and temperature can result. Surgery may be required to fuse or stabilize a very unstable joint.
Pigmented Villonodular Synovitis (PVNS)
This rare disorder occurs when the synovial membrane that lines joints transforms into an aggressive tumor-like growth. In the ankles, this hyperplastic synovial tissue can destroy cartilage and bone over time by releasing hemosiderin, an iron-based pigment. Symptoms include diffuse ankle swelling, stiffness and aching. Diagnosis often involves MRI with contrast dye. Treatment may include arthroscopic synovectomy surgery to remove the excessive tissue from the ankle joint.
Lupus
Systemic lupus erythematosus (SLE) can provoke arthritis in the small joints of the wrists and ankles along with fatigue, fever, rashes and kidney problems. Achy joints may alternate between periods of inflammation and remission. Lupus requires blood tests and often a biopsy of inflamed joint tissue to confirm diagnosis. NSAIDs, antimalarials, steroids and other DMARDs help manage lupus arthritis pain and swelling flare-ups.
Gout
This classic form of arthritis results when uric acid crystals accumulate in the joints, frequently the ankle and wrist. Attacks of gout cause intense pain, hot swelling and redness, often worse at night. A buildup of uric acid called tophi may cause bumps and skin indentations around the ankle and wrist. Gout is diagnosed from fluid extracted from an affected joint. Allopurinol, anti-inflammatories, steroids and diet changes help prevent gout attacks.
Psoriatic Arthritis
Up to 30% of those with the autoimmune skin condition psoriasis eventually develop psoriatic arthritis. The wrist and ankle joints are prime targets. Along with pain and swelling, psoriatic arthritis can cause nail deformities and sausagetoes. X-rays reveal damage and narrowed joint space. Blood tests check for inflammation markers and certain antibodies that confirm psoriatic arthritis. NSAIDs, DMARDs and biologics can relieve symptoms and slow progression.
Lyme Arthritis
Untreated Lyme disease contracted from a deer tick bite can spread to the joints in up to 60% of sufferers months or years after the initial infection. Intermittent episodes of severe knee, ankle or wrist pain and swelling signify Lyme arthritis. Blood testing detects Lyme antibodies while synovial fluid often contains the Lyme spirochetes that directly invade the joint. Powerful antibiotics like IV ceftriaxone can eliminate the bacteria and reduce arthritis.
Ankle Impingement Syndromes
Ankleimpingementsyndromes refer to several conditions where soft tissue gets pinched or compressed, leading to chronic ankle pain. Anterior impingement results when scar tissue limits ankle flexion. Treatment involves PT to improve range of motion or arthroscopic debridement surgery.
Posterior ankle impingement is often seen in dancers or athletes who hyperflex the ankle, pinching the posterior joint capsule. Surgery removes bone spurs irritating the tissue. Treatment aims to reduce overaggressive pointing of the foot.
Osteoarthritis
Although common in older adults, osteoarthritis in young people under 40 is quite rare. Yet some develop this degenerative joint disease at a much earlier age, showing signs of cartilage loss in their 30s or even 20s, especially in the ankles and wrists. Reasons for premature osteoarthritis may include prior joint injury, genetics, or endocrine disorders. Low impact exercise, NSAIDs and injections offer symptom relief before joint replacement surgery may be required.
Rheumatoid Arthritis
Another classic arthritis, rheumatoid arthritis (RA) can also less commonly strike people under 40. The ankles, wrists and hands are often first affected. Lingering morning stiffness, fatigue and flu-like illness signify RA. Blood tests reveal the rheumatoid factor and anti-CCP antibodies diagnostic of RA. Early, aggressive treatment helps prevent rapid joint destruction. Medications like DMARDs, biologics, steroids and NSAIDs reduce painful inflammation and joint damage.
Reactive Arthritis
Various bacterial infections can trigger reactive arthritis, inflaming the ankles, knees, wrists and eyes. Reactive arthritis classically arises following intestinal or genitourinary infections. Wrists and ankles appear swollen, painful and warm, but lack arthritic damage. Testing positively identifies the precipitating bacteria, typically through stool analysis. Reactive arthritis usually resolves on its own over 3 to 12 months as the infection clears. Anti-inflammatories and antibiotics provide symptom relief.
Conclusion
While ankle and wrist pain often stem from repetitive strain or familiar arthritis, rarer conditions can sometimes be the culprits. Being aware of less common causes like cysts, infections, autoimmune disease or bony impingements allows for prompt diagnosis and treatment. If joint pain seems unusual or unexplained, persistent swelling or inflammation arises, or discomfort worsens, it warrants medical evaluation to determine the underlying reason and guide appropriate interventions. Paying attention to atypical symptoms provides valuable clues to uncover uncommon sources of ankle and wrist discomfort.
FAQs
Rare causes of wrist pain include cysts like ganglion or synovial cysts, infections like septic arthritis, autoimmune diseases like lupus or rheumatoid arthritis, injuries like scaphoid fractures, and conditions like Kienbock’s disease or Madelung deformity.
Symptoms include chronic, diffuse pain in the front or back of the ankle, swelling, tenderness, stiffness, and loss of full ankle mobility or range of motion. Pain usually worsens with certain activities.
Treatment often involves arthroscopic surgery to remove the excessive, diseased tissue from the joint. Radiation therapy may be used post-surgery.
While any joint can be involved, sarcoid arthritis most commonly affects the ankles, knees, wrists, shoulders, and small joints of the hands and feet.
There is no specific test. Doctors diagnose it based on symptoms, joint inflammation coming after an infection, and positive identification of the precipitating bacteria.
