Wrist pain and injuries
This is a relatively common problem. The wrist actually is composed of many joints and it is this very complex multijointed configuration that allows the wrist the kind of movement that we enjoy in many of the sports and activities of daily living. This also predisposes the joint to injuries and arthritis.
Wrist sprain is an injury to a ligament. Ligaments are the connective tissues that connect bones to bones; they could be thought of as tape that holds the bones together at a joint. These types of injuries are common in falls and sports. The wrist is usually bent backwards when the hand hits the ground such as when someone slips or trips and falls. After injury, the wrist will usually swell and may show bruising. It is usually very painful to move.
Injuries include wrist fracture, which occurs when substantiate force is applied, causing displacement or breaking of the bones or joints or ligament injuries.
Wrist sprain is sometimes dismissed and results in chronic wrist pain. The 2 commonest problem resulting in chronic wrist pain are
a) Scapholunate instability
b) Distal radial ulnar joint instability.
Osteoarthritis from untreated instability pattern or from intar-articular fracture of the distal radius is also not uncommon.
Rheumatoid arthritis is also another problem that results in wrist pain.
Scapho Lunate Ligament
The most common ligament to be injured in the wrist is the
Scapho-Lunate ligament. It is the ligament between two of the small bones in the wrist, the scaphoid bone and the lunate bone. Disruption of the ligament results in scapho-lunate instability. In the late stages a gap forms between the scaphoid and lunate bone.
Symptoms of scapho-lunate instability include pain, stiffness, and swelling. These may be first treated with splinting and non-steroidal anti-inflammatory medicines, and later with injections. If these treatments fail, surgery may be an option. This may be ligament reconstruction, a partial wrist fusion, removal of arthritic bones (“proximal row carpectomy”), wrist replacement, or complete wrist fusion.
At CHARMS we reconstruct Scapho-lunate instability with a tendon graft. Figure A shows the reconstruction.
Figure A: Scapholunate stabilisation procedure.
Figure B: Scapholunate instability, post reconstruction.
Figure B documents an example of a successful Scapho-Lunate Reconstructive surgery.
Distal radial ulnar joint instability is due to the disruption of the radial-ulnar ligament and this results in pain over the ulnar aspect of the wrist.
Here at CHARMS, we stabilize the joint with a tendon graft.
Figure C: Clinical examination showing distal radial ulnar joint instability.
Figure E: Post-operative review showing complete improvement of pain and range of motion and grip strength at 6 months.
