The wrist is composed of many joints and it is this very complex multi-jointed configuration that allows the wrist the kind of movement that we enjoy in our daily activities. Unfortunately, this advantagealso predisposes the joint to injuries and arthritis. The two most common causes of chronic wrist pain are:
Wrist sprain is an injury to a ligament. Ligaments are the connective tissues that connect bones to bones; they could be thought of as the 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. Following the fall the wrist may be painful for a period of time. Most patients will think nothing of it.
The tell-tale signs that the injuries may be more serious and requires a professional assessments are continued pain for more than a fortnight,especially after a serious fall. Other signs are swelling and bruising. It is usually very painful but the pain may subside, giving the false impression that the injury is minor.
The most common ligament to be injured in the wrist is the scapholunate ligament. It is the ligament between two small bones in the wrist, the scaphoid bone and the lunate bone. Disruption of the ligament results in scapholunate instability. In the late stages, a gap forms between the scaphoid and lunate bone and is known as scapholunate dissociation.
Symptoms of scapholunate 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. In the non-arthritic stage, ligament reconstruction is surgery of choice.
At CHARMS we reconstruct scapholunate instability with a tendon graft.
When arthritis sets in, which is characterised by continued pain swelling, stiffness options are partial wrist fusion, removal of arthritic bones (“proximal row carpectomy”), wrist replacement, or complete wrist fusion.
This condition presents with pain over the ulnar aspect of the wrist. Normal wrist usage is usually pain-free. The patient experiences pain only when there is a force exerted on the wrist in a twisting fashion like when attempting to put the carry-on luggage into the overhead compartment or when playing tennis.
Treatment include wrist splinting and rest. When the pain settles after splinting, strengthening of the muscles that support the joint may help.
Other treatment options include cortisone injection and surgery to repair the torn ligament.
In the event that the instability is chronic and MRI shows a tear of the TFCC off the radial side of the joint, then ligament reconstruction with a palmaris longus graft may be good option.
If you would like to learn more about the treatment and the possible outcomes, feel free to inquire here.
