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Patient Guide to Wrist Pain

Wrist pain is a common complaint. Many types of wrist pain are caused by sudden injuries that result in sprains or fractures. But wrist pain also can be caused by more long-term problems such as repetitive stress, arthritis and carpal tunnel syndrome.

Because so many factors can lead to wrist pain, diagnosing the exact cause of long-standing wrist pain sometimes can be difficult. An accurate diagnosis is crucial, however, because proper treatment depends on the cause and severity of your wrist pain.

DeQuervain's Tenosynovitis

DeQuervain’s Tenosynovitis

Symptoms of Wrist Pain:

Wrist pain may vary, depending on what’s causing it. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing type of pain. The precise location of your wrist pain also can give clues to what might be causing your symptoms.

When to see a doctor
Not all wrist pain requires medical care. Minor sprains and strains, for instance, usually respond to ice, rest and over-the-counter pain medications. But if pain and swelling last longer than a few days or become worse, see your doctor. Delays in diagnosis and treatment can lead to poor healing, reduced range of motion and long-term disability.

Causes of Wrist Pain:

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand. Tough bands of ligament connect your wrist bones to each other and to your forearm bones and hand bones. Tendons attach muscles to bone. Damage to any of the parts of your wrist can cause pain and affect your ability to use your wrist and hand.

Injuries

  • Sudden impacts. Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures. A scaphoid fracture involves a bone on the thumb side of the wrist. This type of fracture may not show up on X-rays immediately following the injury.
  • Repetitive stress. Any activity that involves repetitive wrist motion — from hitting a tennis ball or bowing a cello to driving cross-country — can inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours on end without a break. De Quervain’s disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

  • Osteoarthritis. In general, osteoarthritis in the wrist is uncommon, usually occurring only in people who have injured that wrist in the past. Osteoarthritis is caused by wear and tear on the cartilage that cushions the ends of your bones. Pain that occurs at the base of the thumb may be caused by osteoarthritis.
  • Rheumatoid arthritis. A disorder in which the body’s immune system attacks its own tissues, rheumatoid arthritis is common in the wrist. If one wrist is affected, the other one usually is, too.

Other diseases and conditions

  • Carpal tunnel syndrome. Carpal tunnel syndrome develops when there’s increased pressure on the median nerve as it passes through the carpal tunnel, a passageway in the palm side of your wrist.
  • Ganglion cysts. These soft tissue cysts occur most often on the top of your wrist opposite your palm. Smaller ganglion cysts seem to cause more pain than do larger ones.
  • Kienbock’s disease. This disorder typically affects young adults and involves the progressive collapse of one of the small bones in the wrist. Kienbock’s disease occurs when the blood supply to this bone is compromised.

Risk Factors of Wrist Pain:

Wrist pain can happen to anyone — whether you’re very sedentary, very active or somewhere in between. But your risk may be increased by:

  • Sports participation. Wrist injuries are common in many sports, including bowling, golf, gymnastics, snowboarding and tennis.
  • Repetitive work. Almost any activity that involves your hands and wrists — even knitting and cutting hair — if performed forcefully enough and often enough can lead to disabling wrist pain.
  • Diseases and conditions. Your risk of developing wrist pain is increased if you have diabetes, leukemia, scleroderma, lupus or an underactive thyroid gland.

Diagnosis of Wrist Pain:

During the physical exam, your doctor may:

  • Check your wrist for points of tenderness and swelling
  • Ask you to move your wrist to see if your range of motion has been decreased
  • Assess your grip strength and forearm strength

In some cases, your doctor may suggest imaging tests, arthroscopy or nerve tests to help pinpoint the cause of your wrist pain.

Imaging tests

  • X-rays. Using a small amount of radiation, simple X-rays can reveal bone fractures, as well as evidence of osteoarthritis.
  • Computerized tomography (CT) scan. CT scans can provide more-detailed views of the bones in your wrist. A CT scan takes X-rays from several directions and then combines them to make a two-dimensional image.
  • Bone scan. In a bone scan, a small amount of radioactive material is injected into your bloodstream. This makes injured parts of your bones brighter on the resulting scan images.
  • Magnetic resonance imaging (MRI). MRIs use radio waves and a strong magnetic field to produce detailed images of your bones and soft tissues. For a wrist MRI, you may be able to insert your arm into a smaller device rather than have your entire body slide into a full-size MRI machine.

Arthroscopy
If imaging test results are inconclusive, your doctor may perform an arthroscopy, a procedure in which a pencil-sized instrument is inserted into your wrist via a small incision in your skin. The instrument contains a light and a tiny camera. Images are projected onto a television monitor.

Nerve tests
If your doctor thinks you have carpal tunnel syndrome, he or she might order an electromyogram (EMG). This test measures the tiny electrical discharges produced in your muscles. A needle-thin electrode is inserted into the muscle, and its electrical activity is recorded when the muscle is at rest and when it’s contracted. Nerve conduction tests also are performed as part of an EMG to assess if the electrical impulses are slowed in the region of the carpal tunnel.

CURE YOUR WRIST PAIN TODAY. CALL US AT +65 6471 2744 OR SMS to +65 92357641 FOR APPOINTMENT.

Distal Radius Fractures (Broken Wrist)

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm.

A distal radius fracture almost always occurs about 1 inch from the end of the bone. The break can occur in many different ways, however.

One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles — hence the name “Colles” fracture.

A Colles fracture occurs when the broken end of the radius tilts upward.
 

Other ways the distal radius can break include:

  • Intra-articular fracture. A fracture that extends into the wrist joint. (“Articular” means “joint.”)
  • Extra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture.
  • Open fracture. When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of the risk for infection.
  • Comminuted fracture. When a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures, open fractures, comminuted fractures, and displaced fractures (when the broken pieces of bone do not line up straight).are more difficult to treat, for example.

Sometimes, the other bone of the forearm (the ulna) is also broken. This is called a distal ulna fracture.

This illustration shows some of the types of distal radius fractures.
Causes of Distal Radius Fracture:

The most common cause of a distal radius fracture is a fall onto an outstretched arm.

Osteoporosis (a disorder in which bones become very fragile and more likely to break) can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.

Good bone health remains an important prevention option. Wrist guards may help to prevent some fractures, but they will not prevent them all.

Symptoms of Distal Radius Fracture:

A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. In many cases, the wrist hangs in an odd or bent way (deformity).

Doctor Examination:

If the injury is not very painful and the wrist is not deformed, it may be possible to wait until the next day to see a doctor. The wrist may be protected with a splint. An ice pack can be applied to the wrist and the wrist can be elevated until a doctor is able to examine it.

If the injury is very painful, if the wrist is deformed or numb, or the fingers are not pink, it is necessary to go to the emergency room.

To confirm the diagnosis, the doctor will order x-rays of the wrist. X-rays are the most common and widely available diagnostic imaging technique. X-rays can show if the bone is broken and whether there is displacement (a gap between broken bones). They can also show how many pieces of broken bone there are.

(Left) An x-ray of a normal wrist. (Right) The white arrows point to a distal radius fracture.
 

Treatment

Treatment of broken bones follows one basic rule: the broken pieces must be put back into position and prevented from moving out of place until they are healed.

There are many treatment options for a distal radius fracture. The choice depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon’s personal preferences.

Nonsurgical Treatment

If the broken bone is in a good position, a plaster cast may be applied until the bone heals.

If the position (alignment) of your bone is out of place and likely to limit the future use of your arm, it may be necessary to re-align the broken bone fragments. “Reduction” is the technical term for this process in which the doctor moves the broken pieces into place. When a bone is straightened without having to open the skin (incision), it is called a closed reduction.

After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down. The cast is changed 2 or 3 weeks later as the swelling goes down more, causing the cast to loosen.

Depending on the nature of the fracture, your doctor may closely monitor the healing by taking regular x-rays . If the fracture was reduced or thought to be unstable, x-rays may be taken at weekly intervals for 3 weeks and then at 6 weeks. X-rays may be taken less often if the fracture was not reduced and thought to be stable.

The cast is removed about 6 weeks after the fracture happened. At that point, physical therapy is often started to help improve the motion and function of the injured wrist.

Surgical Treatment

Sometimes, the position of the bone is so much out of place that it cannot be corrected or kept corrected in a cast. This has the potential of interfering with the future functioning of your arm. In this case, surgery may be required.

Procedure. Surgery typically involves making an incision to directly access the broken bones to improve alignment (open reduction).

A plate and screws hold the broken fragments in position while they heal.

Depending on the fracture, there are a number of options for holding the bone in the correct position while it heals:

  • Cast
  • Metal pins (usually stainless steel or titanium)
  • Plate and screws
  • External fixator (a a stabilizing frame outside the body that holds the bones in the proper position so they can heal)
  • Any combination of these techniques

An external fixator.

Open fractures. Surgery is required as soon as possible (within 8 hours after injury) in all open fractures. The exposed soft tissue and bone must be thoroughly cleaned (debrided) and antibiotics may be given to prevent infection. Either external or internal fixation methods will be used to hold the bones in place. If the soft tissues around the fracture are badly damaged, your doctor may apply a temporary external fixator. Internal fixation with plates or screws may be utilized at a second procedure several days later.

Recovery

Because the kinds of distal radius fractures are so varied and the treatment options are so broad, recovery is different for each individual. Talk to your doctor for specific information about your recovery program and return to daily activities.

Pain Management

Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed to relieve pain.

Your doctor may recommend combining ibuprofen and acetaminophen to relieve pain and inflammation. The combination of both medications is much more effective than either one alone. If pain is severe, patients may need to take a prescription-strength medication, often a narcotic, for a few days.

Cast and Wound Care

In some cases, original casts will be replaced because swelling has gone down so much that the cast becomes loose. The last cast is usually removed after about 6 weeks.

During healing, casts and splints must be kept dry. A plastic bag over the arm while showering should help. If the cast does become wet, it will not dry very easily. A hair dryer on the cool setting may be helpful.

Most surgical incisions must be kept clean and dry for 5 days or until the sutures (stitches) are removed, whichever occurs later.

Potential Complications

After surgery or casting, it is important that you achieve full motion of your fingers as soon as possible. If you are not able to fully move your fingers within 24 hours due to pain and/or swelling, contact your doctor for evaluation.

Your doctor may loosen your cast or surgical dressing. In some cases, working with a physical or occupational therapist will be required to regain full motion.

Unrelenting pain may be a sign of Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) which must be treated aggressively with medication or nerve blocks.

Rehabilitation and Return to Activity

Most people do return to all their former activities after a distal radius fracture. The nature of the injury, the kind of treatment received, and the body’s response to the treatment all have an impact, so the answer is different for each individual.

Almost all patients will have some stiffness in the wrist. This will generally lessen in the month or two after the cast is taken off or after surgery, and continue to improve for at least 2 years. If your doctor thinks it is needed, you will start physical therapy within a few days to weeks after surgery, or right after the last cast is taken off.

Most patients will be able to resume light activities, such as swimming or exercising the lower body in the gym, within 1 to 2 months after the cast is removed or within 1 to 2 months after surgery. Vigorous activities, such as skiing or football, may be resumed between 3 and 6 months after the injury.

Long-Term Outcomes

Recovery should be expected to take at least a year.

Some pain with vigorous activities may be expected for the first year. Some residual stiffness or ache is to be expected for 2 years or possibly permanently, especially for high-energy injuries (such as motorcycle crashes), in patients older than 50 years of age, or in patients who have some osteoarthritis. However, the stiffness is usually minor and may not affect the overall function of the arm.

Finally, osteoporosis is a factor in many wrist fractures. It has been suggested that people who have a wrist fracture should be tested for bone weakness, especially if they have other risk factors for osteoporosis. Ask your doctor about osteoporosis testing.

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Hand and Wrist Injuries

Hand and wrist injuries are common following a fall onto an outstretched hand or in individuals involved in ball and contact sports or upper limb weight bearing sports (such as gymnastics). Patients suffering from hand and wrist pain are often seen in physiotherapy practice. Pain may be caused by local structures within or around the wrist or hand or occasionally, may be referred from other sources (such as the neck, upper back, shoulder or elbow).

One common clinical presentation is the patient suffering from sudden onset wrist pain typically as a result of a fall onto an outstretched hand, the cause of which is often torn ligaments or connective tissue around the wrist, such as a Sprained Wrist or occasionally a fracture such as a Radius Fracture or Scaphoid Fracture. In patients who experience finger trauma in ball or contact sports, a Sprained Finger or Thumb is often the result.

Gradual onset hand and wrist pain often develops as a result of overuse particularly in gripping activities such as racquet sports or manual work such as carpentry. One of the more common overuse wrist injuries is Wrist Tendonitis which involves gradual degeneration and inflammation of one or more wrist tendons. In those patients with associated neck, upper back, shoulder, elbow or forearm pain, Referred Pain (frequently from the neck, upper back, shoulder or elbow) is often the cause of symptoms. In older patients with gradual onset wrist pain associated with generalised wrist stiffness, Wrist Arthritis may be the source of symptoms. There are numerous other causes of hand and wrist pain, some of which present suddenly due to a specific incident, others which develop gradually over time.

Below are some of the more common causes of hand and wrist pain with a brief description of each condition to aid hand and wrist pain diagnosis. Conditions have been organised according to sudden or gradual onset and common or less common conditions for ease of use.

Metacarpal Fracture

A break in one of the metacarpal bones of the hand usually due to a punch, a direct blow to the back of the hand or a fall onto an outstretched hand. Associated with severe pain in the hand that may radiate into the wrist or fingers, in addition to swelling, tenderness on firmly touching the affected region of the bone, markedly reduced hand function and sometimes bony deformity.

Find out what may be causing your hand or wrist pain:

Sudden Onset Hand and Wrist Pain

Common Injuries

Sprained Wrist

Tearing of connective tissue and / or ligaments of the wrist joint typically as a result of a fall onto an outstretched hand causing the wrist to stretch excessively. Associated with pain in the wrist that may increase when firmly touching the affected region of the wrist joint, restricted wrist joint mobility and often swelling.

Sprained Finger

Tearing of connective tissue and / or ligaments holding the bones of the finger together typically following excessive stretching of the joint in one direction. Associated with pain on firmly touching the affected joint, restricted joint mobility and often swelling.

Sprained Thumb

Tearing of connective tissue and / or ligaments holding the bones of the thumb together typically following excessive stretching of the joint in one direction. Associated with pain on firmly touching the affected joint, restricted joint mobility and often swelling.

Radius Fracture

A break in the radius bone near the wrist usually due to a fall onto an outstretched hand. Associated with severe pain usually located on the thumb side of the wrist that may radiate into the thumb, hand or forearm, in addition to swelling, tenderness on firmly touching the affected region of the bone, markedly reduced wrist function and sometimes bony deformity.

Scaphoid Fracture

A break in one of the wrist bones located on the thumb side of the wrist (scaphoid) usually due to a fall onto an outstretched hand. Associated with severe pain at the time of injury that may settle to an ache, usually located on the thumb side of the wrist. Swelling, tenderness on firmly touching the affected region of the bone and markedly reduced wrist function are also present.

Phalanx Fracture

A break in one of the small bones of the finger (phalanges) usually due to a traumatic direct blow to the finger such as during ball or contact sports. Associated with severe pain in the affected finger, swelling, tenderness on firmly touching the affected region of the bone, markedly reduced finger function and sometimes bony deformity.

Wrist impingement / impaction syndromes

Pain in the wrist due to compression or pinching of structures within the wrist joint usually during a traumatic end of range wrist movement (e.g. a fall onto an outstretched hand), typically with the wrist in extension and in combination with weight bearing forces through the affected wrist (such as during gymnastics). Symptoms may increase on firmly touching the affected region of the wrist and on certain wrist movements.

TFCC Tear

Damage to cartilage tissue located on the little finger side of the wrist joint usually due to excessive compression forces often in association with twisting or side bending forces through the wrist such as a fall onto an outstretched hand, or during gymnastics, racquet sports or manual work such as using a hammer. Pain is usually located on the little finger side of the wrist and can occasionally radiate into the forearm or hand. There is usually tenderness on firmly touching the affected tissue and often swelling. Reduced grip strength may also be present. In some cases a clicking or catching sensation may be experienced during certain wrist movements.

Dislocated Finger

Tearing of connective tissue surrounding one of the finger joints with subsequent displacement and separation of the bones forming the joint so the joint surfaces are no longer situated next to each other (i.e. the finger often appears deformed). Typically occurs as a result of a traumatic impact to the finger such as during ball sports and causes severe pain in the finger, a feeling of the finger ‘popping out’, deformity of the finger joint and sometimes pins and needles or numbness.

Referred Pain

Pain referred into the wrist or hand from another source such as the neck, upper back, shoulder or elbow frequently associated with symptoms above the wrist and hand (such as in the neck, upper back, shoulder, arm, elbow or forearm). Typically associated with pain on firmly touching the region responsible for the referred pain and / or loss of movement in that region. Sometimes in association with pins and needles or numbness in the affected arm or hand.

Less Common Injuries

Hamate Fracture

A break in one of the small wrist bones located on the little finger side of the wrist usually following hitting the ground during a golf swing, swinging a tennis racquet, baseball bat or playing volleyball or due to a fall onto an outstretched hand. Associated with severe pain at the time of injury that may settle to an ache, usually located on the little finger side of the wrist / hand, on the palm side of the hand. Swelling and tenderness on firmly touching the affected bone are also typically present.

Lunate Fracture

A break in one of the small wrist bones located approximately in the middle of the wrist usually following a fall onto an outstretched hand. Associated with severe wrist pain at the time of injury that may settle to an ache and can occasionally radiate into the hand or forearm. Swelling and tenderness on firmly touching the affected bone are also typically present.

Distal Radio-Ulnar Joint Sprain

Tearing of connective tissue and / or ligaments of the joint located between the ends of the forearm bones just before the wrist typically as a result of a fall onto an outstretched hand, often in combination with twisting of the wrist and forearm. Associated with pain in the wrist that may increase when firmly touching the affected region of the joint, restricted wrist joint mobility (particularly rotation of the wrist) and often swelling.

Carpal Dislocation

Tearing of connective tissue joining adjacent small bones of the wrist with subsequent displacement and separation of the affected bones forming the joint so the joint surfaces are no longer situated next to each other. Typically occurs as a result of severe trauma such as a fall onto an outstretched hand and causes severe wrist pain, deformity of the wrist, pain on firmly touching the affected joint and sometimes pins and needles or numbness.

Kienbock’s disease

Gradual bony tissue death to one of the small bones located approximately in the middle of the wrist secondary to a loss of its blood supply. Typically occurs as a result of trauma to the wrist (such as a fall onto the outstretched hand). Usually associated with chronic pain located on the front or back of the wrist that increases on firmly touching the lunate bone and often reduced wrist range of movement. Pain may also increase during weight bearing activity through the wrist and general use of the hand. Most common in those aged in their twenties.

Finger Tendon Ruptures

Complete tearing of one or more finger tendons, typically following a traumatic incident such as a direct impact to the finger during ball or contact sports. Associated with pain and swelling in the finger that may radiate into the hand, significant weakness of the affected finger and often deformity of the finger (e.g. a bent finger) that typically cannot be straightened by using the affected finger alone. Pain may also increase on firmly touching the affected tendon at the level of the finger.

Ulnar Artery Aneurysm or Thrombosis

Damage to the ulnar artery located on the little finger side of the palm of the hand at the level of the hamate bone resulting in dilation of the artery and / or the formation of a blood clot. Typically occurs following trauma or repeated impact to this part of the hand (e.g. using this part of the hand as a hammer, or during a karate chop in martial arts). May result in pain, discolouration, numbness, coolness, pins and needles or numbness in one or more fingers and sometimes the little finger side of the palm of the hand. Occasionally, swelling or a mass on the little finger side of the palm of the hand at the level of the hamate bone may also be present.

Hand and Wrist Injuries? Get it checked and treated today! Call us at +65 6471 2744 or Email to: info@boneclinic.com.sg

Ligament Injuries to the Wrist

Wrist injuries are common. If a wrist injury causes significant damage to the ligaments, it can result in serious problems in the wrist. Such an injury typically continues to cause problems unless corrected.

This guide will help you understand

  • how ligament injuries of the wrist occur
  • what your doctor will do to diagnose serious ligament injuries
  • what treatment options may be recommended

Anatomy

What structures are involved?

The front, or palm-side, of the wrist is referred to as the palmar side. The back of the wrist is called the dorsal side.

The wrist is made up of eight separate small bones, called the carpal bonesThe carpal bones connect the two bones of the forearm, the radiusand the ulna, to the bones of the hand.The metacarpal bones are the long bones that lie underneath the palm. The metacarpals attach to thephalanges, the bones in the fingers and thumb.

The carpal bones are arranged in two rows: the proximal row of four bones sits next to the forearm (radius and ulna), and the distal row of four bones connects to the metacarpal bones. These two rows of bones work together like the links in a chain to allow the hand to move up (dorsiflex) and down (palmarflex). The connections between each carpal bone also allow the bones to shift as the hand is moved sideways (radial deviation and ulnar deviation).

One reason that the wrist is so complicated is because every small bone forms a joint with the bone next to it. Articular cartilage covers the ends of bones where they meet in a joint. Articular cartilage is a smooth, slippery substance that lets the bones slide against one another without causing damage to either surface.

Ligaments connect all the small wrist bones to each other. Ligaments also connect the bones of the wrist with the radius, ulna, and metacarpal bones.These ligaments are important in balancing the movement of all of the wrist bones.

When one or more of these ligaments is injured, the way the bones move together as a unit is changed. This can lead to problems in the wrist joint that cause pain. Eventually, arthritis may develop in the wrist joint.

Causes

How do ligament injuries of the wrist occur?

By far the most common way the wrist is injured is a fall on an outstretched hand. (The same type of force can happen in other ways, such as when you brace your self on the dashboard before an automobile crash.) Whether the wrist is broken or ligaments are injured usually depends on many things, such as how strong your bones are, how the wrist is positioned during the injury, and how much force is involved.

Any kind of injury to the wrist joint can alter how the joint works. After a wrist injury, ligament damage may result in an unstable joint. Any time an injury changes the way the joint moves, even if the change is very subtle, the forces on the articular cartilage increase. It’s just like a machine; if the mechanism is out of balance, it wears out faster. Over many years, this imbalance in joint mechanics can damage the articular cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint can no longer compensate for the damage, and the wrist begins to hurt.

Symptoms

How do I know if I have a ligament injury of the wrist?

When an injury occurs, pain and swelling are the main symptoms. The wrist may become discolored and bruised. Doctors refer to this as ecchymosis. The wrist may remain painful for several weeks. There are no specific symptoms that allow your doctor to determine whether a wrist ligament injury has occurred.

Once the initial pain of the injury has subsided, the wrist may remain painful due to the instability of the ligaments. If the ligaments have been damaged and have not healed properly, the bones do not slide against one another correctly as the wrist is moved. This can result in pain and a clicking or snapping sensation as the wrist is used for gripping activities.

In the late stages, the abnormal motion may cause osteoarthritis of the wrist. This condition can cause pain with activity. During activity, the pain usually lessens, but when the activity stops, the pain and stiffness often increase. As the condition worsens, a person may feel pain even when resting. The ability to grip with the hand may be diminished. The pain may interfere with sleep.

Diagnosis

What tests will my doctor do?

The diagnosis of ligament injuries of the wrist begins with a medical history. Your doctor will want to know about any injuries to the wrist, even if they were years ago and healed without much problem.

Your doctor will then physically examine your wrist joint. It may hurt when your doctor moves or probes your sore wrist. But it is important that your doctor sees how your wrist moves, how it is aligned, and exactly where it hurts.

You will need X-rays. X-rays are usually the best way to see what is happening with your bones. After a wrist injury, X-rays can help determine whether a wrist fracture has occurred. X-rays can also help your doctor determine whether certain types of ligament injuries have occurred by looking at how the bones of the wrist line up.

If X-rays do not show enough information, other tests may be ordered to view the ligaments better. In some cases, an arthrogram of the wrist is used. This test requires that dye be injected into one of the small joints of the wrist. Special X-rays are then taken to look for leakage of the dye out of the joint. This may help confirm that the ligaments are torn.

More recently, doctors are also using magnetic resonance imaging (MRI) to look at the wrist ligaments. The MRI machine uses magnetic waves to create pictures that look like slices of the wrist joint. Unlike X-rays, an MRI scan shows the soft tissues such as ligaments quite well and can sometimes confirm the presence of a torn ligament in the wrist.

Finally, for cases in which the diagnosis is still in question, arthroscopy of the wrist joint may be used to determine whether a ligament injury is causing the continued symptoms. The arthroscope is a miniature TV camera that is inserted into the wrist joint to allow the surgeon to see the ligaments that may be torn. In some cases, the arthroscope may also be used to assist with repair of the ligaments at the same time.

Treatment

What can be done for ligament injuries of the wrist?

The first challenge in treating a ligament injury of the wrist is recognizing that it exists. Many patients fall and injure their wrist and assume they have a sprain. They treat the sprain with rest for a few weeks, and then resume their activities. Many ligament injuries go unrecognized until much later when they cause problems.

The treatment of a ligament injury depends on whether it is an acute injury (just happened within weeks) or a chronic injury (something that happened months ago).

Nonsurgical Treatment

A wrist injury that causes a partial injury to a ligament, a true wrist sprain, may simply be treated with a cast or splint for three to six weeks to allow the ligament to heal.

Surgery

In cases where the ligaments are completely torn and the joints are no longer lined up, surgery may be suggested to either repair the ligaments or pin the bones together in the proper alignment to hold them in place while the ligaments heal.

There is no single operation that is used to fix ligament injuries of the wrist. Several surgical procedures are used depending on the problem.

Percutaneous Pinning and Repair of the Ligaments

If the ligament damage is recognized within a few weeks after the injury, the surgeon may be able to insert metal pins to hold the bones in place while the ligaments heal. This procedure is called a percutaneous pinning. (Percutaneous means through the skin; an incision is not required.) The surgeon uses a fluoroscope to watch as the pins are placed. The fluoroscope is a type of continuous X-ray machine that shows the X-ray image on a TV screen.

In some cases, getting the bones lined up properly is not possible, and an incision must be made to repair the ligaments. The longer the surgery is done after the initial injury, the less likely it is that the bones can be aligned properly. It is also less likely that torn ligaments will heal once scar tissue has developed over the ends. The metal pins are placed to hold the bones still while the ligaments heal. The pins are usually removed four to six weeks after the procedure.

Ligament Reconstruction

When the ligament damage is discovered six months or more after the initial injury, the ligament may need to be reconstructed. This procedure involves making an incision over the wrist joint and locating the torn ligament. Once this is done, a tendon graft is used to replace the ligaments that have been torn. The tendon graft is usually borrowed from the palmaris longus tendon of the same wrist. This tendon doesn’t do much and is commonly used as a tendon graft for surgical procedures around the hand and wrist. The tendon is removed from the underside of the wrist through one or two small incisions.

Again, metal pins are used to hold the bones stationary while the tendon graft heals. The pins are removed six to eight weeks after the surgery.

Fusion

When the ligament instability is discovered long after the injury and arthritis is present in the joints between the unstable bones, a fusion may be suggested. Two or more bones are fused by removing the cartilage surface between the bones. When the raw bone surfaces are placed together, the bone treats them as it would a fracture. The surfaces heal together. The bones fuse into one bone. This stabilizes the motion between the bones and reduces the pain that occurs when the arthritic joint surfaces rub together.

If the entire wrist has become arthritic from longstanding instability, a complete wrist fusion may be required.

Rehabilitation

What should I expect after treatment?

Nonsurgical Rehabilitation

After wearing a splint or cast for three to six weeks, your doctor may have you work with a physical or occupational therapist. Treatments are used to help you regain wrist range of motion, strength, and function.

After Surgery

If you have surgery, your hand and wrist will be bandaged with a well-padded dressing and a splint for support. Physical or occupational therapy sessions may be needed for up to three months after surgery. The first few treatment sessions focus on controlling the pain and swelling after surgery. Patients then begin to do exercises that help strengthen and stabilize the muscles around the wrist joint. Other exercises are also used to improve the fine motor control and dexterity of the hand. The therapist suggests ways to do activities without straining the wrist joint.

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Wrist fracture in Adults

A wrist fracture is a break in one or more bones of the wrist.

What causes a wrist fracture?

A wrist fracture is usually caused by a fall on an outstretched hand. Wrist bones may also be broken when hit directly by a hard object. Medical conditions, such as osteoporosis (brittle bones), may increase your chances of having wrist fractures.

What are the signs and symptoms of a wrist fracture?

  • Pain, swelling, and bruising of your injured wrist
  • Wrist pain that is worse when you hold or squeeze something
  • Weakness, numbness, or tingling in your injured hand or wrist
  • Trouble moving your wrist, hand, or fingers
  • Change in the shape of your wrist

How is a wrist fracture diagnosed?

  • X-rays: You may need x-rays of your wrist, hand, and forearm to check for broken bones. X-rays of both your injured and uninjured wrists may be taken.
  • CT scan: This test is also called a CAT scan. An x-ray machine uses a computer to take pictures of your forearm, wrist, and hand. The pictures may show if you have broken a bone. You may be given a dye before the pictures are taken to help caregivers see the pictures better. Tell the caregiver if you have ever had an allergic reaction to contrast dye.
  • MRI: This scan uses powerful magnets and a computer to take pictures of your forearm, wrist, and hand. An MRI may show if you have broken a bone. You may be given a dye to help the pictures show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body.

How is a wrist fracture treated?

Treatment will depend on which wrist bone was broken and the kind of fracture you have. You may need the following:

  • Cast or splint: A cast or splint keeps your wrist from moving to allow it to heal. They may also help decrease pain and prevent further damage to your broken bones.
  • Medicine: Medicine may be given to ease your pain. You may need antibiotic medicine or a tetanus shot if there is a break in the skin.
  • Surgery: If a bone has moved out of place, you may need surgery to put it back in its normal position.

What are the risks of a wrist fracture?

Surgery or an open wound may cause you to bleed or get an infection. You may get a blood clot in your arm. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke. If not treated, the bones may not heal properly. This may also cause blood supply problems to the wrist and hand. You may have problems with hand movement or decreased grip strength.

How can I manage my symptoms?

  • Ice: Ice helps decrease swelling and pain. Use an ice pack or put crushed ice in a plastic bag. Cover it with a towel and place it on your fractured wrist for 15 to 20 minutes every hour as directed.
  • Physical therapy: You may need physical therapy after your wrist heals and the cast is removed. A physical therapist can teach you exercises to help improve movement and strength and to decrease pain.

Fracture your Wrist? Call us at +65 6471 2744 for professional consultation and treatment or email to: info@boneclinic.com.sg

Hand, Finger and Wrist Injuries

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it’s not surprising that symptoms develop from everyday wear and tear, overuse, or an injury.

Finger, hand, or wrist injuries most commonly occur during:

  • Sports or recreational activities.
  • Work-related tasks.
  • Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools.
  • Accidental falls.
  • Fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury.

In children, most finger, hand, or wrist injuries occur during sports or play or from accidental falls. Any injury occurring at the end of a long bone near a joint may injure the growth plate (physis) and needs to be evaluated.

Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk of accidental injury.

Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Sudden (acute) injury

An acute injury may occur from a direct blow, a penetrating injury, or a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

  • Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity. See a picture of a bruise (contusion) .
  • Injuries to ligaments. See a picture of a torn thumb ligament  as in skier’s thumb.
  • Injuries to tendons, such as mallet finger.
  • Injuries to joints (sprains).
  • Pulled muscles (strains).
  • Broken bones (fractures), such as a wrist fracture .
  • Dislocations.
  • Crushing injury, which can lead to compartment syndrome.

Overuse injuries

Overuse injuries occur when too much stress is placed on a joint or other tissue, often by “overdoing” an activity or repeating the same activity. Overuse injuries include the following:

  • Carpal tunnel syndrome is caused by pressure on a nerve (median nerve ) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand. See a picture of carpal tunnel syndrome .
  • Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.
  • De Quervain’s disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become inflamed. See a picture of de Quervain’s disease .

Treatment

Treatment for a finger, hand, or wrist injury may include first aid measures; medicine; “buddy-taping” for support; application of a brace, splint, or cast; physical therapy; and in some cases, surgery. Treatment depends on:

  • The location, type, and severity of the injury.
  • How long ago the injury occurred.
  • Your age, health condition, and activities (such as work, sports, or hobbies).

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Sprained Wrist

One of the most common causes of wrist pain in athletes is a sprained wrist. A wrist sprain typically occurs after a fall on an outstretched hand stretches or tears the ligaments of the wrist. Common causes of wrist sprains include falls during sports such as inline skating, snowboarding, soccer, football, baseball, and volleyball. When an athlete falls on the outstretched hands, the muscles, tendons and ligaments in the wrist take the majority of the impact, and can be stretched and possibly torn. If these tissues are inflexible or weak, the risk of injury increases.

It’s helpful to understand the difference between a sprain and a strain.

A sprain is an injury to a ligament, the tough, fibrous tissue that connects bones to other bones. Ligament injuries involve a stretching or a tearing of this tissue.

A strain is an injury to either a muscle or a tendon, which is the tissue that connects muscles to bones. Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear.

Signs and Symptoms of a Sprained Wrist Prevention In the wrist, a sprain is much more common that an strain due to the number of ligaments that support the bones in the wrist. A wrist sprain typically causes pain, tenderness, and swelling over the wrist after a fall. It will be red, tender and warm to the touch. There may be bruising, decreased range of motion, and a dull deep ache in the wrist.

If you have these symptoms after a fall on a hand, you should see a physician for an exam to make sure there is not fracture. One particular fracture to the scaphoid (or navicular) bone in the wrist can be fairly serious if not treated properly. For this reason, any wrist injury should be seen by a physician for an evaluation.

Wrist sprains (like other sprains) are graded according to severity:
Grade 1 (mild) — over-stretching / micro-tears of ligaments
Grade 2 (moderate) — partial ligament tears and mild joint instability
Grade 3 (severe) — severe or complete ligament tears and significant joint instability

Sprained Wrist Treatment

R.I.C.E is the first line treatment of a sprained wrist. This includes:

  • Rest. Stop activity and don’t use the injured wrist for 48 hours or until the pain and swelling has subsided.
  • Ice. Ice the wrist by applying a cold pack (wrapped in a towel) or a bag of crushed ice to the wrist for 15 minutes, several a day for several days, until swelling subsides. Don’t ice you injury for more than than 20 minutes at a time.
  • Compression. Use an elastic compression bandage to wrap the wrist and limit swelling. Start the wrap at the base of the fingers and stop just below the elbow. The wrap should be snug, but be careful not to cut off circulation to the fingers.
  • Elevation. Keep the injured wrist higher than your heart as often as possible during the day and at night for the first two days after the injury. This will help drain fluid and reduce swelling around the wrist.
  • Bracing. Your doctor may recommend that you use a brace to immobilize your wrist, especially when playing sports. cast
  • Immobilization. If you have a severe sprain, your doctor may recommend a cast for two to three weeks.
  • Rehabilitation Exercises. You may also see a physical therapist for flexibility, range of motion, and strengthening exercises for the injured wrist.
  • Surgery. In rare cases, surgery may be needed to repair a ligament that is torn completely or if there is a bone fracture.

Sprained Wrist Prevention

Wearing protective gear, such as wrist guards, may help prevent wrist sprains in some sports. Playing by the rules, and simply being aware of your surroundings may also help prevent falls that lead to wrist sprains.

Stop the pain and get your Wrist checked! Call +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg