The soft tissue structure of the wrist is highly intricate, consisting of various components that contribute to its mobility and stability. The wrist joint is characterized by its extensive range of motion, which is facilitated by ligaments, capsules, and other tissues that form a complex framework.
Anatomy
In terms of anatomy, the wrist comprises multiple bones, including the carpal bones. These small bones play a crucial role in the overall structure and functionality of the wrist.
Causes
The most common cause of wrist-related issues is trauma or falling onto an outstretched hand, resulting in injury to the triangular fibrocartilage complex (TFCC).
Athletes, particularly those involved in sports such as tennis or gymnastics, including individuals in younger age groups, are at a higher risk of TFCC injuries. Additionally, drilling incidents can also lead to TFCC lesions, where the twisting motion of the drill in the wrist causes tearing within the triangular fibrocartilage complex.
Symptoms
The main indication of wrist involvement is the occurrence of pain in the ulnar region. Some individuals may experience more widespread pain throughout the entire wrist area, and this discomfort can escalate with specific movements like twisting a doorknob or turning a key. Even simple motions of the wrist can exacerbate the intensity of the pain.
Additional symptoms encompass swelling and a sensation of instability in the wrist, prompting patients to avoid rotational actions involving the affected area.
Diagnosis
A comprehensive medical history is obtained from the patient, accompanied by specialized tests to assess the presence of traumatic injuries or degenerative changes. A novel diagnostic test, known as the fovea sign, is employed as a part of the examination process. This procedure involves applying external pressure to the fovea region of the wrist, and the presence of tenderness and pain signifies a positive outcome.
In instances of acute injuries that entail severe pain and swelling, performing the fovea sign test may not be feasible. In such cases, patients are advised to utilize nonsteroidal analgesics, apply ice to the affected area, and stabilize the wrist. Subsequently, further diagnostic procedures such as magnetic resonance imaging (MRI) or arthrograms are conducted to establish an accurate diagnosis.
Wrist arthroscopy holds significant importance in both the diagnostic and therapeutic aspects. It enables the evaluation of ligaments and cartilage, allowing for the execution of therapeutic interventions within the same session.
Treatments
Non-Surgical Treatment
If the stability of the wrist is determined, a period of 4-6 weeks is prescribed for the application of a wrist splint, along with the utilization of anti-inflammatory drugs and the implementation of physical therapy.
Surgical Treatment
A thorough examination and necessary diagnostic tests should be conducted to determine the need for surgical treatment, with particular emphasis on assessing the presence of fractures. If a fracture is present and accompanied by inadequate stabilization, surgical intervention should be performed as soon as possible.
Artroscopic repair, specifically focusing on TFCC (triangular fibrocartilage complex) repair and evaluation of intra-articular pathologies, should be primarily considered and prioritized. In cases where ligament injury coexists with a fracture, fixation with wires or screws is recommended.
Rehabilitation
The duration of immobilization and the transition to rehabilitation following wrist injuries depend on the extent of the injury. The initiation of movement exercises and the patient’s adherence to prescribed protocols play a crucial role in the rehabilitation process. The use of a splint may be necessary for a period of 6-8 weeks, after which the patient can proceed to a structured physical therapy program.
Physical therapy is essential for restoring optimal range of motion, regaining strength, and achieving normal functional mobility. While many patients are able to return to work without any limitations, a subset of individuals may experience certain restrictions in specific movements. Potential complications include persistent pain and stiffness, although instances of infection or delayed fracture healing are rare occurrences.
