The wrist is a bio-mechanically complex joint allowing the wrist to move in extension (up), flexion (down), radial deviation (towards the thumb), ulnar deviation (towards the small finger) and minimal degrees of rotation. view
Trauma is the term used to describe injury. Trauma is classified by its severity depending on the amount of force used to cause the injury. view
Wrist Fractures or breaks in the wrist are the most frequent fractures seen in the emergency room. view
The distal end of the ulna is rarely fractured(broken) in isolation except when direct trauma like a gunshot wound or a direct blow to the ulna occurs when the arm is elevated to protect the face. view
The scaphoid is the most frequently fractured (broken) carpal bone in the wrist. view
Dislocations of the wrist are rare injuries frequently associated with high energy trauma like a fall from a height, a motor vehicle collision or a high impact sporting event. view
Open wrist wounds indicate the skin is breached, the wound contaminated and exposure with potential injury of deeper structures is a possibility. view
An amputation is the severing of a body part. Amputations are classified as partial and complete and if the amputation was a clean cut, a crushing amputation or an avulsion amputation where the amputated limb is pulled right off of the body. view
The primary vessels or channels that supply blood to the hand while traveling across the wrist are the Radial and Ulnar Arteries. view
Carpal tunnel syndrome is the most frequent cause of nerve compression in the human body. It is caused by compression of the median nerve at the level of the wrist. view
Ulnar Tunnel Syndrome is the compression of the ulnar nerve at the level of the wrist. Similar to the median nerve, this nerve can be compressed at more proximal locations and can occur in combination with other nerves. view
Tendonitis is swelling or inflammation of the tendon or tendon lining called tenosynovium. Tendons at the wrist are normally confined to tunnels they travel through. view
After injury, patients can develop decrease range of motion as a consequence of swelling, pain, and scar formation occurring with significant adhesions that bind various tissue layers. view
Infections about the wrist are diseases caused by micro-organisms that invade tissue and cause destruction with the consequent loss of function. view
The most frequent cause of swelling or masses found at the wrist level is ganglion cysts. More frequently found in women, ganglions are like a little balloon made out of the joint capsule, filled with a clear, colorless, gelatinous fluid that comes from the joint itself. view
The scaphoid is the most frequently fractured carpal bone in the wrist. This fracture is often the result of a fall from ground level with the wrist hyperextended and turned towards the thumb (radially deviated).
In lower energy injuries, patients with a scaphoid fracture may have minimal discomfort with no swelling. Furthermore, the fracture of the scaphoid when initially undisplaced is often times not visible on a plain x-ray. In this low energy presentation, the fracture is often misdiagnosed as a wrist sprain unless a high index of suspicion is present by the clinician. If a scaphoid fracture is missed and the wrist is not immobilized, a nonunion will develop, which is difficult to treat.
In higher energy injuries, such as a fall from a height, a sports injury, or a motor vehicle accident, the fracture and ligamentous injuries are more obvious. Patients with a scaphoid fracture may complain of thumb sided wrist pain, decreased range of motion of the wrist, swelling and weakness and on exam will demonstrate tenderness in an area of the wrist called the “snuff box”.
The scaphoid receives little blood supply and often fails to heal in 13- 50% of fractures. This percentage increases in fractures of the scaphoid involving the proximal pole. Due to the limited blood supply, scaphoid fractures have a prolonged healing time, ranging from nine months to one year for confirmed healing.
When a scaphoid fracture does not heal, it will progress to scaphoid collapse and progressive wrist arthritis. Treating a scaphoid fracture that doesn’t heal is very challenging and therefore an accurate diagnosis and timely treatment is preferable.
Plain X-rays are initially obtained when suspicion of a scaphoid fracture exists after a wrist injury. Classically, patientswith clinical findings of a scaphoid fracture but normal x rays findings are still treated with immobilization in a cast. They are re-evaluated in two weeks with repeat x-rays because it takes time for the fracture line to appear on x-ray film when it is non-displaced.
If a physician has a high index of suspicion that a scaphoid fracture is present and immediate surgical intervention is the preferred method of treatment, an MRI (Magnetic Resonance Imaging) can be obtained.
An MRI will detect all occult fractures and is the gold standard when an early scaphoid fracture diagnosis is desired. A scaphoid fracture that is not displaced can be treated in a cast or fixed surgically with a screw.
If treated in a cast, it takes at least 12 weeks of continuous immobilization followed by a removable splint and frequent x-rays to assure the fracture healing is progressing in the correct direction. Patients may experience significant stiffness and weakness after such a prolonged period of wrist immobilization.
Surgical treatment consists in the application of specially designed headless screws that create stable fixation of the fracture. Surgical treatment has been reported to improve union rates to 95% or higher for all types of scaphoid fractures, improve the wrist range of motion and shortens the healing time.
Almost all proximal pole fractures and all displaced scaphoid fractures are best treated with surgery. Once surgically fixed, patients can be protected with a removable brace. The brace allows for early gentle hand and wrist activities while facilitating hygiene.
A therapy program may be necessary depending on the type of treatment selected and the patient’s limitations found after the fracture has healed.