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WRIST

Wrist Anatomy

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 

Wrist Contusion

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

Wrist Fractures or breaks in the wrist are the most frequent fractures seen in the emergency room. view 

Distal Ulnar Fractures and Traumatic Injuries

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 

Scaphoid Fractures

The scaphoid is the most frequently fractured (broken) carpal bone in the wrist. view

Wrist Dislocations / Fracture Dislocation

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

Wrist Open Wounds

Open wrist wounds indicate the skin is breached, the wound contaminated and exposure with potential injury of deeper structures is a possibility. view

Wrist Amputations

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

Wrist Arthritis

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

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

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

Wrist Tendonitis

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

Stiff Wrist

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

Wrist Infections

Infections about the wrist are diseases caused by micro-organisms that invade tissue and cause destruction with the consequent loss of function. view

Wrist Tumors

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

WRIST DISLOCATIONS /…

Pathology

Common Wrist Injuries

  • Carpal Fracture
    • Breaking the bones of the wrist
  • Dislocation the Wrist
  • Wrist Fracture Dislocation
    • Combination of both a carpal fracture and dislocation

Wrist Dislocation
A wrist dislocation is the separation of the bones at the level of the joint with disruption of the ligaments. Ligaments attach bones to other bones and normally keep them together, providing stability while the joint moves.

Perilunate Dislocations
The most frequent dislocations about the wrist involve the joints around the lunate wrist bone, and are called perilunate dislocations.

In a perilunate dislocation, the ligament disruption occurs sequentially. It starts initially at the scapholunate joint, then progresses in a clockwise direction around the lunate, through the lunocapitate joint and lunotriquetral joint before culminating in a complete lunate dislocation in the palmar side of the wrist.

Wrist Fracture Dislocations
Wrist fracture dislocations represent a spectrum of the perilunate wrist dislocation. As in the perilunate dislocations, they are the result of high energy trauma.

Transscaphoid Perilunate Dislocation (TSPLD) 

  • More frequent than a lunate dislocation
  • TSPLD is a dislocation of the lunate

Instead of the ligament tearing, there is instead an associated fracture of the scaphoid and the proximal scaphoid fragment is carried along with the lunate dorsally towards the back of the wrist.

 

Treatment

When a TSPLD has occurred, it is necessary to attempt immediate reduction of the scahoid fracture. This is necessary to avoid progressive swelling and kinking of the remaining blood supply to the scaphoid, which can potentially result in necrosis of the scaphoid bone.

This is rarely achieved by closed manipulation in the emergency room and requires the patient to be brought to the operating room for treatment. The median nerve responsible for the commonly known carpal tunnel syndrome, is located in the same vicinity, is also assessed for acute traumatic compartment carpal tunnel syndrome and is decompressed if necessary.

If the bones are successfully repositioned at the emergency room, the patient can be splinted for comfort and final treatment scheduled within days once the swelling has subsided.

If surgery is required, the surgeon will fix the scaphoid fracture (open reduction and internal fixation) and the injured ligaments in combination with pins to maintain carpal bone alignment while the ligaments that are repaired can heal in good position.

Immobilization for 8 – 12 weeks is done to allow for ligamentous healing. During initial healing, the wrist should remain supported by a splint with minimal motion allowed; the pins can easily toggle, loosen and become infected. The pins are removed after 8-12 weeks when enough time has elapsed for the ligaments to heal.