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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 TENDONITIS

Pathology

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. With swelling, the tendon gets trapped and won’t glide well. Technically any tendon can suffer tendonitis, but the most common tendonitis occuring in the wrist is called Dequervain’s disease, which invlolve the tendons on the thumb side of the wrist(tendons of the first dorsal compartment) that straighten the thumb. Other sites of frequent tendonitis is the Flexor Carpi Radialis(FCR) tendon that is a tendon on the palmar side of the wrist which bends the wrist towards the palm and thumb side. The FCR tendon travel in an independent compartment within the carpal canal. The Extensor Carpi Ulnaris tendon travels at the sixth dorsal compartment on the back of wrist and can also suffer tendonitis. The tendons of the first dorsal compartment and the second dorsal compartment cross paths at the distal forearm, just proximal to the extensor retinaculum pulley mechanism which can on occasion also cause mechanical irritation resulting in a teondonitis of the second compartment called Intersection Syndrome. In general tendonitis can be caused by overuse, pregnancy or inflammatory conditions such as rheumatoid arthritis. Repetitive motions during grasping or pinching can predispose to a tendonitis. Symptoms of tendonitis include mechanical pain, swelling, tenderness, an associated lump or thickening of the tendon with an occasional ganglion cyst is present on the tendon or extensor compartment.

Treatment

Treatment is focused on prevention to those individuals at risk who are involved in certain professions. Prevention includes changing the work station environment, education about body posture and positions during activities at work, use of ergonomic assisted tools, breaks during heavy repetitive tasks for stretching and to rest the extremities and limit fatigue that can instill a risk of error and progressively deteriorate body posture. From an anatomic approach, or goal is to make the space around the tendons bigger, or make the contents of the space smaller. Treatment always begins by breaking the vicious cycle of swelling and friction with ergonomic changes and education, splinting, and the use of acortisone injection between the tendon and its pulley, helping to shrink the size of the tendons and tendon lining in the tendon compartment. Anti-inflammatory medication often does not help resolve the symptoms of tendonitis and therefore although they are tried, often an injection is required. The maximum number of injections allowed in one year is three, preferably spaced no closer together than 6 months apart. Most patients have symptom resolution and return to their normal activities. A small number of patients fail a conservative nonoperative approach and require surgery involving a simple surgical release of the tight tendon compartment. This is done as an outpatient, often under local anesthesia, and always with a small incision. There are no formal restrictions after surgery. Patients return quickly to all their usual activities.