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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 TUMORS

Pathology

Ganglion cysts are the most frequent cause of swelling or masses found at the wrist level. Ganglion cysts are like a little balloon made out of the joint capsule, filled with a clear, colorless, gelatinous fluid coming from the joint itself. Ganglions usually present with a single cavity but may contain multiple chambers. They remain filled because they have a one-way valve mechanism allowing for fluid to easily come in but difficult to return into the joint.

Ganglion cysts occur most frequently in women. 70% of cases occur in patients between 20 and 40 years old. In older patients, they may be associated with arthritis. Ganglions are rarely seen in children. 60-70% of ganglions occur on the back of the wrist over the scapholunate ligament and about 20% are found in the palmar side over the scaphotrapezoid joint.

Patients complain of localized wrist pain aggravated with activity and weakness during repeated use of the hand. Characteristics of a Ganglion Cyst:

  • Slow growing
  • Firm
  • Smooth
  • Rubbery
  • Rounded
  • Slightly fluctuant mass that initially comes and goes and in time becomes both permanent and tender

Dorsal ganglions become more obvious with wrist flexion. Cysts on exam can transmit the light of a flashlight when in the dark. This is a technique used to confirm the diagnosis.

On occasions, patients will present with pain at maximal wrist extension but no obvious mass is noted on palpation over the scapholunate joint during the physical exam. This may represent an occult ganglion cyst and an MRI may be necessary to confirm the diagnosis.

Treatment

Non-operative treatment consists of aspiration of the cyst with or without steroid injections, followed by wrist splinting. Only 30 to 50 % of cases are successfully treated this way and this technique is commonly only a temporary solution.

Technically, it is very challenging to aspirate the fluid, even with a large needle. The larger the needle, the higher the risk of tendon injury during the procedure. It is also difficult because the cyst may collapse and the needle tip become blocked before the fluid is completely removed. Aspirations are rarely recommended or performed at ROC.

The most reliable procedure for a cyst is surgical excision. This can be done through a small transverse incision over the mass. The incision is cosmetic and in certain cases, removal can be done arthroscopically through small incisions. Both procedures provide comparable outcomes for resolution of symptoms, return to full activities, and recurrence rate. Recurrence after excision is 5-10% of cases.