The wrist has a structure which undertakes a transmission role between fingers and the wrist and formed of 8 small bones. They are connected with ligaments which hold these bones within suitable positions during movements.
Wrist injuries usually occur falling on the wrist or traumas during various activities. Generally the wrist swells after the trauma, sometimes bruising may occur. Generally pain accompanies to the movement.
Ligament injuries may present as dislocation and fractures as well as ligament injuries that may be detected without any fracture. (Figure 1)
Ligament injuries without fractures are not considered seriously which may present with serious problems in the future.
The most injured ligament in the wrist is Scapholunate ligament which is one of the ligaments providing the main coordination of wrist bones.
This ligament is between scaphoid and lunate bones of the wrist. In injuries positions of the wrist change and continuous pain of the wrist may be seen further. Injuries of other ligaments between the wrist bones are rarer. Ligament injury is generally as stretching or breakaway in small traumas. Complete breakaway occurs in more serious traumas.
Sensitivity is detected in the thumb side of the wrist during the examination. Sometimes abnormal sounds are present during the wrist movements. By X-ray examination, sequence and position changes between the wrist bones are examined. MR Imaging and computerized tomography is required for the diagnosis.
The treatment varies from brace using to the surgery. Wrist arthroscopy is examination of the inner structures of the wrist by opening two small holes on the wrist and entering with a camera from one hole and tolls from the other hole. Wrist arthroscopy is a necessary examination for patients whom wrist ligament injury is thought. Solution of a treatable situation may be provided with the wrist arthroscopy simultaneously. Sometimes open surgery intervention may be decided after the arthroscopic surgery. Ligament repair may be performed by pins, screw application or various methods during the open surgery.
For the patients who apply continuous wrist pain which has occurred before with significant wrist bone displacements, position of bones, the injury level of the ligament and whether cartilage damage is present are investigated. Wrist brace and pain killer drug treatment may be applied to moderate symptoms. Pins and screws may be applied surgically and various ligament repairs may be performed via ligaments taken from other places. One of the important treatment options is to combine some of wrist bones with each other. If cartilage damage is present or previous treatments were not successful, complete freezing of the wrist, removal of upper bones (proximal row carpectomy) or wrist prosthesis which is developed and started to be applied recently are among treatment options. To provide disease not to progress to these steps, treatment should be applied correctly in the early stage.
The wrist is a very complex structure. Especially due to abnormal position changes in chronical cases, unsuccessful results may arise during treatments. Recurrent operations may require due to wrist movement limitations, continuous pain complaints. Even the problem seems to be small, to provide solution may be difficult in delayed cases.