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Wrist Joint/Ligament Sprain
Less serious falls on the wrist that do not result in fractures may cause a tear of the capsule or ligaments around the wrist joint when the wrist is forced backward or forward. This tear of capsule/ligaments will result in local swelling and tenderness. Loss of range of movement will also be experienced in the wrist. Compression, ice and immobilization will help control symptoms.
Thumb Tenosynivitis (De Quervain’s Disease)
This injury is an overuse injury of the tendons in the thumb at the back of the wrist (dorsal aspect of the wrist). Inflammation of the tendons and their surrounding ‘sheath’ is commonly caused by overuse in racquet sports, bowling or extended typing or writing. Symptoms include pain and swelling on the back of the base of the thumb which may extend up into the forearm or down into the thumb as well as a creaking sensation when moving the thumb. Effective treatment must be sought as well as rest from the aggravating activity to ensure adequate recovery.
For this problem there are three modes of treatment, not treatment, conservative treatment and surgery.
As a last resort, when conservative treatment has failed, surgical decompression of the tendon by opening up the pulley can be performed as an outpatient procedure under local anesthesia with a small incision. This has a good success rate.
Conservative treatment consists of modification of activities, use of a thumb brace and occasional icing and then possible use of anti-inflammatory medications. If the pain still persists despite the above treatment a cortisone injection can be helpful. No more than three cortisone injections are recommended per year in any one location.
Triangular Fibrocartilage Tear
The triangular fibrocartilage is a piece of cartilage that sits in the wrist joint between the ulna and carpal bones. This cartilage may be progressively damaged when compression and rotation forces are continually being placed on the wrist. These forces are commonly experienced in the wrists of gymnasts and racquet sport players. Symptoms include swelling and pain on the little finger side of the wrist and will increases when deviating the wrist toward the little finger and pulling back against resistance. Clicking may also be felt in the wrist with movement. Bracing, rest and anti-inflammatory treatment may be required.
This cartilage is similar to that of the knee in that is often torn and does not have an adequate blood supply to it. The reason it is causing discomfort is usually there is a flap of tissue that is flapping back and forth and causes irritation of the joint.
For this problem there are three modes of treatment; no treatment, conservative, and surgical.
Conservative treatment would consist of resting the wrist in a wrist brace or a cortisone injection. Physiotherapy is sometimes of benefit.
If there is persistent pain despite conservative treatment, arthroscopic surgery with debridement of the tear to give the tear smooth edges is usually very successful. This can be performed under local anesthesia on an outpatient basis with two or three small incisions on the wrist. Occasionally, the cartilage can be repaired.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R - Rest
I – Ice
C - Compression
E – Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.
Strengthening programs should only be commenced when:
Exercises should be 3 sets of 8-12 repetitions.
The taping technique below can be used following injury to limit the wrist joint range of movement. This may be useful when returning to sport follwing injury or to protect a repetitively injured wrist. Ensure you seek adequate advice prior to returning to sport following injury.