Key hole surgery also known as wrist arthroscopy is often required to diagnose exact cause of pain or joint instability. The commonest symptoms are: pain when wrist is loaded, weakness, clicking and swelling. Most problems can be resolved.
The following injuries can be dealt with successfully, especially if treated early:
- Sprains – immobilisation and physiotherapy;
- Ligament tears – direct repairs and splint; joint reinforcement;
- Fractures of the distal radius – splint or fixation with pins or plates;
- Scaphoid fractures – splint or fixation with special scaphoid screw;
- Joint dislocation – splint and/or joints stabilisation;
- Infections – medication and/or surgical washout.
Chronic conditions lead to slow, gradual deterioration of pain, weakness and stiffness. The commonest causes and its treatment are listed:
- Arthritis - medication, splint, steroid injections, arthroscopic (key hole) joint washout, prosthesis insertion, bone fusions, bone excisions;
- Instabilities – delayed reconstruction of torn ligaments, splints, injections;
- Inflammations – medication, splint, physiotherapy;
- Bone cysts/tumors – surgical excision and bone grafting;
- Kienbock’s disease (avascular necrosis of the lunate) – revascularisation, bone excisions, bone fusions.
Pictures illustrate complex anatomy of the wrist joint – bones (picture 1) and ligaments (picture 2).
TFCC (triangualar fibrocartilage complex) is a dynamic structure which sits between bones of the forearm and wrist and can sometimes be seen as a “meniscus of the wrist”; it consists of specialised ligaments and cartilage and provides joint stability, especially at extremes of wrist rotation; injuries are common in athletes and those who accidently fall on outstretched hand.
Wrist ganglion; despite variations in sizes, interventions are often not required as many of these benign lumps resolve spontaneously; for long standing ganglions, however, only surgery provides permanent cure