Wrist

Wrist is probably one of the most sophisticated joints in the body. If injured or affected by degenerative process, technically demanding operations and specific expertise is required to restore its complicated anatomy.

 

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).

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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.

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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