Wrist Injuries

Wrist injuries are seen to occur in both traumatic instances, such as in falls and in overuse instances when structures such as tendons are overloaded.

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Scaphoid Fracture

What is a scaphoid fracture?

The scaphoid is one of the small bones in the wrist known as the carpal bones. The scaphoid sits at the base of the thumb.

What causes a scaphoid fracture?

Typically, the scaphoid is fractured when a person falls onto the outstretched hand. This is a traumatic injury.

How does a scaphoid fracture feel?

Acute pain is felt at the base of the thumb. Tenderness is found at the anatomical snuff box which is the little cavity found at the base of the thumb. Swelling will not always develop as with most other boney fractures. You may also experience weakness of grip strength.

Management of a scaphoid fracture and how to fix it?

If there is trauma and pain around the region of the scaphoid, you should immediately stop participation of activity and suspect a fracture until proven otherwise. Immobilise or bandage the wrist and seek attention by a medical practitioner or sports physician. A physiotherapist can assist in the diagnostic process and refer you to the appropriate expert for further attention. An X-ray is essential, however, quite often a fracture will not be seen in the initial period. An MRI or bone scan is more sensitive. Repeat x-ray after 10 days will normally find the fracture site.

Immobilisation in a scaphoid cast is required for 4-6 weeks. Because the blood supply to the scaphoid is poor, delayed or non union is a complication. For this reason, some surgeons opt for immediate surgical fixation at the acute phase. Typically, this allows for a quicker return to sport or activity.

De Quervain’s Tenosynovitis

What is De Quervain’s Tenosynovitis?

This is a condition referring to inflammation of the soft tissues surrounding the two main tendons that move the thumb. These are the abductor pollicis longus and extensor pollicis brevis. The condition is the most common lateral side tendinopathy seen amongst athletes.

What causes  De Quervain’s tenosynovitis?

Due to overuse or overload, the tendon structures sustain microtrauma as they pass in a fibro-osseous tunnel at the level of the radius. It is commonly seen with raquet sports and rowers or canoeists as well as in the left thumb of a right hand golfer. In the non sporting population, the condition is seen in occupations that require prolonged typing and writing and also in new mothers who suddenly are lifting and holding awkward wrist positions e.g breast feeding and general carrying of unfamiliar objects.

How does De Quervain’s tenosynovitis feel?

Pain and tenderness is felt over the tendons at the edge of the radius. Swelling may be obvious and often creeking or crepitus occurs with movement of the thumb or wrist. Most movements of the wrist are painful, as is lifting.

Management of De Quervain’s tenosynovitis and how to fix it?

As with other tendon injuries, stop or modify aggravating activities and postions of the wrist. Commence RICE regime (Rest, Ice, Compresion, Elevation) and seek physiotherapy advice and treatment. Your physiotherapist may decide to splint the wrist and thumb, progress you through a stretching and strengthening program. Equally important is the assessment of your sporting technique, work set-up and posture during the performance of your activities as this may contribute to the overuse loads.

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition when the median nerve is compressed as it passes through the carpal tunnel with a number of tendons in the front of the wrist.

What causes carpal tunnel syndrome?

The cause of carpal tunnel syndrome is largely idiopathic i.e unknown or spontaneous. There is a strong genetic predisposition, therefore a structural and biological underlying cause. There is also an association with other conditions and illnesses such as rheumatoid arthritis and hypothyroidism. Other examples include pregnancy in which fluid retention causes the compression of the nerve. Also predisposing carpal tunnel syndrome is obesity. There is ongoing debate as to whether work related activities are a cause of the condition.

How does carpal tunnel syndrome feel?

The condition is characterised with burning pain, numbness or paraesthesia in the thumb, index and middle fingers. This particularly occurs at night time, because people tend to bend their wrists when they sleep, which further compresses the carpal tunnel.

The Management of carpal tunnel syndrome and how to fix it?

Seek medical or physiotherapy attention as soon as possible. Physiotherapy may include a range of modalities ranging from soft tissue massage, stretches, exercises and techniques to mobilize the nerve tissue. It can also include immobilizing braces and splints.  Medications to reduce inflammation and swelling are also of use. Steroid injections can be quite effective for temporary relief from symptoms, however, surgical release of the transverse carpal ligament is often the only effective treatment option.

Ulnar Sided Wrist Pain (Triangular Fibrocartilage Complex tear – TFCC)

What Is TFCC?

The triangular fibrocartilage complex is the combination of a piece of cartilage that is found at the end of your forearm bone, ligaments and tendons that all blend together on the side of your little finger. This structure can be inflammed or torn and cause pain with wrist movement.

What causes TFCC?

This injury can be caused by one traumatic event such as a lifting task or progressively over time with repetitive loading and twisting of the wrist.

How does TFCC feel?

Pain is usually felt on the little finger side of the wrist. It is commonly felt during the gripping of an object particulary when the palm of your hand is down.

Management of TFCC and how to fix it?

The majority of these injuries are managed conservatively with rest in a splint, techniques to reduce swelling and ultimately a progressive functional strengthening program. If the tear is big enough and in a place that does not have good blood supply for healing then surgery maybe required.

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