Wrist Injuries

Wrist Injuries

Athletic Wrist Injuries

Falling on the outstretched arm during athletics is very common. Most times, this does not result in any injury. However, if the fall is atypical, a wrist injury may occur. The wrist is a very complex structure comprised of 8 carpal (wrist bones), the radius and ulna of the forearm, and 5 metacarpal bones (hand). See this labeled x-ray.

The joint also has numerous tendons, nerves, arteries, and veins crossing the joint. This complex of joints is capable of flexion, extension, radial and ulnar deviation, and to some extent rotation. Eighty per cent of the force passing through the wrist is supported by the radius, 20% by the ulna. Proper evaluation and treatment is necessary to afford the athlete with the best possible environment for healing.

Most fractures about the wrist involve the radius and ulna. In preteens and teenagers growth plate fractures are very common. These should be treated with a long– or short-arm cast, depending upon the injured area, for 4 to 6 weeks then immobilized in a splint for another 2 to 4 weeks while returning to play.

Scaphoid Fractures

Other less common, but far more worrisome, fractures will involve the scaphoid (or navicular), the carpal bone at the base of the thumb. This bone is very important as it is the bridge between the two rows of carpal bones. This bone presents a unique healing problem, it has been given the title of “slowest healer” by many orthopaedic surgeons. This is due to its limited blood supply. Only one small artery supplies blood to the scaphoid and it is limited to the proximal pole.

An injury to the scaphoid usually results from a fall on the outstretched hand. There may be swelling of the wrist. The most remarkable symptom is usually pain with palpation of the anatomical “snuff box” (arrow in picture).

Due to the poor blood supply, this injury heals properly only when diagnosed early. Early x-rays are often negative for fracture. The athlete should be splinted for 7 to 10 days and then re-examined. If the “snuff box” is still tender, repeat x-rays should be taken. If they are still negative, a bone scan or CT scan should be performed to rule out this fracture. This CT scan shows a scaphoid fracture.

Once the fracture is confirmed the athlete will be placed in a long arm cast for 6 to 8 weeks. This will be followed up with a short arm cast for 4 to 6 weeks, then splinting for 4 to 6 weeks. This serial casting and splinting is necessary to give the bone the best environment for healing. If these measures fail, surgical fixation with a screw may be necessary.

Hook Of The Hamate Fractures

The hook of the hamate is a common fracture and can pose problems to athletes that use a club, bat, or racket. Pain with a baseball swing in the volar and ulnar side of the wrist while swinging a bat can be indicative of a hamate fracture.

The hamate has a hook which the flexor carpi ulanris tendon passes thru. The hook acts as a fulcrum to increase the strength of the muscle. Loss of grip strength, especially on the little finger side is another symptom of this fracture.

Standard x-rays usually do not show the hook of the hamate. Many orthopaedic surgeons will order special x-ray views to better visualize the bone. One such example is the carpal tunnel view, shown by following this link. If this x-ray is negative, but there is still a strong suspicion of a hamate fracture, a CT may be ordered. The CT on the next page shows an excellent view of the hamate and its fractured hook.

Treatment routinely includes casting for 4 to 6 weeks to immobilize the bone. Healing is usually complete in 6 to 8 weeks.

deQuervain’s Tenosynovitis

Pain that travels along the radius from the wrist up the forearm for about 6 inches could be from deQuervain’s tenosynovitis. This injury is common in boxing and football. Boxers sustain this injury by sustaining repeated punches that glance off of their opponent. With football players it is generally an injury secondary to a contusion of the radial shaft.

The evaluation of this injury should include the Finkelstein test, shown by following this link. This test applies a stretch to the abductor pollicus longus tendon. A positive test is signaled by pain that radiates down the forearm to the wrist.

Treatment for this injury should involve the use of nonsteroidial anti-inflammatory medications, wrist stretching, gentle strength training, and protection from repeated trauma.

Wrist injuries must be taken seriously. A good differential diagnosis must include all major joints, ligaments, tendons, and nerves. Many long term problems can be avoided by early detection of potentially debilitating injuries.

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 10/24/2009 12:09:35 AM