Injuries caused due to stretching or tearing of the ligaments in the wrist are called wrist sprains. These injuries are usually caused by a fall during daily activities or sports activities. Sprains can range from mild to severe based on the extent of injury to the ligament. Some of the main symptoms of wrist sprains include:
- Swelling and pain in the wrist
- Difficulty in moving your wrist
- Bruising around the wrist
- Popping sensation inside the wrist
- A feeling of warmth or fever in the wrist
This condition is diagnosed with the help of your medical history and a physical examination of your wrist. Imaging tests such as X-rays, CT scans and MR Arthrograms may be used to diagnose partial ligament tears.
One of the common sprains in the wrist involves the ligament between 2 of the small carpal bones: the scaphoid and the lunate. Insufficiency of this scapholunate ligament causes scapholunate dissociation. The sprain can also involve the joint of the 2 forearm bones near the wrist. This joint is known as the Distal Radio-Ulnar Joint or DRUJ. The Triangular Fibro-Cartilage Complex or TFCC is the ligament that stabilises the DRUJ. Non healing of this ligament can lead to DRUJ instability.
Treatment for wrist sprains includes surgical and non-surgical treatments. Non-surgical treatment involves immobilisation of the wrist and performing strengthening exercises once the pain has reduced.
Surgical treatment is used to repair the ligament if it is completely torn. Surgery for scapholunate dissociation involves a diagnostic wrist arthroscopy and stabilisation of the small hand (carpal) bones with suture anchors (which are devices with strong suture material) implanted into bone. Dr Bala usually adds some wires to protect his repair for 6 weeks until the ligament heals.
Surgical treatment for DRUJ instability involves a wrist arthroscopy to clean the torn portion of the ligament inside the wrist and stabilisation of the DRUJ with a tissue graft harvested from the backside of the wrist (known as the extensor retinaculum) and fixing it using suture anchors. A splint is usually given for 4 to 6 weeks after surgery to protect the repair until it heals. Physiotherapy is initiated after 2 weeks to help improve motion and strength.
Sometimes the DRUJ is unstable because of the inner forearm bone being slightly longer than normal. This is called ulnar positive variance. This condition can also cause DRUJ instability and ulnar sided wrist pain. Dr Bala addresses this problem with a wrist arthroscopy to trim the ligament and shortens the ulna by a few millimetres using a specialized jig. He then fixes the bone cut (ulnar shortening osteotomy) using a plate and screws.
Dr Bala uses special magnification loupes to visualize and protect structures when operating around the wrist to minimize complications.