Wrist
Distal Radius Fracture
Description
A fracture of the radius, the larger of the two bones in your forearm and sometimes includes a fracture of the ulna, the smaller bone as well. The fracture usually occurs within one inch of the wrist end of the bone. One of the most common fractures is a Colles fracture in which the broken fragment of the radius tilts upward. Other examples of distal radial fractures include:
- Intra-articular – a fracture that extends into the wrist joint;
- Extra-articular fracture – a fracture that does not extend into the wrist joint;
- Open fracture – when the fractured bone breaks the skin;
- Comminuted fracture – when the bone is broken into more than two pieces.
The most common cause is a fall onto an outstretched arm.
Symptoms
Immediate pain, tenderness, bruising and swelling around the wrist and lower forearm. In many cases the wrist hangs in an odd or bent way.
Treatment
Non-surgical: If the broken bone is in a good position a plaster cast/splint may be applied until the bone heals.
If the broken bone is out of alignment it may be necessary to re-align the broken bone fragments known as a ‘reduction’ if this can be done without having to open the skin it is known as a closed reduction’.
This process is followed by application of a plaster cast/splint until the bone heals usually up to 6 weeks, followed by physical therapy to improve strength and range of motion.
Surgical: This typically involves making an incision to directly access the broken bones to improve alignment known as an ‘open reduction’. Surgery will involve the use of plate and screws or metal pins to hold the bones in the correct alignment. A splint or cast followed by physical therapy is also used.
Recovery
Wrist fractures are varied and so the treatment options are also varied, recovery depends on the type of fracture and method of treatment. Most people do return to all their former activities following this type of injury. The combination of pain relieving medications and physical therapy assist complete recovery which may take 6 to 12 months. There may still be some pain or stiffness following this especially with vigorous activity or in elderly or osteoporotic patients.
Scaphoid Fracture
Description
The scaphoid is one of the small bones in the wrist and it is located on the thumb side of the wrist where the wrist bends. The most common cause is to fall onto an outstretched hand landing on the palm.
Symptoms
Persistent pain and swelling at the base of the thumb. This pain may be exacerbated when you move your thumb or wrist or when you try to grip something. If the wrist is not deformed at all it can sometimes be mistaken for a sprain, but the pain will persist long after a sprain should have healed.
Treatment
Non-surgical: If the fracture is in a good position the application of a cast or splint with regular monitoring and subsequent physical therapy is the most common treatment option. The closer the fracture is to the thumb the quicker it will heal because of better blood supply in this region.
Surgical: If the fracture is broken in the middle or towards the wrist, surgery may be recommended and metal screws and wires may be used to hold the scaphoid in place until the bone is fully healed. In some cases a bone graft may be needed and is usually taken from your forearm bone in the same arm. Surgical management is also followed by application of a splint or cast while the fracture heals and then physical therapy to regain strength and movement.
Recovery
A cast or splint may be needed for up to six weeks followed by exercises with a hand therapist. Some residual stiffness may occur in the wrist and it may not regain full strength.
Arthritis of the Wrist
Description
Arthritis in the joints of the wrist can be as a result of osteoarthritis which is wear and tear to the cartilage or rheumatoid arthritis which is an inflammatory response by the body which results in cartilage damage. Joints that have had previous trauma or injury are more susceptible to arthritis. Rheumatoid arthritis often affects the joint between the two bones of the forearm resulting in damage to the tendons that straighten your fingers resulting in joint deformity such as bent wrists or gnarled fingers.
Symptoms
Both types of arthritis can cause swelling, pain, limited motion and weakness in the wrist, however in the case of rheumatoid arthritis this is usually accompanied by pain, stiffness and swelling in the knuckle joints of the hand.
Treatment
Non-surgical: Early treatment is non-surgical and designed to help relieve pain and swelling, options include limiting aggravating activities, immobilisation with a splint, anti-inflammatory medications, exercise program or steroid injections into the wrist joint.
Surgical: When non-surgical treatments are no longer effective, surgery is an option Dr Marchant can discuss. The aim of surgery is to relieve pain and preserve or improve hand function, options include removal of arthritic bones, fusion of joints between the bones or joint replacement.
Recovery
Recovery depends on the management option taken and may involve a cast or splint and physical therapy to increase strength and movement.
Ganglion
Description
A ganglion is a usually harmless, fluid filled cyst that occurs in various locations but most frequently on the back of the wrist. Can quickly appear, disappear and change size with increased activity and many do not require any treatment unless painful, interferes with function or has an unacceptable appearance.
Most ganglion’s form a visible lump however smaller ganglions can remain hidden under the skin (occult ganglions).
Symptoms
Ganglions may cause pain, tingling or muscle weakness if it puts pressure on the nerves in the region.
Treatment
Non-surgical: If there are no symptoms the doctor may just monitor the ganglion. As activity often causes the ganglion to increase in size, a period of immobilisation may relieve symptoms and decrease the size of the ganglion. Another option is for the fluid to be drained from the ganglion using a needle in a procedure known as aspiration, although this does not eliminate the ganglion and it is likely that the ganglion will return.
Surgical: If your symptoms are not relieved by non-surgical management, surgery may be recommended by Dr Marchant. Surgery can remove (excise) the ganglion as well as part of the involved joint capsule or tendon sheath which is considered the ‘root’ of the ganglion. There is a small chance the ganglion will return following excision.
Recovery
Excision is an uncomplicated surgery and you will be able to go home after the procedure on the same day in most cases. There may be some tenderness, discomfort and swelling following surgery. Normal activities are usually resumed two to six weeks following surgery.
De Quervain’s Tenosynovitis
Description
Swelling of the tendons and tendon sheath around the base of the thumb following irritation or constriction. Can be caused by overuse of the tendons, also associated with pregnancy and rheumatoid disease.
Symptoms
De Quervain’s can cause pain and tenderness along the thumb side of the wrist which is particularly noticeable when forming a fist, gripping something or when turning the wrist. Pain may appear gradually or suddenly and can travel up the forearm. There may also be some swelling over the thumb side of the wrist. A catching or snapping feeling may accompany movement of the thumb.
Treatment
Non-surgical: The use of splints may be used to rest the wrist, other management includes anti-inflammatory medication or steroid injection into the tendon sheath.
Surgical: If symptoms are severe or do not improve with non-surgical management, Dr Marchant may recommend surgery. The goal of surgery is to cut the tendon sheath to open up the thumb compartment and make more room for the irritated tendons. This is an uncomplicated surgery performed as a day surgery.
Recovery
There will be some soreness and swelling after surgery which will get better in a few days. A splint may be recommended to allow the hand to heal completely. Physical therapy may also be recommended to prevent stiffness and restore hand and wrist motion. Normal use of the hand can usually be resumed once comfort and strength have returned.
Wrist Arthroscopy
Description
Arthroscopy is a surgical procedure using a small fibre optic instrument called an arthroscope to diagnose and treat problems inside a joint. The wrist is a complex joint with eight small bones and many connecting ligaments, arthroscopy can be used to diagnose and treat a number of conditions of the wrist including: chronic wrist pain, fractures, ganglion cysts and ligament tears.
Symptoms
An arthroscopy is used to diagnose and treat wrist problems where it is not clear what is causing the wrist pain or when non-surgical management has not been successful.
Treatment
Arthroscopy can be used to diagnose the cause of the problem and once diagnosis is made can often be used to treat the condition.
Recovery
For the first few days after surgery ice, elevation and exercises can be used to keep swelling downs and maintain or rebuild strength. Pain medications will help relieve any pain.