WHAT YOU SHOULD KNOW
Traumatic contractures of the wrist can develop after either injury or surgery. Once the limiting scar tissue is mature (usually after 3 months from the last event) no amount of therapy will be able increase motion. Wrist contractures are more difficult to treat than other contractures because the limiting tissue around the joint cannot simply be removed entirely as it can in certain other joints. Many ligaments that are critical for proper wrist function must be preserved. Wrist contractures almost always involve adhesions both within the joint and around the outside of the joint.
MEDICAL HISTORY
Patients typically complain of pain, stiffness, weakness, and loss of hand function. The doctor will ask questions to uncover all the events that led up to or contributed to the development of the contracture. Knowing how the contracture formed is the key in planning to eliminate the contracture.
EXAMINATION
Each direction of motion will be specifically measured. The degree resistance at the end of each direction’s stopping point is an important clue to predicting the chances of improvement with release.
ADDITIONAL TESTS
Plain x-rays will show any underlying joint damage that might make achieving good motion more difficult.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL RELEASE | |
| CONSISTS OF | Outpatient therapy | Surgically excising scar tissue from the inside and outside of the wrist joint |
| FEATURES | Stretching exercises and splints | Outpatient surgery, fiber optic camera used inside joint, limited incisions to access outside of joint |
| ADVANTAGES | Avoids surgery | Maximum correction possible, used when previous scar is mature |
| DISADVANTAGES | Only effective early when scar tissue is immature | Correction proportionate to original problem, some new scar tissue forms after surgery |
RECOVERY
Patients must be very committed to their treatment to choose surgical correction of a contracture. Intense outpatient rehabilitation begins immediately after surgery. Patients must perform motion exercises every hour on the hour when awake, seven days a week. Sutures are taken out after 2 weeks in the office. Splints are used at night and sometimes during the day to preserve increases in motion. New scar tissue gradually forms and matures over about a 3-month period after surgery. When therapy is finished after the scar matures patients will have some percentage of motion that is still less than the freedom achieved on the day of surgery.
