WHAT YOU SHOULD KNOW
The ligaments that stabilize the many connections inside the wrist joint are critical for normal functioning of the wrist. They are extremely short and tight ligaments rather than long cords like certain other ligaments in the body. Once they are torn, there is a short opportunity of around a month to get them repaired before they shrink away. After this time the strategy for recovering function of that ligament changes from repair to reconstruction and becomes a much larger scale treatment.
MEDICAL HISTORY
Early after injury patients usually recall the specific injury event followed by pain, swelling, stiffness, and weakness. Later the patient may note primarily weakness and a sense of giving way when trying to use the wrist for more strenuous activities. Some patients note a “popping” or “clicking”.
EXAMINATION
Pressure applied over the damaged ligament usually produces tenderness. The joint may have lost motion. But the key to the examination is testing the function of each specific ligament with stress maneuvers.
ADDITIONAL TESTS
A test called an arthrogram was previously used to test for breaks in the ligaments but has been shown to be highly inaccurate and not relevant to ligament function. Magnetic resonance images (MRI) is more accurate than arthrogram regarding breaks in the ligament but gives absolutely no information regarding the functional performance of the ligament and is far less useful than a physical examination by a dedicated wrist surgeon. The only truly accurate test for ligament injury is direct examination by a fiber optic camera (arthroscopy) while testing the ligament under stress.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL REPAIR | SURGICAL RECONSTRUCTION | |
| CONSISTS OF | Early range of motion exercise | Arthroscopic repair | Tendon transfer or graft |
| FEATURES | Regaining full motion of the wrist is followed by strengthening of specific muscle groups | Outpatient surgery, fiber optic camera guides ligament alignment | Series of limited incisions allows rerouting of tendon material through passages in bone to stabilize joint |
| ADVANTAGES | Avoids surgery | Heals the original ligament at its correct attachments | Can be used at any time prior to collapse |
| DISADVANTAGES | Only useful for partial tears that do not affect wrist stability | Some permanent stiffness results | More invasive, reconstruction can never truly reproduce the function of the original ligament |
RECOVERY
Sutures are removed in the office at 2 weeks and a cast applied. The ligaments must be immobilized to heal correctly. Pins that prevent forearm rotation are removed at 4 weeks post-op. Pins buried under the skin in the small wrist bones are removed under local anesthesia at 8 weeks post-op. Once all pins are out, exercises are started in outpatient therapy to regain as much motion as possible. Once motion has maximized, strength is developed. The whole process keeps the patient in rehabilitation for at least 4 months. Final range of motion and strength always remain partially diminished after major wrist ligament injuries.
