Wrist Injuries – Have we Diagnosed them Correctly?
This week I will discuss different types of injury to thumb side (radial zone) of the wrist joint. It is a common area where fractures and ligaments sprains are misdiagnosed. Firstly let’s take a look at the mechanism of injury and then the types of injury.
Mechanism of Injury
A Fall on an Outstretched Hand is likely to produce a fracture or Ligament type injury
A blow of a Hurley to the wrist is more likely to result in a fracture
A sudden twisting of the wrist joint resulting in forced rotation is more likely to result in injury to Distal Radioulnar joint, Ulnocarpal Joint and Triangular Fibro Cartilage Complex.
Repetition type injuries caused by repetitive wrist use such as constantly using a screwdriver or playing a musical instrument can lead to Tendinitis of local wrist tendons, arthritis and ganglion cysts formation.
Types of Injury to the Thumb area of Wrist
Dorsal Branch of Radial Nerve Impingement- Tingling or pain around the thumb area and Tenderness in the 1st Web Space of the Web of the hand (between the thumb and Index Finger). This is confirmed with Nerve testing. Can result from a simple wrist sprain injury. It is often misdiagnosed as DeQuervains Tenosynovitis, which is inflammation of the tendon sheath that extends the thumb.
Distal Radial Ulna Joint Injury - An Excessive Bony prominence on the back of the wrist joint, can indicate an elevation of the head of the ulna bone.
Carpal boss injury - is swelling at the base of the 1st and 2nd Metatarsal bones of the wrist. It occurs due to forced extension movements such as in hurling and Racquet sports.
Scaphoid Fracture due to impact type trauma to the wrist. Need an x-ray 12 days after trauma to truly confirm if it is fractured, can often mimic a simple wrist sprain. The Scaphoid is one of the carpal bones that is located above the thumb.
Injury to Scapholunate Ligament - joins the carpal bones of the scaphoid and lunate together. Symptoms include wrist pain and reduced strength. If the gap between the bones on x-ray view is 3mm or greater, a tear is indicated. There 5 types of Scapholunate Ligament Injury all indicating different levels of tear and space between the bones. This is important to note for hand position during x-ray for correct diagnosis.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672. Email: tomaspry