Torn ligament on the wrist

introduction

The mobility of our wrist is based on a complicated construction of bones and ligaments on which both the two forearm bones ulna (Ulna) and spoke (radius) and the eight carpal bones are involved. They are held together by a multitude of ribbons. If this ligamentous apparatus is injured, a structural disorder results in which the carpal bones move out of their natural position and tilt among each other. In the long term, this leads to incorrect loading of the joint surfaces and thus to excessive wear and tear on them. A wrist osteoarthritis is the result. In the advanced stage, this is ultimately accompanied by pain, restricted mobility and loss of strength.

causes

The most common cause of wrist ligament injuries are Accidents and Falls. But also can rheumatic diseases or metabolic disorders like that Pseudogout be responsible for ligament damage. Especially the Fall on outstretched hand or sudden severe twists these lead to ligament tears.

The ribbon connection between Scaphoid (Scaphoid bone) and moonbone (Lunate bone), the so-called SL band, is most often affected because this is where the greatest force is applied. As a result, the wrist and lunar bones rotate in opposite directions, the joint space increases and the joint surfaces wear out. On the other hand, the ligament between the lunar and triangular legs is less often affected. However, if left untreated, osteoarthritis is the consequence.

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Symptoms

Immediately after the accident there are shooting Wrist painwhich are indistinguishable from a fracture of the wrist bones. These are accompanied by Restrictions on movement, since the first row of carpal roots can no longer be effectively moved. At the same time, the patient complains Loss of strength in the wristwhich is caused by the misalignment of the affected carpal bones. If the injury is left untreated, a palpable swelling of the wrist can occur, which is caused by a Overgrowth of the synovial membrane (Synovitis) is conditional.

Gradually, these symptoms can subside, which is why the injury is often referred to as a sprain by the patient (see: Sprained wrist) is interpreted and there is no subsequent treatment. This injury can then asymptomatic for many years (without complaints) remain until the signs of wear and tear exceed a critical point and the Wrist osteoarthritis manifest becomes. Symptoms such as pain, loss of strength and restricted mobility then appear again.

How does the pain feel?

If the scapholunar ligament is torn in the wrist, the symptoms are often not very pronounced at the beginning. At first, those affected only suffer from pain in certain situations, for example when propping up or grasping firmly. There is a sharp shooting pain in the wrist. Occasionally, the pain then subsides in the first few weeks to months after the ligament tear. In the event of an untreated torn ligament in the wrist, osteoarthritis develops over time as a result of incorrect loading. With osteoarthritis, the pain increases.

diagnosis

Even a skilled hand surgeon can find a torn wrist ligament difficult to diagnose. After a recording of the complaints and a physical examination If a wrist injury is suspected, a X-ray in normal position and then a Function recording of the same are made. The latter describes fluoroscopy in certain common wrist positions. If necessary, a dynamic X-ray examination (X-ray with movement of the wrist) or even a Magnetic resonance imaging (MRI hand) be performed.

therapy

A fresh ligament tear on the wrist can cause both conservative (i.e. non-operational), as well operational be treated. However, if the injury has been around for a longer period of time and osteoarthritis may already be present, the only treatment option is surgical intervention.

Conservative therapy (plaster of paris and taping)

If the torn ligament on the wrist has only recently appeared and is uncomplicated (especially without tilting the bones), the therapy can be a six weeks of rest respectively. Here is above all that Applying a cast common. For control purposes, additional x-rays should be taken at longer intervals.

Also read more on the topic: plaster

Taping is a relatively new therapy method that is used to prevent and treat minor injuries to the musculoskeletal system. If the ligament is only partially torn, a torn ligament can also be taped on the wrist. However, it is important to ensure that the wrist is spared. Excessive stress can seriously jeopardize uncomplicated healing. Taping can also be used as a support for a few weeks after a torn ligament has healed on the wrist.

Also read more on the topic: Wrist tapes

rail

A slight torn ligament, i.e. a partial tear in a ligament in the wrist, is often immobilized with bandages or a splint, usually for four to six weeks. Slight ligament injuries can therefore be treated conservatively with a splint. A torn ligament splint is also an important part of the postoperative treatment of a torn ligament on the wrist. The splint serves to stabilize the joint after an operation and secures the joint in the desired position.

When is an operation necessary?

Surgery may be needed for a torn wrist ligament, a complete tear, such as a skier's thumb, or if a ligament tears off along with a fragment of bone. An operation can also be considered if there is a possibility that the pain could become chronic and the joint function could be permanently impaired.

Surgical intervention

A surgical procedure is usually chosen if one should old injury or one that has already occurred arthrosis exist. With a fresh injury, a Arthroscopy (please refer: Arthroscopy wrist) if an X-ray does not give a clear result. Should be a wide gaping joint space are discovered, the tape is mostly sewn open over a cut on the back of the hand and the bones through Wires temporarily connected.

At a old Torn ligament In some cases the tape may have grown back together on its own, but it may be too long. This can be partially corrected with electrochemical methods. In most cases, however, an open reconstruction is necessary, which is a demanding surgical procedure.
Is already one arthrosis (please refer: Wrist osteoarthritis) have occurred Ligament reconstructions no longer make sense. In this case, there are various surgical treatment options to choose from. A purely symptomatic form of treatment is the Wrist denervation represents which one emanating from the wrist Severed pain fibers become. Sensitivity and motor skills of the hand are not damaged, but at the same time the arthritic movement restrictions of the wrist are not eliminated. An effective pain reduction is often not permanent.

Other surgical procedures are based on the Removal of single or multiple carpal bones and / or one Partial stiffening of the wrist. A Total stiffening is considered if a large part of the wrist is affected by osteoarthritis. It is done by placing a titanium plate on the back of the hand. Stretching and bending the wrist is then no longer possible, which results in significant restrictions in everyday life. Because of this, a total stiffening of the wrist is only required rarely done.

As a last option, and above all as an alternative to completely stiffening the wrist, there is finally the insertion of a Wrist prosthesis. The frequent and heavy mechanical use of the wrist make this procedure a demanding surgical procedure, which is why it should only be performed by an experienced hand surgeon. However, if the operation is successful, the joint has good mobility, resilience and freedom from pain.

Duration of healing

The time it takes for the torn ligament to heal completely is long depending on the severity of the injury.
At a Partial crack and the following attachment is a cast with an immobilization of the wrist of about 4 - 6 weeks to be expected. However, it is one OP necessary, the forearm becomes for the next 6 - 8 weeks immobilized.
The prospect of subsequent freedom from symptoms depends primarily on the cooperation of the patient and the extent and age of the injury.

Also read more on the topic: Ligament tear duration

Length of incapacity for work

If the wrist has a torn ligament, the length of time on sick leave depends on the severity of the injury and the degree of healing. Typically, the wrist is immobilized for at least four to six weeks, so that a sick leave is required for this period.
If an operation is necessary, the affected person can be on sick leave for a few months.

As a result, if you have a torn ligament on your wrist, you will be on sick leave for about six weeks to three months, depending on the constellation of findings. A sick leave can be extended until the person concerned is able to work again.