The wrist is made up of eight bones and soft tissue structures called ligaments and cartilage. The carpal bones are arranged in two rows, four bones per row. The row closest to the arm is called the proximal row and connects to the arm bones (radius and ulna). The second carpal row is called the distal row and articulates to the hand bones (metacarpals).
These articulations or joints are held together and stabilised by strong fibrous tissue called ligaments. Within the joints is articular cartilage, a structure that covers the end of each bone and creates a smooth surface so that the bones can glide over each other. Due to the stability created by the ligaments the hand is able to move in different ways (up/down and side to side).
A wrist ligament injury is a stretch or tear within the ligament or even at its attachment sight at the bone. They are classified as grade 1,2 or 3 depending on the degree of injury to the ligament.
Grade 1- ligament is stretched but not torn
Grade 2- ligament is partially torn
Grade 3- ligament is completely torn or pulled off its attachment to the bone (avulsion injury)
These injuries occur when the wrist is bent or twisted with force (eg fall onto the hand) or with repetitive use over time.
Wrist ligament injuries may present with the following symptoms:
Clinical examination of the wrist along with other radiological studies may be done to assess the location and severity of the injury.
Treatment depends on the severity of the ligament injury. Grade 1 and 2 injuries, usually heal without needing surgery. Early intervention may include rest, ice, compression, and elevation of the limb. Sometimes a doctor may prescribe anti- inflammatory medication to help reduce swelling and pain. A wrist splint may be recommended to help rest and support the wrist. Your hand therapist will assist you with this if required.
Grade 3 injuries will need surgery to repair the ligament. If this does not happen, the carpal bones are at risk of separating or dislocating and causing further damage to the wrist. Surgery usually involves reconnecting the ligament to the bone or using a tendon graft to reconstruct the injured ligament.
Post-op a thermoplastic splint is fabricated by your hand therapist to immobilise the wrist. This splint prevents the wrist from moving so that the ligament can heal without tension. Once the ligament is deemed ready, an exercise program is commenced.
Exercises are designed to gently move the wrist to stimulate healing and function. Proprioceptive exercises are incorporated into the program as soon as possible. These exercises specifically target the mechoreceptors within the wrist and involve multidirectional movements/ stability or controlling the wrist with perturbations.
Depending on the type of surgery, you may need to wear a splint for up to 6 weeks, after which it will be weaned. Strengthening exercises are generally commenced at 8 weeks. The ligament will take 12 weeks to fully heal. Throughout this time, your hand therapist will work closely with you to ensure return of movement, strength, and use.
Wrist injuries often occur from a fall and during sport. The use of wrist guards may be helpful to prevent injuries.
At Melbourne Hand Therapy, our team works closely with your medical team and are able to assist you with splinting and rehabilitation. Our treatment is tailored to your individual needs and is dependent on the presentation and severity. Book in to today to see one of our highly skilled therapists if you are experiencing any of the symptoms above.