All this year I’ve been wanting to avoid surgery with different treatments but evidently the injury is more serious. The recovery time is prolonged but it depends on many factors that can’t be measured today.
Juan Martin Del Potro, Argentinian tennis player and US Open Champion 2009, announcing surgery for a wrist flexor tendon injury.∗ May, 2010 quoted in Guardian.co.uk.
The wrist is frequently injured during sport.1 Distal radial fractures are the most common fracture seen in emergency departments,2 and scaphoid fractures are the most common carpal fracture.3 Men are more likely to sustain a hand or wrist injury;4 children and adolescents are more likely to have a wrist injury compared with adults.5 Injuries to the wrist range from acute traumatic fractures (such as occur during football, hockey, and snowboarding) to overuse conditions (which occur in racquet sports, golf, and gymnastics). If wrist injuries are not treated appropriately at the time of injury, they can lead to future impairments that can affect not only sporting endeavors but also activities of daily living.6
In this chapter we address two common clinical scenarios:
the acute wrist injury (usually as a result of a fall onto the outstretched hand)
the longer-term (chronic, or subacute) wrist pain that has developed gradually with or without a clear history of a past injury.
The wrist joint has multiple axes of movement—flexion–extension and radial–ulnar deviation occur at the radiocarpal joints, and pronation–supination occurs at the distal radioulnar joint (in conjunction with the proximal radioulnar joint). These movements provide mobility for hand function.
Injuries to the wrist often occur due to a fall on the outstretched hand (FOOSH). In sportspeople, the most common acute injuries are fractures of the distal radius or scaphoid, or damage to an intercarpal ligament. Intercarpal ligament injuries are becoming more frequently recognized and, if they are not treated appropriately (e.g. including surgical repair where indicated), may result in long-term disability. The causes of acute pain in this region are shown in Table 23.1.
Causes of acute wrist pain
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Causes of acute wrist pain
|Common||Less common||Not to be missed |
Distal radius fracture (often intraarticular in the athlete)
Wrist ligament sprain/tear
• Intercarpal ligament
• Scapholunate ligament
• Lunotriquetral ligament
Fracture of hook of hamate
Triangular fibrocartilage complex tear
Distal radioulnar joint instability
Anterior dislocation of lunate
Traumatic ulnar artery aneurysm or thrombosis (karate)
The anatomy of the wrist is complex (Fig. 23.1). It is helpful to know the surface anatomy of the scaphoid tubercle, hook of hamate, pisiform, Lister’s tubercle, and anatomical snuffbox. The bony anatomy ...