The Wrist: Common Injuries and Management
Section snippets
Epidemiology
Child and adolescent athletes suffer relatively more wrist injuries than adult athletes. Three percent to 9% of all athletic injuries involve the hand and wrist [1]. This number is as high as 14% in high school football [2], and 46 to 87% of gymnasts suffer wrist injuries or have chronic wrist pain [3], [4]. Injuries of the wrist can be divided into acute traumatic injuries and overuse injuries.
Acute wrist fractures are common injuries among athletes. In a study of football players aged 9 to
General approach to wrist injuries
To begin, be familiar with the most common wrist injuries in active people and the common sport-specific injuries. Obtain a careful history regarding the athlete's wrist complaint, including how the complaint is related to activity and rest. It is important to have good clinical knowledge of the functional anatomy of the wrist in order to maximize the information gathered on examination. The evaluation of wrist complaints requires at least two radiographic views of the wrist (Fig. 1). An
DeQuervain's tenosynovitis
DeQuervain's tenosynovitis is the most common tendonopathy of the wrist in athletes [9]. DeQuervain's tenosynovitis is inflammation of the tenosynovium of the first dorsal compartment tendons, the abductor pollicis longus (APL) and extensor pollicis brevis (EPB). These tendons course under the extensor retinaculum in a groove along the radial styloid process. Repetitive wrist motion causes shear stress on the tendons in their small compartment, which results in inflammation of the tenosynovium.
Distal radioulnar joint and triangular fibrocartilage complex
DRUJ and TFCC injuries are often discussed together, due to closely related anatomy and frequently overlapping symptoms. The DRUJ is located between the distal radius and the head of the ulna. Five structures are important in ensuring the stability of the DRUJ: (1) the triangular fibrocartilage (TFC), (2) the ulnocarpal ligament complex, (3) the infratendinous extensor retinaculum (ie, the ECU tendon sheath), (4) the pronator quadratus muscle, and (5) the interosseous membrane [19]. Intimately
Distal radius fracture
Distal radius fractures are very common in sports. This injury typically occurs with a FOOSH with hyperextension, impacting the distal radius. The athlete presents with pain, swelling, ecchymosis, and tenderness about the wrist. Initial radiographs should include PA, lateral, and oblique views of the wrist. The examiner needs to determine the type of distal radial fracture and assess displacement, shortening, and intra-articular involvement. The goal of treatment is to correct and maintain
Ligamentous injury
Carpal instability is due to the disruption of the interosseous ligaments that connect and stabilize the carpal bones. These severe carpal disruptions are injuries that are frequently missed. It is important to recognize that all wrist pain is not a “wrist sprain,” and to appropriately diagnose and properly treat suspected carpal instability injuries. Carpal instability is a continuum of disorders that can result from an acute trauma or from repetitive injury. Multiple ligaments may be torn in
Wrist ganglia
Ganglia are common about the wrist. Thick, clear, fluid leaks through a tear (degenerative or traumatic) in the joint capsule or tendon sheath to form a ganglion cyst. Common locations include the dorsum of the wrist directly over the scapholunate joint, and the volar radial aspect. Dorsal wrist ganglia arise from the scapholunate joint, and volar ganglia typically arise from the radiocarpal joint, scaphotrapezial joint [62], or FCU tendon. Ganglion cysts may or may not be painful. Typically
Compressive neuropathies
Upper extremity compression neuropathies are relatively uncommon in athletes, particularly at the wrist; however, direct contusion of the tissue overlying peripheral nerves or repetitive activity causing tissue swelling can cause neuropathic symptoms. Neuropraxia is the type of nerve lesion most commonly seen in athletes. This is a conduction block along the nerve, typically from compression or impingement, with nerve elements intact. Compression of radial, median, distal posterior
Summary
Primary care physicians not only have an important role in the diagnosis and initial treatment of wrist injuries, but also play a key role in the education of families about prevention. Children and adolescents are often competitive in sports throughout the year. Periods of rest can be important in prevention of overuse injuries in the very active, developing athlete. Protective gear such as wrist guards, used during activities such as inline skating and snowboarding, has been shown to prevent
Acknowledgments
The authors thank Jean-Paul Guiboux, MD of Michigan Hand & Wrist and Thomas Hall, MD, Providence Hospital and Medical Centers Department of Radiology for their assistance with radiographs.
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