AT BEL AIR CENTER FOR PLASTIC AND HAND
Like hand and wrist fractures, ligament injuries occur most often after a fall, due to landing on an outstretched hand. It’s not uncommon for many men and women to experience fractures and ligament injuries at the same time. Damage to the ligaments can affect the way the wrist is able to work, and surgery may be needed to get back on track.
A ligament is the tough connective fiber that connects one bone to another bone. One of the reasons that ligament injuries in the wrist are so complex is because the wrist joint is very complicated. There are eight smaller bones through the wrist, called the carpal bones. These act as a transition area between the larger arm bones (the radius and the ulna) and the smaller bones in the hand. Ligaments connect all the tiny bones inside the wrist to each other, and also connect the wrist bones to the ulna and radius as well as the bones in the hand (metacarpals).
The ligaments are important for maintaining balanced movement throughout the wrist. An injury to even one of these many ligaments affects the way the bones are able to move together. Instead of moving as a single unit, the motions become out of sync; the wrist joint become unstable. This causes pain and friction in the wrist joint that can promote the development of other joint problems like arthritis.
In case of trauma to the wrist, whether or not the ligament is damaged depends on a number of different factors, like the amount of force, bone strength and the angle of the wrist at the time of injury. Signs of a ligament injury include pain and swelling that’s similar to many other hand and wrist injuries. The wrist may also look bruised or discolored, and feel painful for several weeks.
In some cases, a ligament injury may go undiagnosed, causing the joint to heal improperly. Although the severity of the symptoms may ease up, ongoing pain and a feeling of clicking inside the wrist during gripping movement can continue over the long-term.
X-rays may be used to determine bone placement in order to see which ligaments may be affected. A special dye injection can also help map out the ligaments; this is called an arthrogram. An MRI can also help diagnose problems in the ligaments and other soft tissues. Sometimes proper diagnosis is one of the biggest challenges in treating any type of wrist injury.
Understanding Ligament Injuries
Treatment for ligament injury depends on how serious the trauma is. A minor wrist sprain can be treated with a specially fabricated splint that lets healing occur while the wrist is held in correct alignment.
If the ligament is torn and joint misalignment is noted, there are a few surgical approaches that can help:
Pinning/Repair: Ligament damage that’s recognized fairly early (within a few weeks of injury) can be repaired by the insertion of metal pins to stabilize the bones, which allows the ligaments to heal. After healing, the pins are removed. This is less likely to be helpful if too much time has passed since the injury.
Arthroscopy: Arthroscopic surgery can be used to access and repair ligaments in the wrist. Wrist arthroscopy enables the surgeon to see the wrist anatomy and ligament movements without the need for large incisions into the muscle and tissue.
Reconstruction: For injuries that occurred six months or more before treatment, reconstruction of the ligament may be needed. A tendon graft is used to replace the torn ligament, and the wrist is temporarily held in place with metal pins throughout the initial healing process.
Fusion: If arthritis is already present, fusion of the joint may be needed to reduce joint pain during movement and stabilize the area.
In many cases, a combination of these techniques may be used. Treatment is customized to the specific ligament injury and the needs and preferences of each patient.
Recovery and Results
After surgery, patients wear a splint or cast at first. Once this is removed, some patients notice stiffness in their wrists, while others notice a limited range of motion. Hand therapy is often incorporated as part of the recovery process to ensure proper joint alignment and function recovery during healing.
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