Radiocarpal or wrist joint is one of the most complex joints in our body. It is build up of distal (lower) sections of the two forearm bones and another 7 bones of the hand.
These bones are linked with numerous ligaments (which we will cover in the next section) which can get damaged through wear and tear that comes with age, but injury-induced torn ligament in wrist is more common.
In the following text you will learn more about:
- The anatomy of the wrist joint
- Most common causes
- Symptoms and
- Ways you can address and treat ligament tears in wrist
If you look at most anatomy text books, you will see that wrist joint is referred to as the joint between lower end of the radius and upper surface of three carpal ( carpus – a group of bones connecting hand with forearm) bones – navicular (scaphoid), lunate and triquetrum (triangular) 1; as you can see on the image below:
But when we talk about the wrist in “layman`s terms”, we usually imply joints between the radius and ulna, and joints between two rows of carpal bones. For this reason we are going to cover all these joints now:
Distal Radioulnar Joint
This is a joint between distal ends of the ulna and radius, connected by two ligaments – anterior (front) and posterior (back) radioulnar ligaments. Movement in this joint is fairly limited and it consists of the radius rotating around the head of the ulna. When the radius rotates forward, result is a movement called pronation (thumb is closer to the body) and supination (thumb away from the body).
Radiocarpal Joint – Wrist Joint
This is the joint we mentioned above – between distal radius and scaphoid, lunate and triangular bones. The joint is strengthened by many ligaments, which is why torn ligament in wrist is such a common injury. Those ligaments are:
- Volar Radiocarpal
- Dorsal Radiocarpal
- Ulnar Collateral and
- Radial Collateral
Movements this joint permits are: flexion, extension, abduction and adduction. You can check out the short video below for the demonstration of these movements:
This is a group of joints which we can divide into three subgroups:
- Joints between the top three bones of the carpus – secured with a set of three ligaments
- Joints between bottom four bones of the carpus – also secured with a set of three ligaments and
- Joints between the top and the bottom row of bones – secured with 4 ligaments
I know that many of you reading this article, are not doctors or medical students and you might think all this anatomy is redundant, but I wanted to help you fully grasp the complexity of the wrist joint. There are so many different structures in this confined space, so an injury can cause a lot of damage, of course, tear one (or more) wrist ligaments.
The most common cause of injury, or in our case a torn ligament in wrist, is physical trauma. Two of the most common traumas resulting in a ligament tear are:
- Falling onto your outstretched hand – if the force is substantial this can be a serious injury, causing strains, sprains, ligament tears but also break bones
- Bracing yourself on the dashboard before a car collision – this is usually just a natural instinct, extending your arms and bracing on the dashboard in order to stop your body from going forward
- Repetitive stress – most sport activities involve some sort of repetitive motion. In basketball, for example, during a jump shot a player is required to flex his joint (to propel the ball forward and give it a backward rotation); and in tennis, players are constantly flexing and extending their wrist joint, depending on the type of shot they choose. These repetitive movements can weaken the ligaments, put a lot of strain onto them and, eventually, cause tears
- Aging – aging is, of course, a natural process our body goes through, and there is nothing we can do about it. Ligaments problems in, healthy adults, will usually start around the age of 40
- Arthritis – arthritis is not so much a cause of torn ligaments in wrist, more a collateral damage. When ligaments become weaker bones start to move abnormally, the wear and tear becomes more intense and bone and joint damage intensifies, resulting in pain, at first, and eventually arthritis
Weaken ligaments may go undetected for some time, because they will present with no symptoms. But, as the time goes by, the damage can add up and result in unstable joints, pain, limited range of motion and complete or partial ligament tears.
How To Diagnose A Torn Ligament Yourself?
To summarize it into one word – don`t! There is a common misconception in people… they think that you can read a few articles online and become an expert. If that were the case, there would be no need for higher education… The truth is that nothing can replace a well trained expert`s eye, backed up with years of experience, not to mention MRIs and X rays. This is why I always advise people to talk to their doctor, if they experience pain, swelling or any other problem with their wrist.
What will the doctor ask you?
No need to worry about it, you probably already know the all the answers you doctor will need. Most common questions are:
- When did your symptoms started?
- How did the injury occur?
- Is the pain becoming more intense?
- Have you tried to treat it yourself?
- Do you think you have a torn ligament in wrist?
Next comes the physical examination, and I have to warn you that it may hurt a bit. Your doctor will try to access the severity of the injury, move your wrist to see if there are any problems with the range of motion, how are bones aligned and to pinpoint the exact location of the pain.
What Medical Tests Can You Expect?
Doctors will usually order an X ray of your wrist – to see whether any bone is broken, and MRI – to see what is the condition of the ligaments and other soft tissues around the joint; they can also do blood tests or an EMG to measure the electrical activity of the muscles.
In some rare cases, doctor may even require an arthroscopy. This is a procedure where a tiny camera is inserted into the wrist joint to show the surgeon exactly which ligament is damaged/torn, and can also assist during the surgery itself, to grant a better view of the ligaments that are being repaired.
Of course, there is no one specific symptom to confirm a torn ligament in wrist, but there are symptoms which will point us in that direction. They are:
- Initial localized pain and swelling
- Ecchymosis – this is a hematoma, commonly called a bruise, larger than one cm (0,39 in) in diameter. Discoloration and bruising will last a few days, but will eventually subside on its own
- The pain that does not go away – after that initial intense pain is gone, patients might experience pain which is not as intense but it last for a long time (several weeks). Patients might also feel the pain which intensifies with movement, or becomes more intense on its own as the time goes by. If you experience this type of pain, you should go see a doctor
- Joint instability – joint instability will become more noticeable after that initial pain period, when you start using your wrist and hand more. If the injury was severe enough, it might have damaged the ligaments to the extent where they are not able to secure wrist joint and bones properly. The bones may slide incorrectly, pop out of place (clicking and snapping noises may appear) and start to grind against each other
- This grinding can lead to arthritis of the wrist. This is a severe condition where the pain can appear during an activity (involving this joint), but it can also intensify after the activity itself, and cause the joints to become stiff.
Doctors usually say that accurate diagnosis is the key in efficient treatment, which is 100% true! Why? Well, most people don`t really like going to their doctor. They tend to diagnose themselves and assume injury is not severe: “It`s just a sprain, the ligament is not torn.” Then they rest for a few days (until the pain goes away) and resume with their daily activities. They only visit their doctor after several months, when they start noticing something is not right.
As for the treatment, it can be non-surgical or surgical.
Non-surgical treatment is usually reserved for patients with partial wrist ligament tear. It involves:
- Taking painkillers and/or anti-inflammatory medication
- Applying gel to the injured area
- Splints or a cast to immobilize the joint and allow the ligament to fully heal (up to six weeks)
After the ligament is fully healed, patient will usually require physical therapy to regain the range of motion and strength within the muscles and joints.
Surgical treatment is for patients where the ligament is completely torn; it may also be required if the bones are not aligned properly. It is vital that the surgery (if it is required) gets done as soon as possible, before scar tissue forms and bones fall out of their place.
There are several surgical procedures that can be done and surgeon will usually choose the best one based on your current situation.
Bone pinning is a procedure where the surgeon will insert a metal pin to hold the bones in place, until the ligament is fully healed. This procedure is good for partial torn ligament in wrist, but it needs to be done within couple weeks after the injury, before the scar tissue starts to develop.
Ligament Repair/Reconstruction Surgery
This surgery is usually performed after six or more months after the injury occurred. The goal of this surgery is to identify the torn tendon and insert a tendon graft (a tendon taken from another place) in its place.
Recovery Time After Surgery
Recovery time will depend on the type of surgery that was performed, but patients are usually able to use their hand within the first couple days after the surgery. After two weeks stitches are removed and patients are advised on which exercises to perform and in an effort to regain full mobility.