Wrist Conditions

Dr. Donnelly and his staff understand the value of a healthy wrist. Like our hands, the wrists are a critical component for the hands to perform our most complex actions. A wrist injury or condition can significantly compromise your mobility, as well as the quality of your life.

Below you’ll find more information about common wrist conditions, how they are diagnosed and how they are treated.

What Are Distal Radius Malunions?

A malunion is a bone that has healed, but in a non-anatomic position. Common symptoms include:

  • Pain
  • Stiffness
  • Weakness
  • Dysfunction
  • Deformity

How Are Distal Radius Malunions Diagnosed?

Much Like acute fractures, malunions are diagnosed initially with a history detailing the initial injury and thorough physical exam.  X-rays are routinely taken, and at times advanced imagining with CT scan or MRI is needed.

How Are Distal Radius Malunions Treated?

Treatment of distal radius malunions depends on several factors.  These include amount of displacement, location of fracture, severity of pain, age, and activity level as well as physical demands of the patient.

In instances where there is minimal functional limitations or in low demand individuals, a malunited fracture can be tolerated quite well.

In cases of marked deformity, dysfunction, or significant pain, surgical fixation may be needed to realign the bone.  With the bone healed, the bone may have to be “re-broken” in a controlled manner called an osteotomy.  Plates and screws, and often time bone grafting, is needed to fix the bone.

After surgery, the wrist is immobilized for 1-2 weeks.  Following this, protected mobilization and bracing is used until the bone is healed.

What Are Scaphoid Fractures?

The scaphoid is one of the eight small carpal (wrist) bones. It is typically fractured due to a fall on an outstretched hand. Symptoms of scaphoid fractures include pain and tenderness—especially when pinching or holding an object—near the base of the thumb. Treatment depends on the severity and location of the fracture.

How Are Scaphoid Fractures Treated?

Non-displaced fractures (fractures where the fractured bone does not loose its alignment) are typically treated conservatively. Nonsurgical treatment consists of immobilization—a brace, splint, or cast holds the arm, wrist, and hand in place while the fractured bone heals.

Displaced fractures (fractures where the fractured bone loses alignment) may require surgery. Surgical treatment consists of a reduction and fixation procedure—the pieces of broken bone are aligned and a small compression screw is used to hold them together so they can heal. In some cases, bone graft is used to promote bone healing and growth.

What Are Hook of the Hamate Fractures?

The hamate is one of eight small carpal (wrist) bones. It is divided into two parts: the body and the hook. Although both can be fractured, hook fractures are far more common than body fractures. Symptoms of hook fractures include:

  • Pain (near the outside portion of the wrist) while pinching and/or gripping
  • Swelling
  • Weakness
  • Tenderness

Treatment depends on the severity of the fracture.

How Are Hook of the Hamate Fractures Treated?

Nonsurgical treatment consists of immobilization in a brace, splint, or cast. While immobilized, the fractured bone is able to heal.

Surgical treatment may be necessary to repair some hook of the hamate fractures. A typical procedure involves the removal of the fractured hook. After the procedure, patients are able to return to a normal, symptom-free life.

What Are Wrist Ligament Injuries?

The wrist ligaments connect the eight small wrist (carpal) bones to one another and to the bones of the forearm and hand. When they are injured, usually due to a fall on an outstretched hand, any of the following symptoms may present:

  • Pain
  • Swelling
  • Tenderness
  • Bruising
  • Weakness

Wrist instability can also occur.

Nonsurgical treatment of wrist ligament injuries is usually effective. However, in some severe cases, surgical intervention may be necessary.

How Are Wrist Ligament Injuries Treated?

There are many nonsurgical treatment options available, including:

  1. Activity modification. Slowing down of stopping activities that cause pain.
  2. Semi-immobilization. A removable wrist brace.
  3. A splint or cast.
  4. Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter and prescription medications used to decrease inflammation and pain.
  5. Hand therapy. Stretching and strengthening exercises.

Any, all, or any combination of these treatments can be used to decrease symptoms and heal the injured ligaments.

Surgical treatment may be used to repair severely damaged and/or torn ligaments. Because tendon damage is patient specific, tendon repair surgery is something that should be discussed with an orthopedic hand surgeon.

 

What Are Triangular Fibrocartilage Complex (TFCC) Tears?

The TFCC is located on the pinky side of the wrist. Because the TFCC performs the important functions of stabilizing, cushioning, and moving the wrist joint, a tear can be problematic. Typical symptoms include:

  • Wrist pain on the pinky side
  • Tenderness
  • Weakness
  • A clicking or crunching sound when moving the wrist

Common causes of TFCC tears are:

  • Falling on an outstretched hand
  • Racquet sports
  • Bat sports
  • Gymnastic movements that involve weight bearing on the hands
  • Degeneration with age

TFCC injuries are serious enough to warrant an appointment with an orthopedic hand specialist.

How Are TFCC Tears Treated?

Nonsurgical treatment measures are tried first and are usually effective. Common options include:

  1. A brace, splint, or cast.
  2. Hand therapy. Stretching and strengthening exercises.
  3. Nonsteroidal anti-inflammatory drugs. Over-the-counter and prescription medications that decrease pain and inflammation.
  4. Corticosteroids.

Surgery may be performed when a TFCC tear does not respond to nonsurgical treatment or when a tear is large. An arthroscopic procedure is used to locate the tear, trim torn cartilage, and when possible, repair torn ligaments.

What is Wrist Arthritis?

Arthritis refers to the inflammation of joints with age and/or traumatic injury. Because wrist arthritis can limit a patient’s ability to perform day-to-day activities, the condition should be taken seriously. The three most common causes of wrist arthritis are:

  1. “Wear and tear” of cartilage associated with aging.
  2. Rheumatoid arthritis. An immune system disorder where the body destroys its own cartilage.
  3. Post-traumatic arthritis. Damage and deterioration of the cartilage following a joint injury.

Regardless of the type of arthritis, symptoms remain consistent. They include:

  • Pain
  • Stiffness
  • Weakness
  • Decreased range of motion
  • Swelling

Unfortunately, arthritis is a chronic condition—it can not be cured. Treatment is geared toward decreasing symptoms and slowing down the progression of the disease.

How is Wrist Arthritis Treated?

Conservative, nonsurgical treatment options are effective when arthritis is detected early. In many cases, a comprehensive arthritis treatment plan includes:

  1. Activity modification. Slowing down or stopping activities that involve painful movements.
  2. A removable brace or splint.
  3. Nonsteroidal anti-inflammatory medications. Medications that decrease inflammation and pain.
  4. Physical therapy. Stretching and strengthening exercises.

In some cases, corticosteroids can be administered via injection to quickly decrease inflammation and pain.

Surgical treatment may be recommended for cases of severe wrist arthritis. The two most common procedures are:

  1. A proximal row carpectomy. Three carpal (wrist) bones on the side of the wrist closest to the forearm are surgically removed to improve wrist function and decrease pain.
  2. A wrist fusion. Worn and/or damaged cartilage is removed and a plate and screws are used to fuse the wrist. After the procedure, the wrist can no longer move and pain decreases.

Because these are life changing surgeries, patients wishing to learn more should contact an orthopedic hand surgeon.

What is Kienböck’s Disease?

The lunate is one of the eight small carpal (wrist) bones. When blood supply to it is limited, a condition known as Kienböck’s disease develops. The cause of the disease is unknown. Because a lack of blood to the bone can cause bone deterioration, the disease may present with any of the following symptoms:

  • Wrist pain
  • Wrist swelling
  • Wrist stiffness
  • Decreased grip strength
  • Tenderness
  • Difficulty turning the palm up

When the disease is left untreated, symptom severity increases as the disease progresses through its five stages.

How is Kienböck’s Disease Treated?

There is no cure for Kienböck’s disease. However, when the disease is detected and treated early, immobilization and anti-inflammatory medications can be used to decrease or eliminate symptoms. When the disease reaches its final stages or produces severe symptoms, surgical intervention may be required. This is something best discussed with an orthopedic hand surgeon.

 

What Are the Causes and Symptoms Wrist Pain?

Wrist pain is common in active individuals, manual laborers, athletes, and aging patients. The most common causes of wrist pain are:

  1. Typically, falling on an outstretched arm.
  2. Osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis can all affect in the wrist.
  3. Diseases and medical conditions. Carpal tunnel syndrome, ganglion cysts, and Kienböck’s disease.

Wrist pain may present with any of the following symptoms:

  • Stiffness
  • Weakness
  • Swelling
  • Bruising
  • Decrease range of motion
  • Numbness, tingling, and/or weakness in the hand and/or fingers

Wrist pain and its associated symptoms are treated by treating the underlying cause.

How is Wrist Pain Treated?

Nonsurgical treatment consists of any, all, or any combination of the following:

  1. Activity modification. Slowing down or stopping painful activities.
  2. A brace, splint, or cast.
  3. Nonsteroidal anti-inflammatory medications. Medications that decrease inflammation and pain.
  4. Physical therapy. Stretching and strengthening exercises.
  5. Corticosteroids.

Surgical treatment may be needed for severe wrist injuries/medical conditions. Because there are many types of pain relieving wrist surgeries, interested patients should contact an orthopedic hand surgeon.

What is Wrist Tendonitis?

Wrist tendonitis is a condition in which the flexor and/or extensor tendons of the wrist become irritated and inflamed due to overuse (usually during athletics or activities that involve lots of wrist movement). Common symptoms of wrist tendonitis include wrist:

  • Pain
  • Stiffness
  • Swelling
  • Tenderness

Luckily, wrist tendonitis and its associated symptoms can be effectively treated by nonsurgical treatment options.

How is Wrist Tendonitis Treated?

A typical wrist tendonitis treatment program may include:

  1. Activity modification. Slowing down or stopping activities that produce pain.
  2. Splinting or bracing. A splint or brace helps hold the wrist is a neutral position.
  3. Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter and prescription medications that decrease inflammation and pain.
  4. Cortisone injections. Anti-inflammatory medication is injected into the affected area.
  5. Physical therapy. Different types of treatment modalities and stretching and strengthening exercises.

Surgical intervention is rarely necessary and something that should be discussed on an individual patient basis.

What Are Ganglion Cysts of the Wrist?

Ganglion cysts are fluid-filled cysts that are most frequently seen on the back of the wrist. When cysts are small and come and go without symptoms, they typically do not require treatment. However, patients who have large, symptom-producing cysts that do not go away usually require treatment.

How Are Ganglion Cysts of the Wrist Treated?

Initial treatment is done using conservative, non-surgical measures. Immobilization is used to decrease pain and inflammation that is associated with movement. Aspiration is done to decrease cyst size and symptoms. During the quick procedure, an orthopedic specialist uses a needle to aspirate fluid from the cyst.

Surgical treatment is used when non-surgical treatment proves to be ineffective. A ganglion cyst removal is a procedure used to remove the cyst and parts of surrounding structures. The procedure is done on an outpatient basis and usually takes less than an hour.

Other Things to Know About Ganglion Cysts:

  • Ganglion cysts are non-cancerous
  • The cause of ganglion cyst formation/development is unknown
  • Ganglion cysts are most common in patients between 15-40-years old

Ganglion cysts can also develop in the hand and fingers

 

 

 

 

What is Intersection Syndrome?

Intersection syndrome refers to the inflammation of the radial (side nearest the thumb) wrist extensor tendons. The condition is caused by overuse of the wrist during athletics or activities that involve lots of wrist movement, such as:

  • Typing
  • Writing
  • Playing musical instruments
  • Skiing
  • Rowing
  • Weightlifting

Regardless of the cause, intersection syndrome can be effectively treated using nonsurgical treatment options.

How is Intersection Syndrome Treated?

Treatment may include any, all, or any combination of the following:

  1. Activity modification. Slowing down or stopping activities that produce pain.
  2. Splinting or bracing. A splint or brace helps hold the wrist is a neutral position.
  3. Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter and prescription medications that decrease inflammation and pain.
  4. Cortisone injections. Anti-inflammatory medication is injected into the affected area.
  5. Hand therapy. Different types of treatment modalities and stretching and strengthening exercises.

When patients adhere to the treatment plan prescribed by their orthopedic hand specialist, they can expect to see a steady decrease in pain that is caused by intersection syndrome.

What is a Distal Radius Fracture?

The two bones of the forearm are the ulna and radius. The radius is the larger of the two and is most commonly broken. When it is broken on its distal end (near the wrist), the fracture is called a distal radius fracture. The most common cause of distal radius fractures is falling on an outstretched arm.

 

How Are Distal Radius Fractures Treated?

Before a fracture can be treated, it needs to be properly diagnosed. A physical examination and x-rays are used to diagnose a fracture as:

  1. Extra-articular. Not extending into the wrist joint.
  2. Intra-articular. Extending into the wrist joint.
  3. Bone is breaking through the skin.
    * Immediate medical attention is required for open fractures
  4. Comminuted. There are multiple pieces of broken bone.

Extra-articular fractures with good bone alignment are treated used non-surgical treatment: a splint and/or cast is used to immobilize the bone while it heals.

Intra-articular, open, and comminuted fractures may require surgical intervention. Regardless of the fracture type, the goal of surgery remains the same: restore bone alignment and anatomy by reducing and then fixating the fracture.

Because recovery following non-surgical and surgical treatment of distal radius fractures depends on the fracture and medical and social histories of the injured patient, recovery time is something that is best discussed during an appointment.

What Are Forearm Fractures? 

The forearm is primarily responsible for rotating itself, the wrist, and hand—turning the palm upwards and downwards. It also helps bend and straighten the elbow. The two bones of the forearm are the radius and ulna. Either can be fractured by:

  • A direct blow
  • A fall on an outstretched arm
  • A blow sustained during a collision accident

Fractures are typically categorized based on the region in which they occur.

  • Distal fractures are those that are nearest the wrist
  • Midshaft fractures are those seen in the middle of the forearm
  • Proximal fractures are those that are nearest the elbow

Although each fracture is different, the goals of both nonsurgical and surgical treatment are the same.

How Are Forearm Fractures Treated?

Nonsurgical treatment of forearm fractures consists of immobilization in a splint or cast. While immobilized, the fractured bone is able to heal.

Surgical treatment of forearm fractures involves the reduction and fixation of the fractured bone using a small plate and screws.

What is De Quervain’s Tendinitis?

De Quervain’s tendinitis occurs when the tendons near the base of the thumb are overused and become irritated, inflamed, and swollen. Typical symptoms of De Quervain’s tendinitis include:

  • Swelling seen near the thumb side of the wrist
  • Wrist and/or hand pain
  • A catching, snapping, or popping sensation felt when moving the wrist and/or thumb

Mild to moderate cases of De Quervains tendinitis are treated using nonsurgical treatment options. Severe cases may require surgical intervention.

How is DeQuervain’s Tendinitis Treated?

The goal of nonsurgical treatment is to decrease inflammation, pain, and swelling. This can be achieved using any, all, or any combination of the following treatment options:

  1. Bracing or splinting the wrist and thumb limits movement, which in turn gives inflammation time to cool down.
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter and prescription medications decrease inflammation and pain.
  3. Numbing and anti-inflammatory medications can be administered via injection into the affected area.

When these treatment options fail to decrease symptoms, surgical intervention may be necessary. A De Quervain’s tendon release is performed by cutting the tendon sheath that the irritated tendons run through. This frees the tendons and gives them space to move.