Monday, March 7, 2016

Its Just a Wrist Sprain

by Charles Goldfarb, MD

A Wrist Sprain seems like such an innocent diagnosis.  And I would expect that almost every possible wrist injury has been called a Wrist Sprain at some point.

The classic Wrist Sprain patient in my office is the teenager who comes in about 2 months after the high school football season is over with a wrist that is still sore.  The story is predictable- a fall during a game and immediate pain in the wrist.  The parents and the trainer do not notice any real deformity and only a little or no swelling.  The pain gets better fast.  And the player returns to playing football.  But the pain never quite goes away completely. The pain lingers and eventually he finds his way to my office.  Unfortunately, this all-too-common situation is rarely a Wrist Sprain may not actually be a sprain.

The definition of a sprain is an injury to a ligament around a joint.  More information can be found here or here.  Ligament injuries are a big part of sports medicine because every single joint is stabilized by a ligament.  When an ankle is twisted or an elbow is dislocated or a knee is 'blown out', these are all ligament injuries.  It is impossible to read the sports section of the local newspaper or scan through the sports sites on the Internet without reading about a sports star with a ligament injury.  The injury occurs when a force is placed across the joint and the liagment is needed to stabilize the joint.  If the force is too much, the ligament (or ligaments) tear.

The wrist is different than some of the other joints because many injuries around the wrist are not actually sprains. But occassionally, a Wrist Sprain may really be just that- a ligament injury to the wrist.  The classic wrist ligament injury is to the scapholunate ligament.  An injury to the scapholunate ligament is a serious injury as we, the hand surgeons, do not have a perfect treatment.  Sometimes we can put sutures into the ligament and sometimes we can move ligaments around to support it.  But often times, we do not have a perfect treatment.  Other possible ligament injuries include the lunotriquetral ligament, the volar radiocarpal ligaments, and others.
One other common wrist injury is to the TFCC- the triangular fiborcartilage complex.  The cartilage is similar to a ligament as it is a supporting structure  on the pinky side of the wrist which provides support and stability in a way similar to the knee meniscus.    Future blog posts will review each of these injuries.

The reason that the wrist is different from other joints is that because many patients labeled as having a Wrist Sprain do NOT, in most cases, actually have a wrist sprain.  Instead they often have a fracture of the bones around the wrist.  Most common in this situation is a fracture of the scaphoid bone.  Such patients may have some pain at the base of the thumb and they may have limited wrist motion.  The proper diagnosis can be made with an x- ray although more advanced imaging (CT scan or MRI) may be required.  Or the may have a radius fracture, an ulna fracture, or a fracture to one of the other bone is the wrist (the carpal bones).  Here are two examples of a scaphoid bone fracture.

The scaphoid bone is the wrist bone at the base of the thumb.  The arrow marks the fracture.

A close up view of another scaphoid bone fracture.

So a Wrist Sprain may not really be a wrist sprain.  It can also be a fracture or a cartilage injury. While not every patient with a Wrist Sprain needs to see an orthopedic surgeon or a hand surgeon, if the pain lingers for more than 1-2 weeks, I would recommend that the patient see the pediatrician or the orthopedic specialist.

Charles A. Goldfarb, MD
My Bio at Washington University

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