Wrist Instability

Overview:

Wrist is a complex joint with articulating surfaces of 8 carpel bones connecting the hand to the forearm. It performs complex movements and bears weight. Wrist has two components. One of the joint is between the two bones of the forearm, namely the radius and ulna. This is called the Distal radio-ulnar joint. Distal radio-ulnar joint is supported by a ligamentous complex. This is also called TFCC or the triangular fibro-cartilagenous complex. Injury to this soft tissue is often missed at primary presentation. This may lead to pain and wrist instability

Symptoms:

Most cases will present with a history of traumatic episode or sudden loading of the wrist joint with associated torsional force. This leads to a distal radius and or an ulnar styloid fracture in most cases. Usually the patients present with persistent pain even after weeks to months of injury along with a restricted range of movement. Some may also complaint of wrist instability while lifting loads or playing sports. The two most commonly involved structures include a triangular fibro-cartilaginous complex(TFCC) and the meniscal homologue. These make the DRUJ and any sprain or tear in the complex may give troublesome symptoms.

Treatment:

Most patients following a sedentary lifestyle, do well with conservative management but patients belonging to high demand group need a surgical intervention for restoration of joint kinematics. The procedure yields good results in expert hands. Physiotherapy and rehabilitation plays essential role in functional recovery. Rehabilitation exercises for DRUJ injury start after the period of rest decreases pain and swelling. Exercises in a graded manner help prevent recurrence of symptoms.

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Wrist injury involves TFCC and Meniscal homologue