Diagnosis
Even for an experienced hand surgeon, a torn ligament on the wrist can be difficult to diagnose. After an x-ray of the symptoms and a physical examination has been carried out, if there is a suspicion of a wrist injury, an x-ray should be taken in the normal position, followed by a functional image of the wrist. The latter refers to fluoroscopy in certain wrist positions that are common in everyday life. If necessary, a dynamic X-ray examination (X-ray image taken while moving the wrist) or even a magnetic resonance tomography (MRI hand) can be performed.
Therapy
A fresh torn ligament on the wrist can be treated conservatively (i.e. non-surgically) or surgically. However, if the injury has existed for a long period of time and arthrosis may already be present, the only treatment option is surgery. If the torn ligament of the wrist occurred recently and is uncomplicated (especially without tilting of the bones), the therapy can be carried out by immobilisation for six weeks.
The application of a plaster cast is particularly common here. Additional x-rays should be taken at longer intervals for control purposes. Plastering is a relatively new therapy method, which is used to prevent and treat minor injuries to the musculoskeletal system.
If there is only a partial tear of the ligament, a torn ligament on the wrist can also be taped. In this case, however, care should be taken to protect the wrist. Excessive strain can seriously endanger healing without complications.
In addition, taping can also be used as a support for a few weeks after a torn ligament has healed. A slight torn ligament, i.e. a partial tear of a ligament in the wrist, is often immobilised with bandages or a splint, usually for four to six weeks. Slight ligament injuries can therefore be treated conservatively with a splint.
A torn ligament splint is also an important part of the postoperative treatment of a torn ligament in the wrist. The splint serves to stabilize the joint after surgery and secures the joint in the desired position. Surgery may be necessary in the case of a torn ligament of the wrist if there is a complete tear, for example, in the case of a ski thumb, or if a ligament tears off together with a bone fragment.
Surgery may also be considered if there is a possibility that the pain may become chronic and permanently restrict joint function. Surgery is usually chosen if there is an old injury or osteoarthritis that has already occurred. However, in the case of a fresh injury, arthroscopy of the joint (see: arthroscopy of the wrist) can still be performed if an X-ray does not provide a clear result.
If a widely diverging joint space is discovered, the ligament is usually sutured open via an incision on the back of the hand and the bones are temporarily connected to each other with wires. In the case of an old torn ligament, the ligament may in some cases have grown back together by itself, but it may be too long. This can be partially corrected with electrochemical methods.
In most cases, however, an open reconstruction is necessary, which is a demanding surgical procedure. If arthrosis has already occurred (see: wrist arthrosis), ligament reconstructions are no longer useful. In this case there are various surgical treatment options available.
A purely symptomatic form of treatment is wrist denervation, in which pain fibres emanating from the wrist are severed. The sensitivity and motor function of the hand are not damaged, but at the same time the arthrotically induced restrictions of wrist movement are not remedied. An effective reduction of pain is often not permanent.
Other surgical procedures are based on the removal of individual or several carpal bones and/or partial stiffening of the wrist. Total stiffening is considered if a large part of the wrist is affected by osteoarthritis. This is done by inserting a titanium plate on the back of the hand.
Stretching and bending of the wrist is then no longer possible, resulting in significant restrictions in everyday life. For this reason, total stiffening of the wrist is rarely performed. As a last option, and above all as an alternative to complete stiffening of the wrist, the insertion of a wrist prosthesis is finally offered. The frequent and also heavy mechanical use of the wrist makes this procedure a demanding surgical procedure, which is why it should only be performed by an experienced hand surgeon. However, a successful operation offers good mobility, resilience and freedom from pain for the joint.
