Fields of treatment / Orthopedy / Wrist and hand surgery
Wrist and hand surgery
The wrist is a complex anatomic structure whose parts function together to move the hand. The wrist is made up from several bones. The framework consists of ends of forearm bones (two bones called radius and ulna) and eight carpal bones in two rows of four. The carpal bones consist of scaphoid (os scaphoideum), lunate (os lunatum), triquetrum (os triquetrum), pisiform (os pisiforme), trapezium (os trapezium), trapezoid (os trapezoideum), capitate (os capitaum) and hamate (os hamatum).
Information and appointments
One Day Surgery Centre Hradec Králové
recepce@1chirurgie.cz / +420 495 269 768 (weekdays 10 a.m.-3 p.m)
Štefánikova 454/28a, 500 11 Hradec Králové (Hvězda Complex)
Basic info
The wrist further comprises over 20 joints, 26 ligaments and 24 tendons, and a number of veins and nerves. Joint capsules in the wrist are rather thin. Clutch role falls to two ligaments of note called radiotriquetral ligament and scapholunate ligament, both of which ensure stability. Wrist bones and soft portions of the wrist are very likely to get damaged as a result of either injury or chronic degenerative condition.
Our new orthopaedics department focuses on diagnostics and treatment of various problems and conditions of soft and hard tissue in wrist and hand. Surgical interventions are performed by our contracted surgery partners.
Explanation of the most common terms
Lunotriquetal (LTq) wrist instability is the second most common wrist injury. It is mostly sustained through a hard fall on the ulnar side of the wrist. It is difficult to detect on radiographs, unless capsular ligaments are damaged too. Thus, the radiograph is often misread and a mere sprained wrist is often diagnosed. Untreated, LTQ instability may lead to degenerative changes in wrist and arthritis.
This condition is characterized by pain in the ulnar portion of the wrist when one tries to clench their fist or grips an object
For diagnosis, beside X ray, arthroscopic examination is the most reliable to confirm LTQ instability.
When surgical treatment takes place in up to 4 months after the injury, the carpal bones (the lunate and the triquetrum) are repositioned. K-wires are inserted for fixation. A high plaster reaching up above the elbow is applied for 6 weeks. At 8 weeks after the surgery, K-wires are removed, and the patient may start rehabilitation.
It is a devastating injury to the carpal bones. After it occurs, it should be treated without any delay as there is a high degree of damage to the carpal bones. If untreated, it may lead to reduced function of the hand and progress of wrist instability.
For treatment, traction weights are used for pulling the carpal bones into correct position followed by application of cast for immobilization. When the wrist is no longer swollen, surgical intervention is performed to conclude the treatment. The lunate and scaphoid are repositioned, and capsular ligaments are sutured. After that, a high cast is applied for 8 weeks.
Bennett fracture is the break of the base of the first metacarpal bone. The base of the first metacarpal breaks into two parts and it is always accompanied by a displacement. It classically occurs when a person falls on their thumb. The symptoms include pain, swelling and bruising of the thumb, and weakened ability to move the thumb. In most cases, operative treatment is necessary.
It is the break of the neck of the 5th metacarpal bone. Classically, it occurs after a person hits an object with a closed fist, or as a result of a fall on a closed fist. Symptoms include pain and swelling of the thumb and the dorsal side of the hand. The hand and finger may often be deformed.
Operative management is necessary when the bone fragments are out of place too far. It involves stabilization and fixation using K-wires and plates as necessary. After that, a cast is applied for 4 to 6 weeks, followed by physical therapy.
This procedure involves performing an arthroplasty of the CMC joint. It is indicated to treat patients with severe thumb arthritis. It enables the surgeons to address CMC deformities and problems of adjacent joints.
Fractures involving carpal bones are mostly caused by a hard fall on the dorsal side of the wrist. They are either isolated or they may be associated with partial or complete rupture of the ligament. The scaphoid fracture is the most common one, scaphoid being the largest of the proximal row of bone.
Carpal tunnel syndrome, a type of compression neuropathy, is a condition in the hand, affecting the nerves in the upper extremity. It is also called median nerve compression. It is caused by the pressure on the median nerve, which runs through the carpal tunnel. The pressure is caused by either an injury, or by putting too much stress on your wrist. Typically, this happens when you use your PC mouse over and over again in an incorrect position. The condition mostly affects middle-aged women.
Symptoms classically include tingling, numbness, pain and loss of feeling in the fingers, usually at night or when resting.
Conservative treatment is usually the first option. It may involve changes to your lifestyle, physical therapy, taping, application of non-steroid antirheumatic drugs or local steroid injections directly into the carpal tunnel. When conservative management does not yield positive results, you might need to have a surgery called carpal tunnel release, which eases the pressure on your median nerve. This is done as an open surgery or arthroscopically.
Chronic lunotriquetal instability is often detected using arthroscopy. When the injury is acute, damaged lunotriquetal ligament is hard to detect on a radiograph. Furthermore, differential diagnostics often suggests a wide range of possible wrist injuries.
The method of treatment consists of stabilization of LTq joint by arthrodesis, or reconstruction of LTq ligament by tenodesis using a graft that is passing through a tunnel in the triquetrum (original method by Pilný et al, 2011). After that, a high plaster cast reaching up above the elbow is applied for 4 weeks, followed by application of a short splint for another 2 weeks.
Chronic scapholunate instability means that treatment of the injured ligament began more than 4 weeks after the injury and the ligament cannot be reinserted. Modified Brunelli procedure (Brunelli tenodesis) for wrist reconstruction is used to treat this condition. It consists of using a tendon graft and K-wires for stabilization and fixation. The patient will wear a cast for 6 weeks with their thumb immobilized. K-wires are removed after six weeks and the patient may start rehabilitation.
Most common cause of carpometacarpal joint breakdown is an injury. It may also be caused by benign congenital hypermobility. When the condition is untreated, it may lead to CMC arthritis and degeneration.
The symptoms classically include pain in the thumb, reduced wrist movement and loss of gripping and pinching ability of the thumb.
When the condition is treated operatively, the procedure involves using one’s own tendon tissue to stabilize the joint. After that, the wrist is put in a cast for 6 weeks.
Arthrodesis is referred to as joint fusion. CMC arthrodesis is a surgical procedure that is performed to treat severe degenerative conditions. Rheumatic arthritis of the thumb and its instability are other best indications for the procedure. It is performed to alleviate pain and stabilize the thumb. Considerations for the procedure should be based on the patient’s age and line of work, as the procedure is associated with the risk of decreased fine motion ability (pinching small objects).
Surgical options include K-wires for fixation or a T-Plate for stabilization. After the surgery, the hand is immobilized with a cast for either 4 weeks (T-plate) or 6 to 8 weeks (K-wires).
It is a chronic condition characterized by pain. It is a result of dysfunction of central and peripheral nervous systems, that is caused by neurogenic inflammation. CRPS typically develops after an injury to the limbs. The condition is also known as Sudeck’s syndrome, algodystrophy, algoneurodistrophy, causalgia, reflex sympathetic dystrophy syndrome, hand-shoulder syndrome.
The diagnosis is based on signs and symptoms that the patients present, and on a person’s medical history.
CRPS comes in three stages. Its acute stage is characterized by increased blood supply, swelling, reddening and reduced range of motion. Stage 2, referred to as dystrophic, is characterized by decreased blood supply, increased swelling and greatly reduced range of motion. Stage 3 leads to irreversible changes to soft tissue and joints, deformities in the limbs. Ultimately, the limb loses its function completely.
CRPS requires a complex multidisciplinary treatment. It includes changes to daily routine, analgesics, vasodilators, physical treatment and gentle rehabilitation.
Cubital tunnel syndrome is the second most common type of compression neuropathy in the upper extremity. It involves pressure or stretching of the ulnar nerve, which runs in a groove in the elbow. The ulnar nerve is also known as funny bone nerve. The syndrome can develop in persons who have jobs that involve heavy labour. It can also be caused by an injury, when a person breaks or dislocates their elbow. If the nerve is not released, it can be damaged beyond repair. There may be loss of sensation and adjacent muscles may stop working. Ultimately, the nerve may lose its function completely.
The symptoms typically include tingling, felt in the ring finger and little finger. There is also reduced degree of motion and fine motor skills of the affected hand may worsen.
Diagnostics that is needed to confirm the compression syndrome and to rule out other nerve conditions includes nerve tests (EMG-electromyography). MR scan and radiography may also be needed.
In early stages, conservative treatment is indicated. It consists of changes to your lifestyle to avoid pressure on the nerve. The hand may be immobilized in a splint or a cast. Steroid injections may be needed as well. Advanced stages may require a surgery. The procedure releases the pressure on the nerve, moving the nerve above the elbow. The recovery includes some intensive physical therapy.
De Quervain’s disease is a condition affecting the tendons of your thumb. Specifically, it is an inflammation of the tendons that bend your thumb: musculus abductor pollicis longus and musculus extensor pollicis brevis. It is caused by overuse of the hand, repeating the same motion day after day. It is a condition that classically affects hairdressers, but also mobile phone users more recently.
The symptoms include pain near the base of the thumb when you try to rotate your wrist.
Conservative management of the condition involves avoiding too much movement of your wrist, a course of non-steroidal anti-rheumatic drugs and steroid injections. When conservative management does not work, you may need a surgery. The procedure is done under general anaesthesia. The doctor opens the sheath of your tendons to release the pressure. After that, your hand will be immobilized in a splint.
The distal radius fracture is a break of the lower end of the radius, caused by falling on an outstretched hand. In younger people, the fracture occurs during high energy sports injury. In older people, the fracture also occurs, often in women experiencing menopause, who might fall when sitting or standing.
The symptoms are characterized by wrist deformities, reduced range of wrist motion, pain, swelling and bruising.
Nondisplaced distal radius fracture is treated conservatively with a closed repositioning and immobilization through a cast. Other cases require surgical management using internal fixation with a plate.
Dupuytren’s contracture is a condition of the hand. First, it presents as a nodule or thickening in the palm and in the fingers on the ulnar side of the hand. Later, as the condition progresses, the fingers and joints become permanently bent in a flexed position. Ultimately, this may lead to stiffness and reduced range of motion.
At early stages, it is managed conservatively. The conservative treatment includes immobilization in a splint, ultrasound therapy and enzyme injections. Surgical options include fascietomy, cutting through the tendons, or complete removing of the tendons.
The following are other types of elbow fractures: radial head fracture and olecranon fracture.
Radial head fracture is the most common type of elbow fracture. Radial head is the part of radius bone that meets the humerus within the elbow joint. Its fracture may occur from a fall on an abducted arm with pronation. The fractures may involve no displacement, displacement or they can be comminuted. The fracture is characterized by pain in the radial head elbow part, swelling in the elbow joint and great difficulty in pronation and supination of the elbow. X ray is done to confirm the diagnosis. If the fracture is dislocated, the arm is immobilized in a plaster cast for 3 to 4 weeks. Fractures with displacement may require surgery.
Olecranon fracture occurs from a fall on the elbow when it is contracted. The fracture may also involve dislocation of the elbow joint. It often occurs as a result of other bone injuries or may be associated with soft tissue damage in the elbow. Olecranon fracture may be displaced, nondisplaced or it may be a fracture dislocation.
Patients often present with pain in the back of the elbow and inability to straighten the arm in the elbow is common. The fracture site is bruised and swollen.
Olecranon fracture is always treated surgically through osteosynthesis. Internal fixation is typically performed using K-wires or plates.
Artificial finger joints are implanted to replace the proximal interphalangeal joint and metacarpophalangeal joint. The replacements, made out of silicone, are implanted to treat finger joint trauma or severe degenerative joint conditions. However, these implants are not lifetime devices. When there are more affected joints, they are all treated in a single procedure.
Golfer’s elbow, sometimes called medial epicondylitis, is a condition that causes pain where the tendons of your elbow attach to the inside of the elbow joint, on its medial side. This is the site where the forearm and wrist flexors are attached, and they can be torn as a result of an untypical motion (for instance, when one tries to rip out some grass). This may lead to acute epicondylitis. It can also be caused by excess stress on the elbow, which is how the condition typically develops in athletes.
Golfer’s elbow is characterized by pain in fingers and wrist. The pain is felt when one bends their fingers or rotates the inner side of the wrist. The patients feel weakness of muscles in the wrist and their grip is worsened. Ulnar compression of the elbow may also occur. Besides pain in the elbow, patients often report tingling and pain that radiates into the ring finger and little finger.
The condition is managed conservatively in its acute stage. The management involves reducing excess stress on the affected limb on the part of the patient. Also, the affected limb may be immobilized in a long arm cast for 4 to 6 weeks. Treatment of chronic stage of the condition may involve medication. To help relieve pain, local or oral application of antirheumatic non-steroidal drugs is recommended. Corticosteroid injections (cortisone, trimecaine) should also be considered. Electric therapy is a popular option as well. If the signs and symptoms do not respond to conservative treatment, surgery might be an option.
Guyon canal syndrome is a relatively rare peripheral ulnar neuropathy that affects the upper arm. It involves compression of the ulnar (nervus ulnaris), located on the inside of the wrist. The compression may have various causes. It may occur through wrist trauma, repetitive stress injury, chronic condition (e.g. diabetes melitus), or rheumatoid arthritis.
The symptoms include numbness in the little and ring fingers, tingling, pins and needles sensation. Fine motor skills of the hand may also worsen as the small muscles in the hand get damaged.
Diagnostics that is needed to confirm the compression syndrome and to rule out other nerve conditions includes nerve tests (EMG-electromyography). MR scan and radiography may also be needed.
In early stages, conservative treatment is indicated. It consists of changes to your lifestyle to avoid pressure on the nerve. The hand may be immobilized in a splint or a cast. Steroid injections may be needed too. Advanced stages may require a surgery. The procedure releases the pressure on the cubital nerve, moving the nerve above the wrist. The recovery includes some intensive physical therapy.
Lunotriquetal joint arthrodesis is a surgical intervention that involves immobilization of the joint. It is the method of choice for treatment of isolated degenerative lunotriquetal joint problem (lunotriquetal arthritis). The procedure involves surgeon removing parts of the joint surface and stabilizing the treated area using Herbert screws. The treatment is concluded by applying a cast reaching up to the elbow, enabling patients to fully flex and extend their elbow.
Scapholunate ligament is one of interosseous ligaments of the wrist and one of the main stabilizers in the proximal row of wrist bones. When this ligament is damaged. the lunate and the scaphoid are pushed at an angle to one another. Most commonly, it is either injured on its own or it may be associated with 1st degree perilunate dislocation. When there is a complex trauma to the wrist, it may be affected too.
Main symptoms include a haematoma and the wrist gets swollen. There is diminished mobility and pain, which increases with maximum dorsiflexion (backward bending of the wrist).
Radiographs, ultrasound, MR and CT scans of the wrist are done to diagnose scapholunate disassociation.
Degree of injury (rupture and tear) and time between injury and treatment are the key factors to consider when choosing the surgical option to treat scapholunate ligament injury. The injury is acute when it is treated 3 to 4 weeks after it was sustained. Surgical treatment options include either suturing the ligament or reinserting it. Also, the scaphoid and the lunate are repositioned followed by K-wire fixation. Post-surgically, the patient will wear a cast for 7-8 weeks. K-wires will be removed after 7 to 8 weeks so that patients can start active rehabilitation.
This procedure involves performing a hemiarthroplasty of the CMC joint. It is indicated to treat patients with severe thumb arthritis. It cannot be performed when adjacent joints are damaged.
The metacarpal shaft fracture occurs after a blow on the ulnar side of the hand. It is typical for karate fighters or hockey players. Such a blow causes severe damage to soft tissue and the broken bone could be displaced. If this is confirmed, the fracture must be managed operatively. Nonoperative treatment involves appropriate immobilization with a cast for 6 weeks followed by a rehabilitation regimen.
It is another name for avascular necrosis (death of bone tissue) in the wrist. Due to interruption of blood supply, the lunate collapses. The bone structure is changed, ligaments are damaged and wrist arthritis develops. Exact cause of the disease is not known.
Typically, the symptoms include dorsal wrist pain that is detected when the doctor performs palpation, and light reduction in wrist motion and swelling. Avascular necrosis is usually confirmed by MR scan. Wrist arthroscopy can be performed to assess the severity of degeneration.
In early stages, the disease is treated conservatively. Wrist support can be applied, and magnetic therapy is often the option. Surgical options vary depending on what was the likely cause of the condition. A procedure called radial shortening may be performed when there is a difference in length between the radius and the ulna, reducing the pressure on the lunate. When there already is severe degeneration due to arthrosis, a procedure called proximal row carpectomy is performed. This improves range of motion of the wrist and relieves pain.
Perilunate dislocation is a severe injury to the carpal bones. It needs immediate surgical treatment as it is associated with severe pain and swelling. It may lead to more severe damage of the wrist complex as it may cause compression of the median nerve (nervus medianus.)
This injury causes disruption of capsular ligaments stabilizing the lunate. In younger patients, the injury is most commonly caused by a trauma, such as a fall (off a bike, off a high ground) on extended forearm. This injury can be missed for several months, as patients typically show symptoms of carpal tunnel syndrome when they present for treatment, which may lead to worse treatment outcomes.
Acute PLD symptoms include wrist pain, a haematoma, swelling, tingling sensation in fingers (thumb, index). There may also be palpable wrist deformity. X ray scan is performed to confirm the diagnosis.
PLD dislocation treatment requires general or local anaesthesia. Acute PLD dislocation is addressed by reduction of the dislocation using traction weights, followed by applying a cast for stabilization.
When the swelling goes completely away, perilunate dislocation can be treated through a surgical intervention. Herbert screws and K-wires are used for internal fixation of the wrist. Damaged interosseous ligaments are repaired. 8 weeks after the surgery, K-wires can be removed and active rehabilitation may be started.
It is a procedure that is indicated in treating cases of severe degenerative conditions in the wrist (SNAC II, SNAC III, SLAC II, SLAC III, Kienböck’s disease, pseudoarthrosis). It is performed to reduce pain and preserve motion, function and grip of the wrist.
The operative technique begins by opening the wrist joint by a dorsal approach, followed by excising the scaphoid, the lunate and triquetrum bones. It is followed by application of a cast for 3 to 4 weeks for immobilization. Following that, patients may start rehabilitation.
It is an arthritis of the first metacarpal (CMC) joint of the thumb. It is caused by an injury or activities that put high stress on the thumb joint. Typically, it occurs in women after 50 years of age. It is the second most common type of hand osteoarthritis.
The symptoms include pain, swelling, decreasing range of motion, loss of grip and pinch ability. As the arthritis progresses, thumb deformities may develop.
In early stages, conservative management can involve taking medication containing chondroitin sulphate and glucosamine sulphate, non-steroidal antirheumatic drugs, application of a wrist support and reduction of stress on the joint. It may be accompanied by local steroid injections, physical therapy and electric therapy.
When the conservative management fails, surgery is necessary. A wide range of surgical options is available, depending on the severity of the arthritis.
Scaphoid excision and four corner arthrodesis is a surgical procedure, whose indications include severe degenerative wrist condition, scaphoid non-union, chronic scaphoid instability and wrist arthritis.
The procedure involves removing the scaphoid bone and fixation of the remaining bones by plates and wires (arthrodesis). It is followed by application of a cast for 6 weeks for immobilization. When it is removed, patients may start rehabilitation.
Of all wrist fractures, scaphoid fractures are the most common ones, reaching up to 80%. Most common cause leading to the fracture is a fall on the outstretched hand (typically when going rollerblading.). Scaphoid fractures can also occur in car accidents, when patients lean their hand against the wheel or dashboard.
Dorsal wrist pain is the most common symptom, accompanied by swelling around the affected side and restricted wrist movement. These fractures are often diagnosed much later after the accidents that caused them. Undetected, they may lead to a non-union and arthritis.
Patients have their X ray done to confirm they have a scaphoid fracture. Following that, X ray confirms either a non-displaced or displaced fracture. Additional CT and MRI scans may be necessary to get a definitive diagnosis.
If the fracture is non-displaced, it is treated by putting the forearm including wrist in a cast for 8 to 12 weeks. If a displaced fracture is confirmed, surgery is required. The surgeon makes a small cut in the palmar or dorsal side of the wrist. Fractured bones are repositioned, and specially designed Herbert screws are inserted into the bone, which will hold the bone fragments together. Following that, forearm is put into a cast for 6 weeks. When the cast is removed, the patients start exercises and rehabilitation.
In general, a non-union is a failure of healing following a broken bone. It is often called a” false joint”. The reasons for non-union include inadequate blood supply and ligaments that cover the broken ends of the bone. The part of upper extremity that is prone to a non-union is the scaphoid.
The symptoms include pain when the doctor palpates the dorsal side of the wrist. Patients also present with stiffness and worsened motion of the wrist. Imaging techniques such as radiography and CT are used to confirm the diagnosis.
Operative treatment is necessary for a non-union. The scaphoid non-union is treated by using a bone graft and a headless Herbert screw for fixation. The site is immobilized by a cast for 6 weeks.
The scapholunate ligament is an interosseous ligament of the wrist, one of the main stabilizers of the proximal row of wrist bones. When this ligament is damaged, the lunate and the scaphoid are pushed at an angle to one another. The most common cause of such an injury is a fall on the thumb side of the wrist, causing either partial of complete rupture of the ligament. To assess degree of damage, Geisler scale of I to IV is used. Depending on the degree, the right surgical treatment is recommended. To select the right surgical option, period of time between injury and treatment is the key factor.
Stenosing tenosynovitis, also known as trigger finger, is a condition of the fingers. The thumb may be affected as well. The underlying mechanism of the condition involves inflammation of the tendon sheath, causing it to be too narrow. This leads to irritation of the tendon. It often affects people who have manual jobs that involve heavy labour as they put too much stress on their fingers and hands.
The symptoms include pain and swelling of the affected finger. When moved, the affected finger makes a popping sound. Initial treatment involves non steroidal anti-rheumatic drugs, and steroid injections. Another option may be shockwave treatment. When the condition is unresponsive to conservative treatment, surgical intervention is performed. It involves releasing the tendon sheath.
Tennis elbow is a painful condition of tendons in your elbow. It typically occurs in the forearm on the outer part of the elbow. Active athletes like tennis players mostly develop tennis elbow. It also affects people who perform repetitive motions (wall decorating, cutting wood, typing.)
The condition can either be caused by an injury, when the tendon is ruptured following a vigorous motion or it can be chronic. Chronic type of the condition is characterized by a painful scar that is caused by tiny tears in the tendon cause , by repetitive stress and overload.
Tennis elbow patients report pain on the outer part of the elbow. The pain is associated with weakness in muscle strength, especially when one tries to carry weights (a shopping bag). Also, the pain makes it difficult to lift objects while gripping them.
Diagnosis involves the doctor doing the physical exam. The doctor tests your middle finger to pinpoint the diagnosis. Additional X-ray may also be taken. The doctor will also talk to the patient about their jobs, hobbies and sports. Medical history of the patient is also considered.
The condition may be treated conservatively when it is acute. Conservative management includes stopping activities that may overload the elbow. Applying a brace for 4 to 6 weeks may also reduce stress and the arm gets rest as it is immobilized. When the condition reaches chronic stage, the doctor may decide to prescribe pain relievers such as local antirheumatic drugs or non-steroidal antirheumatic drugs administered orally. Steroid injection (cortisone and trimecaine) may also prove very effective.
Physical therapy that has success in treating the condition includes methods such as electric therapy, magnetic therapy, cryotherapy. Kinesiotaping and special elbow bands are very popular options too.
Surgery may be an option when nonsurgical management fails. The elbow is repaired under sedation. The procedure is a relatively quick one as the doctor removes damaged tissue in the affected area (where tendons attach to the bone.) A technique called denervation of the lateral epicondyle is performed simultaneously and the flexors are released. After the procedure, the arm is immobilized in a long arm cast for 4 weeks. After it is removed, rehabilitation is started.
The hamate (os hamatum) is a bone in the distal row of carpal bones. One part of that is a hook located on its ulnar side. The hook of hamate fracture occurs when there is a fall on the ulnar side of the palm. It is typically treated by immobilization in a cast.
TFCC (triangular fibrocartilage complex) is a cartilage structure that keeps the radius and ulna stable. TFCC is mostly sustained when a fall on the small finger side of the wrist occurs. It is also a result of heavy load placed on wrist in tennis and golf. TFCC injury can also occur during vigorous pronation and supination (rotation of the forearm into palm up/down position). TFCC can also be injured through overuse as degeneration starts to progress. TFCC injury often goes undetected, along with other soft tissue-related wrist problems.
Patients with TFCC present with ulnar side wrist pain, which gets worse with pronation and supination (such as gripping movements-gripping the door handle).
For diagnosis, X-ray, CT and MR scans are typically used. Arthroscopic examination is the most reliable method to confirm TFCC injury.
Treatment depends on the degree of injury. Conservative management includes immobilisation in a cast, non-steroid antirheumatic medication, local application of corticoids and rest. Common surgical options include arthroscopic repair or other type of intervention as necessary.
It is an injury to the humerus above the elbow. It is a most common fracture in children, most frequently caused by a fall on the outstretched or flexed elbow, e.g. falling off a trampoline, tree or playground equipment.
Children usually present with symptoms that include pain, reduced range of motion, swelling and bruising. Sometimes, tingling in fingers may develop as well.
The doctor uses X ray to confirm the diagnosis while they might also check blood flow and possible nerve damage.
When the bones do not need to be set back in place and there is no nerve or vascular injury, a cast is used to immobilize the joint. If that is not the case, surgical intervention is indicated. Open reduction with internal fixation through K-wires is performed, followed by immobilization in a cast for 3 to 4 weeks.
Wrist is one of the most complex joints of the body. Early rehabilitation is key for a favourable prognosis of all post-injury and post-operative wrist conditions.
Vast majority of cases requires the hand to be immobilized in a cast, which greatly reduces range of motion of the affected limb. The cast is positioned to enable immobilization and healing of the treated joints while leaving other joints intact.
Physiotherapist has the job of advising on the appropriate therapy that involves a large number of exercises, suited to the needs of every patient. The goal of the therapy is for the patient to return to normal daily activities while reducing swelling and stiffness.
Wrist arthrodesis is a surgical procedure that is done to treat severe wrist deformities caused by rheumatoid arthritis, to give an example. It is recommended when other treatments, such as proximal carpectomy or selective denervation cannot be performed, or they were unsuccessful.
The procedure involves immobilizing the patient’s wrist by placing a metal plate in the wrist. The plate holds the wrist in proper position, relieving the pain. This may, however, cause decreased or limited motion, but the grip is improved, and risk of flexor tendon ruptures is minimized. When the wrist is fully healed after an arthrodesis, patients often report improved function of the wrist that enables them to carry out daily routines better. Complications that may arise include risk of failure of bone fusion (non-union) and problems with healing.
Wrist arthroscopy is an endoscope-based diagnostics and treatment method. The surgeon uses a lighted tube and surgical tools to examine and treat the inside of the wrist joints. Arthroscopy is a method that allows to diagnose wrist injuries and problems, which conventional imaging like X ray would have been unable to show. Those injuries typically include damaged ligaments, wrist instability, synovitis (inflammation of synovial membrane) and damaged cartilage (arthritis).
The patients are given general anaesthesia and they are asleep during the surgery. Your arm will be elevated and placed in a special holder and bandage will be put around it. Small incisions will be made and a thin fibre along with special surgical tools will be inserted through it to help with repairing and fixing the damage. After the intervention, your hand will need to be elevated to avoid pain and swelling. You may need to wear a cast or a wrist brace to immobilise the wrist.
Wrist instability occurs mostly in younger patients. Various mechanisms of injury cause damage to wrist bones and ligaments. Fracture of distal end of the radius may occur too.
The scapholunate ligament, lunotriquetral ligament are the most commonly injured ligaments in the wrist. The injury mostly occurs when you fall on your arm. The fall does not need to be a hard one. The symptoms include pain and swelling at the injury site, diminished range of motion and muscle power. If the injury remains untreated, it may alter the stability of the wrist and lead to arthritis.
X ray and arthroscopy are performed to diagnose the problem. Depending on the severity of damage, the best treatment is indicated.
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