WRIST INJURIES
Ganglion cyst Ganglion cysts are synovial cysts that fill with gelatinous mucoid material. They are believed to be caused by repetitive microtrauma, although the exact etiology is unknown. The majority of ganglion cysts are asymptomatic, but some cause pain and tenderness. Many individuals are dissatisfied with the appearance of these cysts (Gregush & Habusta, 2023). Ganglion cysts typically occur between the ages of 15 and 40, affect women more than men, and are common in gymnasts who repeatedly apply stress to the wrist (Pidgeon and Jennings, 2022). Gymnast’s wrist (Distal radial physeal stress syndrome) The distal radius physis is susceptible to injury in gymnasts due to load applied during upper extremity weight-bearing (Mauck et al., 2020). During upper extremity weight-bearing, the radius bears 80% of the load while the ulna bears 20%, making the radius more prone to injury (Watkins et al., 2022). Hockey wrist (Dorsal ulnotriquetral ligament injury) It is thought that the flexed and pronated position of the hand when using a hockey stick leads to ulnotriquetral ligament sprain that results in ulnar-sided wrist pain that increases with hockey stick handling and shooting (Tedesco et al., 2020). Scapholunate ligament sprain/tear Scapholunate ligament injuries can cause wrist pain and instability. This injury occurs most commonly following a fall onto an extended, ulnarly deviated wrist. This is the position the hand assumes when holding a steering wheel, which may predispose the wrist to this injury during a motor vehicle crash. Scapholunate ligament injuries are associated with distal radius fractures (Konopka & Chim, 2018).
Clinical Presentation Wrist ganglion cysts may limit range of motion and may be tender to palpation. Typically, they are masses that are about 1 to 3 cm in size, firm, and freely mobile (Gregush & Habusta, 2023). Volar ganglion cysts may lead to carpal tunnel syndrome secondary to compression of the median nerve or trigger finger due to intrusion on the flexor tendon sheath (Gregush & Habusta, 2023). Clinical Presentation Patients with this injury will complain of chronic dull pain along the radial or dorsal aspect of the wrist. Pain is aggravated with activity. Swelling may be present. Tenderness with palpation is localized to the distal radius. Pain may be worse with wrist hyperextension and axial loading (Watkins et al., 2022). Clinical Presentation Patients with this condition complain of ulnar-sided wrist pain that is sometimes accompanied by swelling and/ or clicking. Examination typical reveals pain with direct palpation of the ulnotriquetral ligament and increased pain with pronation, flexion, and radial deviation of the wrist (Tedesco et al., 2020). Clinical Presentation Clinical presentation includes swelling and tenderness over the dorsoradial aspect of the wrist along with decreased grip strength. Physical examination may reveal tenderness in the anatomic snuffbox or palmar scaphoid tuberosity. Range of motion of the wrist may be diminished. The Watson scaphoid shift test is completed by stabilizing the scaphoid with one hand while using the other hand to move the wrist from ulnar to radial deviation. With ulnar deviation, the scaphoid is extended and with radial deviation, it flexes. If the scapholunate ligament is torn, the proximal pole of the scaphoid will displace dorsally with radial deviation until pressure is relieved. This causes the scaphoid to reduce. This shift is palpable to the clinician performing the test (Konopka & Chim, 2018). TFCC injuries usually occur with axial loading on an ulnarly deviated wrist, such as falling on an outstretched hand. Swinging a bat or racquet with the wrist loaded into ulnar deviation is another common injury mechanism. Previous trauma to this area can lead to degeneration (Jawed et al., 2020). Individuals who perform these activities during their regular occupational performance activities, such as mechanics, construction workers, or bikers, are more at risk. The elderly and those who rely on assistive devices for mobility may be at risk as well.
Triangular fibrocartilage complex (TFCC) injuries The TFCC is located on the ulnar aspect of the wrist joint, where it functions to stabilize the distal radioulnar joint and to act as a shock absorber across the ulnocarpal joint (Jawed et al., 2020). It is considered a load-bearing structure between the lunate, triquetrum, and ulnar head (Casadei & Kiel, 2023). The anatomy of the TFCC is complex. It is comprised of the fibrocartilaginous disc, the dorsal and palmar ligaments that span the radius and ulna, the ulnocarpal ligaments, a meniscal homolog. The TFCCC is subject to both traumatic and degenerative injuries that produce vague ulnar-sided wrist pain that increases with forearm rotation (Jawed et al., 2020).
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