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Orthopedic corner: Most wrist-twisting injuries are soft tissue strains

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Q. I was lifting a heavy box three months ago and twisted my wrist. At the time, I felt a “pop,” and I still have pain along the outside of my wrist. Will this just get better with time? — TJ

A. Dear TJ: Twisting injuries to the wrist are very common, and most represent soft tissue strains.

Frequently, these injuries can be sore for three to six months, but they do generally improve with time. In some instances, however, important bones, ligaments and/or a small cartilage disc within the wrist can be partially or even completely torn, leading to instability and persistent pain.

The scaphoid bone is the most frequently fractured bone in the wrist. It is usually injured during a fall onto an outstretched wrist rather than a twisting injury. Patients with scaphoid fractures usually have pain along the thumb-side of the wrist along with motion loss in extension and flexion.

Untreated scaphoid fractures can lead to progressive wrist collapse and arthritis. The treatment for this injury can include cast immobilization versus surgical repair. The best option is usually based on the location of the fracture within the bone, the amount of displacement between the fractured segments and the needs of the patient. Regardless of treatment selection, however, healing time can be prolonged with the best results in those patients treated early for their injury.

The scapholunate ligament connects two important bones in the wrist and is crucial in maintaining normal mechanics. Injuries to this ligament also occur most commonly after a fall onto an outstretched wrist. Patients with a torn scapholunate ligament usually have pain and/or swelling along the top of the wrist with decreased extension and flexion. If this structure is significantly torn, a progressive loss of alignment between bones in the wrist can occur. This often leads to gradual motion loss, a shift in loading patterns within the wrist, and arthritis. Unfortunately, complete tears of this ligament usually do not heal correctly unless surgically repaired.

The small cartilage disc in the wrist, the triangulofibrocartilage complex, connects the two major wrist bones at the end of the forearm (the radius and ulna), and it is important in coordinating forearm rotation as well as offering a cushion to part of the wrist during lifting activities.

Injuries can occur after forceful lifting activities, especially if accompanied by a forceful twist. Some injuries to this structure can occur over time as a simple manifestation of the aging process resulting in a degenerative tear. Patients with injuries to this structure usually have pain along the small finger side of the wrist that is worsened with full wrist supination (palm up) or pronation (palm down) positions.

A persistent clicking sensation may also accompany these injuries. Many patients will experience pain for three to six months that gradually improves without specific treatment. Other patients can develop ongoing pain with or without instability between the two forearm bones. Treatment for these individuals can include bracing, therapy and sometimes surgery.

At this point, if your wrist pain is not improving, it would be best to undergo an evaluation in order to evaluate these important structures. Good luck.

Ralph Costanzo, M.D., is a board-certified orthopedic surgeon with subspecialty training in hand surgery. He practices at Ortho Montana in Billings.

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