What Ails You: The road to recovery for wrist injuries

/Home/Chiropractic Use of Supports and Braces

What Ails You: The road to recovery for wrist injuries
October 29, 2007
By JACKIE RANDA
Desert Dispatch

Like the knee, the wrist has a cartilage meniscus that helps absorb shock. This meniscus is called the triangular fibrocartilage complex (TFCC) and, like the meniscus in the knee, includes a number of ligaments that anchor the TFCC to surrounding bones. Also like the meniscus in the knee, the TFCC does not enjoy good circulation, so once injured, it does not heal well.

The TFCC can be injured in a number of ways, either traumatic or degenerative. You may have fallen onto your outstretched arm or slammed your extended wrist into the dashboard or steering wheel in a car accident. You may have been holding something when the load shifted and your wrist was pulled and twisted. You may have a job or hobby that requires long hours of twisting your wrist against resistance like when you use a screwdriver, bowl or play tennis. Severe arthritis in your wrist can cause the cartilage to deteriorate leaving the delicate wrist bones unprotected.

If you have a damaged TFCC, you complain of pain on the pinkie finger side of the wrist (the ulnar side). You may notice that your wrist grinds especially when you rotate your forearm to turn your palm up and down (supination or pronation) or when you grip something hard. You may notice a painful clicking deep inside the wrist on that side especially with twisting motions. With a severe tear, you may even notice that your wrist painfully locks up a bit causing you to have to stop and ÏclickÓ it loose.

Before beginning treatment, it is important to be sure the condition is correctly diagnosed. The best treatment for the wrong condition isnÌt going to help you. There are a number of other conditions that can cause pain on that side of the wrist. If you fractured your radius (the forearm bone on the thumb side) and it was shortened, you have altered the way the wrist works and may have an impingement on the ulnar side causing your pain. You could have arthritis in the tiny joints on that side or you may have developed some instability there. You could have narrowing and hardening of the artery that supplies that side of your wrist. You could have tendinitis.

If numbness and tingling are part of your symptoms, you could have an entrapment of the ulnar nerve; the nerve that supplies your fourth and fifth fingers as well as the muscles which move your fingers together and apart.

Your doctor is likely to order x-rays when you tell him about your complaints. X-rays will reveal arthritis changes and the history of old fractures, but they cannot show a problem in cartilage which is a soft tissue. X-rays can show when there is a problem with instability if appropriate films are taken and if the radiologist reading them is skilled in identifying these subtle changes.

The definitive scan for identifying TFCC lesions is the MRI. There are many conditions for which an MRI study is less than reliable, but this is not one of them. An MRI is almost as good as arthroscopic surgery in identifying lesions in the TFCC.

Initially, your wrist will be immobilized in a removable brace. Ideally, you will remember the reason you are wearing the brace is to limit the use of your wrist and you will not keep trying to use it causing further strain. During the four to six weeks that you are immobilized, you will probably be asked to take anti-inflammatory medication. You will remove the brace to apply ice for 20 minutes three to four times each day. Your doctor may suggest a corticosteroid injection to help reduce the inflammation.

Although a torn cartilage is unlikely to heal completely, many tears of the TFCC become painless with time. After this period of rest and anti-inflammatory treatment, you will be sent to physical therapy. We will work to restore normal movement without pain in your wrist and then begin to build up your strength. This conservative treatment should be tried for about three months (including the period of immobilization) before the decision is made to do surgery.

Again, after surgery, your wrist will be immobilized, but this time youÌll be in a cast. If the doctor had to put wires in to hold your wrist bones in place, you will be casted longer, but normally the cast will be removed at about four weeks. Once out of the cast you will begin physical therapy.

Everyone wants to know how long it will be before they are Ïback to normal.Ó Healing rates are as individual as the person. When you are able to resume your usual activities depends on when you recover full, painless motion and strength rather than on how many weeks it has been since your initial injury or subsequent surgery. In general, though, if you have had your injury longer, it will take longer for you to recover. An injury that is treated correctly right from the start may recover more quickly.

What is important to remember is that with this injury, as with any injury, you cannot force it to get better faster. Your rehabilitation is not a Ïno pain, no gainÓ experience. Pushing through the pain hoping to force your wrist to get better faster will only sustain or worsen your injury. Admit you are hurt and get the care you need; that is the fastest road to recovery.

ABOUT THE WRITER:
Jackie Randa is a physical therapist who owns Back on Track in Barstow. She can be contacted at jranda@aol.com

© Copyright 2007, Desert Dispatch, a Freedom Communications newspaper. All rights reserved.