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Wrist injury

Injury in the wrist


1. Sprain to the wrist
2. Traumatic tendonitis (inflammation)
3. Carpal instability
4. Fracture
5. Dislocation
6. Keinbock’s disease
Along the radial
side

Bones 1. Scap 1. Triangular Kienbock's palmar ganglion


hoid fracture, fibrocartilage disease compound
non union, complex
SL ligament palmar ganglion
2. Stylo injuries (TFCC)
id fracture, 2. ulna-carpal tear or a from radial
3. Scap abutment chronic occult bursitis
holunate 3. syndrome or ganglion. in rheumatoid
advanced impaction dorsal or tuberculous
collapse syndrome, ganglion synovitis
(SLAC) lesion, triquetrolunate CTS
4. instability
Scapholunate (VISI),
instability 4. hamate
fracture,
5.ulnar styloid
fracture
Joints 1. Radiocar 1.
pal arthritis, pisotriquetral
2. Scapho- arthritis,
trapezio- 2. caput-ulna in
trapezoid rheumatoid
arthritis arthritis.
(Triscaphe),
3. Trapezio
-metacarpal
arthritis
Tendon 1. de 1. extensor
Quervain's carpi ulnaris
tenosynoviti subluxation/
s and tendinitis
2. Flexo
r carpi
radialis
tendonitis.
Nerve Wartenberg's
chieralgia - -
Superficial
branch radial
neuritis
LUNATE DISLOCATIONS
These are of two types: lunate dislocation and peri-lunate dislocation
In lunate dislocation the lunate dislocates anteriorly but the rest of the
carpals remain in position. In peri-lunate dislocation, the lunate remains in
position & rest of carpal bones dislocate dorsally. The former type is
commoner.
Treatment is usually by open reduction. Severe loss of wrist movements is
inevitable.
Avascular necrosis of the lunate is a common complication.

smallest, the pisiform and trapezoid, to the largest, the

The wrist complex


The wrist comprises three movable joints:
1. the distal radio-ulnar joint,
2. the radio-carpal joint (between the radius and the proximal
row of carpal bones)
3. the midcarpal joint (between the proximal and distal rows of
carpal bones).

THE DISTAL RADIO-ULNAR JOINT (DRUJ)


The distal radius and ulna are linked to each other by
1. The interosseous membrane,
2. The capsule of the DRUJ and
3. The triangular fibrocartilage complex (TFCC).

The head of the ulna articulates congruently with the sigmoid notch
of the distal radius; movement at the joint occurs by the radius both
rotating and sliding in an arc around the head of the ulna during
pronation and supination of the forearm.
Interposed between the head of the ulna and the carpus is a
fibrocartilaginous disc, a fan-shaped structure spreading from an
apical attachment at the base of the ulnar styloid
process to the rim of the radial sigmoid notch. Its dorsal
and volar edges are coextensive with the dorsal and

Stability of wrist complexes


1. Capsule
a. Radio-carpal joint enclosed by strong but loose capsule
b. Mid-carpal joint is anatomically separate from
radiocarpal
c. The fiber of the joint capsule merge with the ligaments
2. Ligaments
most important in
Palmar radio-carpal

If ligament is torn –

a. Interosseous
carpal instability
stabilizing the
ligament is the
strongest &

wrist joint
b. Radio-carpal ligament (palmar & dorsal)
c. Ulnar collateral ligament
d. Radial collateral ligament
3. Tendons
a. Tendon passing the hand give some stability
4. Bone shape
a. Carpal bones are broad in dorsal aspect, narrow in
palmar aspect(except lunate) so joint is more stable in
flexion