WRIST SPRAIN

Definition

A wrist sprain is a traumatic injury to the ligaments that stabilize the wrist joints. Ligaments are elastic tissues that hold bones together and allow the joints to function properly. A sprain occurs when the wrist ligaments are stretched or torn due to excessive force applied to the joint. This can happen during a fall on the hand, direct impact, sudden movement, or twisting of the wrist. Typical symptoms of a wrist sprain include:

1. Pain: Immediate pain in the wrist, which can vary in intensity depending on the severity of the sprain.
2. Swelling: The wrist may become swollen due to inflammation caused by the ligament injury.
3. Bruising: Bruises or discoloration may appear around the affected area due to damaged blood vessels.
4. Stiffness: Joint stiffness may occur, limiting normal wrist movements.
5. Weakness: A sensation of weakness or instability in the wrist may be felt due to ligament laxity.
6. Difficulty moving: There may be difficulties performing certain wrist movements due to pain and stiffness.

The diagnosis of a wrist sprain is generally based on the symptoms described by the patient, the clinical examination of the wrist by a healthcare professional, and imaging tests such as X-rays to rule out any fractures or other bone injuries. Treatment for a wrist sprain may include rest, ice application, immobilization of the wrist with a splint or bandage, elevation of the wrist to reduce swelling, and possibly medications to relieve pain and inflammation. In some cases, rehabilitation with a physical therapist may be necessary to restore wrist strength and mobility.

Why might arthroscopic treatment of deep fiber lesions of the triangular ligament be necessary?

• The triangular ligament (also known as the triangular fibrocartilage complex or TFCC) is a ligamentous structure located on the inner side of the wrist, connecting the two forearm bones (radius and ulna). It plays a crucial role in wrist stability during forearm rotation movements (pronation and supination). Additionally, it serves an essential function as a shock absorber between the wrist bones (carpus) and the forearm during pressure exerted on the hand.

• The triangular ligament can be damaged during certain movements that combine extreme twisting and extension of the wrist. In such cases, it may detach from its attachment points, causing pain on the inner side of the wrist.

• Some alterations of the deep fibers of the triangular ligament are generally mild and heal within a few weeks with wrist immobilization using a splint. If necessary, rehabilitation sessions may be recommended to facilitate wrist recovery. In other cases, the injuries are more serious and may lead, after several months, to the persistence of:
  • Persistent pain on the inner side of the wrist, often exacerbated by pronation and supination movements.
  • Restriction of wrist mobility.
  • Clicking sounds during wrist movements.
  • Sensation of wrist instability.
  • Loss of strength.
• In these situations, a surgical option may be proposed to reattach the deep fibers of the triangular ligament to the ulna.
• During your consultation, the surgeon will suspect a triangular ligament injury in the presence of suggestive signs and symptoms. He will order additional tests to aid in the diagnosis, such as:
  • X-rays to clarify the bone structure of your wrist, which may sometimes show displacement of the ulna relative to the radius.
  • MRI to visualize the triangular ligament and detect any lesions.
  • Arthro-CT (CT scan with contrast injection into the wrist) to highlight tears and detachments of the triangular ligament.

None of these tests are 100% infallible, but they help establish the diagnosis of your condition and propose a treatment plan.

The procedure of the intervention

• The operation is usually performed under regional local anesthesia, although in some situations, general anesthesia may be preferred. The details of the anesthesia will have been explained to you by the anesthesiologist during the preoperative consultation.
• The intervention involves reattaching the triangular ligament to the ulna. The arthroscopic approach (using a camera introduced into the joint) allows for reducing the size of the incisions needed for this procedure.
• Before the intervention, several checks will be carried out to ensure your safety, including your identity, the nature of the intervention, the side to be operated on, and the availability of the necessary equipment. Once all these checks have been completed, the intervention can begin.
• During the intervention, the surgeon may need to adapt and modify the initial plan based on certain findings or circumstances.
• After the operation, a splint will generally be prescribed for a period of 4 to 8 weeks. Then, rehabilitation sessions will be recommended. Force exertion on the wrist and resumption of sports activities will only be allowed after 4 to 6 months.
• In most cases, the intervention will result in a reduction of pain and a normal resumption of wrist use after a few months. However, complications can sometimes occur:
  • Injury to the dorsal cutaneous branch of the ulnar nerve, which can lead to a loss of sensitivity in the inner part of the back of the hand. Generally, this is a benign injury that improves on its own within a few months. In rarer cases, a section of this nerve may require surgical repair.
  • Injury to a tendon in the wrist, which may require surgical repair.
  • Inflammatory reaction to the sutures, sometimes necessitating their removal.
  • Failure of the triangular ligament reinsertion, leading to the persistence or recurrence of the initial symptoms.
  • Persistence of pain despite successful repair of the triangular ligament.

Your intervention in practice

• Preparation for the operation

A pre-anesthetic consultation is required before any intervention. The anesthesiologist will gather the necessary medical information and may prescribe additional tests if needed. Take a shower the night before and the morning of the intervention. On the day of the intervention, avoid using moisturizing cream on your skin and remove jewelry (including wedding rings), piercings, nail polish, and false nails. Follow the fasting instructions given by the anesthesiologist. Follow the anesthesiologist’s instructions regarding the intake of your usual medications.

• The intervention is usually performed on an outpatient basis, but a brief hospitalization may sometimes be considered.
• After an outpatient intervention, make sure to be accompanied when leaving the facility and returning home, and plan not to be alone the evening and night following the operation.
• Regularly take the pain medication that has been prescribed to you.
• Keep your arm in a sling strictly until the anesthesia wears off.
• Start moving your fingers regularly as soon as the anesthesia wears off.
• Make sure not to wet or dirty your dressing.
• Wear the splint continuously for the recommended duration.
• It is essential to carefully follow the instructions provided by the anesthesiologist and the surgeon.