wrist sprain.pptx. .

Wrist sprain
In detailed explanation about wrist anatomy, ligaments and their injury along with surgical management

1. WRIST SPRAIN Dr.Akshay (PT)

2. WRIST SPRAIN Wrist sprain is an injury to the ligaments ,the tough band of fibrous tissue that connect bone to bone. Sprain can tear apart the ligament joining together the end of the two carpal bones and ligaments connecting the proximal raw of carpal bones with the radius and ulna. ligaments are partially or completely torn.

3. GRADES OF INJURY

4. MECHANISM OF INJURY Ligaments can be torn when wrist is bent, twisted forcefully such as caused by fall on the outstretched hand or impact suddenly forces the wrist into a position beyond its normal range of motion. Wrist sprain are common injury in sports like volleyball, basketball, judo, boxing etc.

5. SIGNS AND SYMPTOMS OF WRIST SPRAIN Pain Swelling Redness at the site of injury Numbness Instability and inability of the injured person to move the joint.

6. DIAGNOSIS Watson (scaphoid shift) test Lunotriquetral ballottement test Finger extension against resistance Midcarpal test Distal radiounlar joint test Triangular fibrocartilage complex load test

7. : Watson (Scaphoid shift ) test – The patient sits with elbow resting on the table and the examiner faces the patient. Examiner holds the patient’s wrist with one hand so that the thumb applies pressure over the distal pole of scaphoid .The other hand grasp the patient metacarpal to control the wrist. Move the wrist firstly in ulnar deviation and slight extension and then in radial deviation and slight flexion. This creates subluxation stress if the scaphoid is unstable. If the scaphoid (and lunate) are unstable, the dorsal pole of the scaphoid subluxes or ‘shifts’ over the dorsal rim of the radius and the patient complains of pain indicating the positive test .

8. Lunotriquetral ballotement test: This test is used to determine the integrity of the lunotriquetral ligament .The examiner grasps the triquetrum between the thumb and the second finger of the one hand and the lunate with thumb and second finger of the other hand. The examiner that moves the lunate up and down (anteriorly and posteriorly) , nothing any laxity, crepitus , or pain which indicates a positive test for lunotriquetral instability.

9. Finger extension or “shuck” test : Patient is placed in sitting. The examiner holds the patient’s wrist flexed and asks the patient to actively extend the fingers against resistance-loading the radiocarpal joints. Pain would indicate a positive test for radiocarpal or midcarpal instability.

10. Midcarpal shift test : The test is used to detect metacarpal instability. The patient’s forearm is pronated with the hand held in support by the examiner. The examiner moves the patient’s hand from radial to ulnar deviation while axially compressing the carpus into the radius while applying an anterior directed force to the capitate . If the distal carpal row snaps dorsally and reproduces the patient's symptoms, the test is considered positive.

11. TRIANGULAR FIBROCARTILAGE COMPLEX LOAD TEST- The examiner holds the patient’s forearm with one hand and the patient’s hand with the other hand. The examiner the axially loads and ulnarly deviates the wrist while moving it dorsally and palmarly or by rotating the forearm . A positive test is indicated by pain ,clicking, crepitus in the area of the TFCC.

12. TREATMENT PHASE-1 ( 48-72 hrs) At first, should follow PRICE treatment . P – PROTECTION R – REST I - ICE C - COMPERRSION E - ELEVATION

13. PROTECTION – It is meant to prevent further injury. REST – Stop the activity and use of the injured wrist until the pain and swelling has reduced ICE - Apply a cold pack or a bag of crushed ice to the sprained wrist, for about 15 minutes Cryotherapy will create a superficial vasoconstriction , so that local blood flow decrease and reduce swelling.

14. COMPRESSION – Wrap the wrist with an elastic compression bandage and limit swelling. Start wrapping distal to proximal (at the base of the fingers and stop just below the elbow ). ELEVATION – Try to keep the wrist above the heart level as often as possible. This will help drain fluid and reduce swelling around the wrist. In case of a severe sprain it can be recommended to immobilize the wrist.

15. PHASE-2 In a second phase the patient should do gradual retraining exercises, including Active mobilization ,to increase flexibility and range of motion . Exercise for the strengthening of the injured wrist. - to prevent stiffness and weakness from developing and to ensure the wrist is functioning correctly. Exercise should as soon as pain allows .

16. SURGICAL MANAGEMENT In some cases a surgery may be needed to repair a ligament that was completely torn (grade 3 injury ). Closed reduction and pining – In the arthroscopic procedure, a doctor stabilizes the injured ligament by re-aligning the carpal bones, a process is known as reduction. Thermal shrinkage - Thermal shrinkage involves a specialized radiofrequency probe that uses heat to shrink and tighten a damaged ligament.

17. SURGICAL MANAGEMENT CAPSULODESIS- It is a procedure involving the creation of a flap in the wrist joint capsule .The flap is placed over the injured ligament in order to secure it and promote healing .

18. Cont.. TENODESIS – Tenodesis is a procedure used to stabilize a joint by anchoring tendons close to the joint . Stability is achieved by looping the tendon around the joint using sutures or wires . This technique may be used to stabilize carpal bones that may have misaligned due to ligament tears .

19. Cont.. LIGAMENT RECONSTRUCTION – Wrist sprain may be reconstructed using tendon grafts . Tendon strips are either attached or drilled through the carpal bones to achieve carpal stability. Autograft and Allograft Palmaris longus or flexor carpi radialis tendon are used.

20. Cont.. PROXIMAL ROW CARPECTOMY , ARTHODESIS , ARTROPLASTY - These procedures are only used when ligament injuries fail to heal , and arthritis develops over several years .

21. REHABILITATION Recovery time depends upon on haw serious the sprain is. These injury may take from two to 10 weeks to heal. grade 1 typically takes 2 to 4 weeks as opposed to grade 3 which may takes as long as 3 to 6 months. Practice stretching and strenthening exercises .

22. REFERENCE Orthopedic physical assessment – David J Magee Morgan WJ, Slowman Ls . Acute hand and wrist injuries in athletes Levine W. Rehabilitation techniques for ligament injuries of the wrist https://www.sports-health.com/sports-injuries/hand-and-wrist-injuries/surgery-wrist-sprain#:~:text=Capsulodesis.,different%20type%20of%20ligament%20injury.

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