WRIST SURGERY – FINDING THE CAUSES OF PAIN

A ligament rupture in the hand is typically characterised by a tear in the scapholunate ligament between the scaphoid and lunate bones. This ligament is frequently affected by falls on the wrist. Pain, weakness and immobility are the typical symptoms of ligament rupture in the hand. Every ligament rupture in the hand is a case for hand surgery. The correct treatment is carried out after an X-ray and high-resolution magnetic resonance imaging. This is because a careful diagnosis of a torn ligament in the wrist avoids late damage due to incorrect loading. There are different treatment methods depending on the severity of the ligament rupture in the hand. These range from conservative immobilisation and surgical correction with wire fixation to bone stabilisation and reconstruction of the ligament.

The scaphoid fracture is the most common wrist fracture in falls on the outstretched hand. Due to its oblique position on the thumb side of the wrist, the scaphoid is exposed to extreme forces. Typical symptoms are pain that increases with pressure on the radial side of the wrist. A scaphoid fracture is diagnosed using an X-ray, high-resolution magnetic resonance imaging or computerised tomography. A fresh wrist fracture is usually treated using minimally invasive techniques. Displaced fractures must be fixed with screws so that the ends of the fracture can grow together optimally. In the case of a non-displaced fracture, a screw fixation can lead to a quicker return to mobility. As long-term immobilisation in plaster is not necessary, exercise therapy can be started promptly.

Injuries, incorrect loading, inflammation or degenerative processes in the hand and wrist can lead to wear and tear of the cartilage surfaces. Although osteoarthritis of the wrist cannot be cured, the painful symptoms can be alleviated by hand surgery.

In cases of advanced wear and tear, wrist surgery helps by denervation, i.e. by severing the pain-conducting nerves. The sensation in the hand is retained. Denervation is also useful if a full fusion or the use of a prosthesis is to be delayed.

If the osteoarthritis is not yet severe, partial fusion of the wrist can be helpful. This involves immobilising bones with defective cartilage by fusing them together. This relieves the strain on this part of the wrist. However, mobility is retained.

Only in very advanced stages of osteoarthritis in the wrist with pronounced cartilage damage is the wrist completely stiffened. The first step is to remove cartilage and bone remnants. As a rule, bone is then harvested from the specimen. This leads to a fusion between the radius, the carpal bones and the metacarpus. The wrist becomes rigid. The hand remains mobile and rotational movements of the forearm are possible. However, bending, stretching and sideways movements are unfortunately not possible.

If the wrist is completely destroyed and a client suffers from severe pain, an artificial wrist is used. Compared to full fusion, the prosthesis has the advantage of greater mobility. With the prosthesis, stretching and bending movements as well as lateral movements are also possible, but not too much strain.

If every twisting movement in the wrist hurts or you can no longer support yourself without pain, this may be due to a triangular disc lesion. This is a triangular cartilage ligament structure between the ulna, radius and carpal bones. It serves as a pressure cushion between the carpal and forearm bones. Accidents or incorrect loading of the wrist can lead to a tear in the triangular fibrocartilaginous complex (TFCC). The discus triangularis lesion often appears like a sprain. Therefore, a detailed diagnosis using conventional X-rays or high-resolution magnetic resonance imaging is recommended. Treatment usually involves an outpatient arthroscopy under anaesthetic. This is followed by three weeks of immobilisation and physiotherapy.

Eight bones in the wrist ensure optimum mobility. The first row of the wrist consists of the scaphoid, lunate, triangular and pea bones. Lunate bone death, also known as lunate bone necrosis, lunate malacia or Kienböck’s disease, is a circulatory disorder of the lunate bone. This leads to the death of the bone and thus to a disturbed statics of the wrist. The lack of blood flow to the lunate bone is often only noticed when it has already lost its shape. Pain initially occurs under stress and during movement in the wrist on the extensor side. Later, the joint also hurts at rest. It becomes increasingly weak and immobile.

The three stages of lunate bone necrosis are treated by immobilisation, pressure relief, transplantation of bone material from the radius and partial and full fusion of the wrist. The aim of all surgical methods for lunate bone necrosis is to achieve resilience and permanent freedom from pain.