Wrist Pain & Wrist Arthroscopy
What is it?
The wrist is formed by a number of small bones, which are connected to each other and neighbouring bones by strong pieces of tissue known as ligaments. In certain injuries such as a fall onto an outstretched hand, excessive stretching forces can occur in the ligaments causing them to become sprained, partially torn or completely torn.
Wrist sprains can be divided into three main categories according to the degree of stretching caused within the ligament:
- Grade 1 Mild sprain due to a stretch of the ligament
- Grade 2 Moderate sprain due to partial tear of the ligament
- Grade 3 Severe sprain due to complete tear or disconnection of the ligament at its attachment.
Who gets it and what causes it?
Wrist sprains commonly occur due to a fall on an outstretched hand or direct trauma in sporting activities. They affect all ages of people.
What are the signs and symptoms?
The main symptom is pain, which is worse on movement. In addition there maybe swelling and bruising around the wrist.
What tests will I need?
Following a consultation, including a history and clinical examination of your hand and wrist, imaging tests will be needed to make sure there is no fracture. X-rays are routinely performed, but other tests such as CT or MRI may be needed if there is any uncertainty.
What is the treatment?
For mild sprains the usual treatment is based on addressing the symptoms by resting the wrist, using a splint, applying ice for short periods, using an elastic bandage to compress and raising the arm slightly to reduce the swelling. Simple painkillers such as paracetamol and ibuprofen also help reduce the inflammation. The hand therapist and Mr. Naqui will help with your rehabilitation.
For moderate to severe sprains surgery may be necessary to repair the damaged ligament. Mr. Naqui may wish to further examine the wrist, by way of minimally invasive wrist arthroscopy.
What does the surgical treatment involve?
The aim of surgery will depend upon the particular ligament you have injured and the grade of the injury.
In some cases wrist arthroscopy is performed where 3 small (less than 1 cm) cuts are made over the wrist and a small camera and other instruments inserted. Through this technique injury to the ligaments can be fully appreciated and small damaged parts removed.
In other cases a repair or reconstruction of the ligament is required and this may need to be performed with open surgery. In ligament reconstruction tendon or ligament grafts from elsewhere in your body may need to be used.
Mr. Naqui performs wrist arthroscopy and wrist sprain surgery at a number of hospitals around Manchester (See Hospitals page).
Arthroscopy usally lasts 30 to 60 minutes and is a day case procedure requiring regional or general anaesthetic.
Open surgery usually lasts 45 to 90 minutes and is a day case procedure requiring regional or general anaesthetic. The surgical scars are usually straight approximately 4 cm long.
In open surgery, delicate stitches are used to close the wound. A dressing/cast will be placed over the wound.
What happens after the surgery?
Taking simple painkillers such as paracetamol regularly for the first 2 days after the operation will help to relieve any post-operative pain. Elevating the arm can also help reduce any swelling.
For a wrist arthroscopy you are encouraged to start early mobilisation and this will be discussed with you following your procedure.
In open surgery, any stitches used in the procedure will be removed at 10-14 days after the operation either at your GP surgery or at the Hand clinic. You are advised to wear a splint for 4 to 6 weeks.
Mr. Naqui and the hand therapist will provide you with specific wrist exercises to perform after surgery but early movements are encouraged.
When I can return to normal activity?
In the case of open ligament surgery, the ligament may take 6-8 weeks to mend fully, but the return to normal wrist function may be longer. Therefore your return to work and normal activity will be guided by the severity of your injury and the progress you make after surgery as well as the type of job you have. But you should expect 1-2 months off work.
Your return to sport would be discussed with you by Mr. Naqui and will be catered to your particular sporting needs.
What are the complications of surgery?
For arthroscopy the complication rates are low. Potential complications include infection, nerve injury, swelling, pain, stiffness, scarring and tendon injury.