Wrist Injury

Aka: Wrist Injury, Wrist Sprain, Wrist Pain

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II. Differential Diagnosis: Wrist Sprain

  1. Ligament tear (pain out of proportion, with click/pop)
    1. Scapholunate ligament tear or dissociation
      1. Injury: Excessive extension with radial deviation
    2. Lunotriquetral ligament tear (+/- avulsion Fracture)
      1. Injury: Excessive extension with ulnar deviation
    3. Triangular Fibrocartilage Complex Injury (TFCC)
      1. Ulnar Wrist Pain and weakness
      2. Occurs after Fall on Outstretched Hand
  2. Wrist Fractures
    1. Scaphoid Fracture (Fall on Outstretched Hand)
    2. Radial Epiphyseal Fracture
      1. Non-displaced Fracture of distal radius in children
    3. Hook of Hamate Fracture
      1. Baseball bat handle strikes palm
      2. Golf club head strikes ground transmitted to palm
    4. Bony nonunion from occult Fracture
      1. Sudden onset Wrist Pain and distant Trauma History
      2. Most often affects Scaphoid Bones and Hamate Bones
    5. Idiopathic avascular necrosis (Often overuse related)
      1. Most often affects Lunate Bone and Scaphoid Bone
  3. Tendon Injury
    1. De Quervain's Tenosynovitis
      1. Pain at radial aspect of distal radius
    2. Intersection Syndrome
      1. Pain aand crepitation over dorsum of distal radius
  4. Nerve injury
    1. Median Neuropathy (Carpal Tunnel Syndrome)
    2. Ulnar Neuropathy
    3. Radial Neuropathy
    4. Thoracic Outlet Syndrome
    5. Distal Posterior Interosseous Nerve Syndrome

III. Exam

  1. See Wrist Exam
  2. See Hand Exam and Hand Injury
  3. Focus Areas
    1. Triangular Fibrocartilage Complex (TFCC)
    2. Volar Surface
      1. Ulnar aspect (associated with injury to Guyon's Canal and Ulnar Nerve)
        1. Pisiform
        2. Hook of Hamate
      2. Scaphoid tubercle
        1. See Scaphoid Shift Test
    3. Dorsal Surface
      1. Scaphoid distal pole (most common wrist Fracture)
        1. Located at anatomic snuff box
      2. Carpal Bones on radial side of wrist
        1. Shuck Test evaluates for inflammation/instability
      3. Scapholunate joint (Most common carpal dislocation)
      4. Lunate (Second most common wrist Fracture)

IV. Imaging

  1. Wrist XRay
  2. Carpal Tunnel View Xray
    1. Evaluate for Pisiform Fracture, Hook of Hamate Fracture and Scaphoid Tubercle Fracture

V. Management

  1. Referral for serious Fractures or ligament injuries
  2. Splint for 3 to 4 weeks and reevaluate

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