DIAGNOSIS WRIST INJURIES

COMMON SPORTING WRIST INJURIES

In order to properly diagnose the wrist injuries in sport, the clinician should have a good awareness of the basic anatomy of the wrist and investigate appropriately. This article describes common wrist injuries, investigations and treatment.

BY DR MIKE ROSSITER, MB BS MSc (SEM) FFSEM (UK) MRCGP AND MR DAVID WARWICK, MD FRCS FRCS (ORTH)

INTRODUCTION Wrist injuries in sport are common but are often poorly diagnosed and therefore not managed adequately. In order to properly diagnose the wrist injury, the clinician should have a good awareness of the basic anatomy of the wrist and investigate appropriately. However, as the wrist is a complicated joint, even with good clinical skills and diagnostic tests an accurate diagnosis is not always possible and therefore a “wrist sprain” may be the most appropriate diagnosis. This article aims to briefly describe the common injuries of the wrist, investigations and treatment.

ANATOMY OF THE WRIST Bones and joints

The wrist joint is one of the most complex joints in the body. It is the articulation between the distal radius and ulnar head with the scaphoid, lunate and triquetral bones (the proximal row). It is a synovial ellipsoid joint surrounded by a capsule, which is attached to the lower ends of the radius and ulna and the proximal row of the carpal bones. The capsule is strengthened by a complex system of anterior and posterior ligaments, which stabilise the wrist in all positions. The triangular fibrocartilage complex (TFCC) sits between the ulna head, lunate and triquetrum, stabilising the distal radio- ulnar joint in rotation and providing a cushion to the ulnar side of the wrist. A synovial membrane lines the capsule and attaches to the margins of the articular surfaces.

www.sportEX.net Movement

The radio-carpal and ulno-carpal joints in combination allow the wrist to flex, extend, abduct, adduct and circumduct. Rotation (pronation and supination) occurs at the distal radio- ulnar joint.

Tendons and muscles The following muscles are responsible for each movement: n Flexion: flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), palmaris longus (PL) (+flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP) and flexor pollicis longus (FPL)) n Extension: extensor carpi radialis (ECR), extensor carpi radialis brevis (ECRB) and extensor carpi ulnaris (ECU) (+extensor digiti (ED), extensor indices (EI), extensor digiti minimi (EDM) and extensor pollicis longus (EPL)) n Radial abduction: FCR, extensor carpi radialis longus (ECRL), abductor pollicis longus (APL) and extensor pollicis brevis (EPB) n Ulnar adduction: FCU and ECU.

INTERCARPAL LIGAMENTS The intercarpal joints lie vertically between the individual bones of the proximal row and distal row of the carpus, and horizontally between the proximal carpal row and distal carpal row. The scaphoid and lunate are linked by the scapho-lunate ligament, and the lunate and triquetrum by the luno-triquetral joint. These ligaments are essential for stable function of the wrist.

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