Orthopedic physical assessment - David j magee Morgan WJ . Slowman Ls Acute wrist injuries in athletes Levine W . Rehabilitation techniques for ligament injuries of the wrist

1. WRIST SPRAIN

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.

4. GRADES OF INJURY

5. 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.

6. 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.

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

8. • :
• 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 .

9. 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.

10. • 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.

11. • 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.

12. 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.

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

14. • 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.

15. • 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.

16. • 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 .

17. 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.

19. 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 .

21. 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 .

23. 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 .

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

25. 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.

26. 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%20l
igament%20injury.

27. THANK YOU