FAQ Category: Wrist

The Semmes-Weinstein monofilament test measures the sensitivity of your nerves. It’s used to assess loss of sensory function when a nerve is damaged or injured. It’s commonly used with carpal tunnel syndrome (CTS).

A monofilament is a thin piece of wire. It’s touched to the patient’s fingertip until it bends. Without looking, the patient is asked to say when he or she feels the pressure. The therapist starts out with the thinnest monofilament possible and gives the pressure three times. If the patient doesn’t feel anything, the next size monofilament is tried. This is repeated with larger monofilaments until the patient reports the sensation.

Normal light touch is felt when using a monofilament between 1.65 and 2.83. The sense of light touch is mildly lost when it takes a monofilament size between 3.22 and 3.61 to be felt. Monofilament testing can be used to find a loss of protective sensation and loss of deep pressure. Of course, someone with no feeling will not feel the pressure of any size monofilament.

Surgery is the advised treatment for advanced cases of Kienbock’s disease. There’s a loss of blood supply to the lunate bone in the wrist. Tiny fractures and collapse of the bone result in pain, loss of motion, and weakness.

The operation is designed to restore blood to the area and fuse the bones in place. Studies show that range of motion and grip strength are much improved after the operation. However, they may not return to normal.

Before returning to work, a physical or occupational therapist will measure your motion and strength. Your doctor will release you to return to work when you can do your job without reinjury. Recovery from the surgery takes six to eight weeks. Rehab may take an equal amount of time.

Kienbock’s disease is most often seen in men between the ages of 30 and 40. Manual laborers are affected more than anyone else. In this disease, there is a loss of blood supply to a particular bone in the wrist called the lunate. Without enough blood to the bone, it starts to die.

Most of the lunate bone is covered in a thick cartilage. This cartilage doesn’t have much sensation. This explains why the early stages of Kienbock’s can be without any symptoms. By the time the patient feels pain, stiffness, and loss of motion, the damage can be severe.

At first, the patient may not be able to put pressure on the wrist. Adults often work through the pain and ignore the symptoms until the disease gets much worse. Early detection and early treatment are the key to a successful outcome with Kienbock’s disease.

Kienbock’s disease is the death of a bone in the wrist (the lunate) from a loss of blood supply. This condition is hard to see on X-rays and doesn’t always show up well in other imaging studies.

Early treatment is important and depends on accurate diagnosis. Immobilization in a cast is the first step. The hope is that this less invasive treatment will give the bone a chance to heal. There’s still some debate among doctors about the best way to treat a more advanced case of Kienbock’s.

Surgery to restore the blood supply is often advised. The dead or dying bone is replaced with live bone that has a good blood supply. It may be necessary to revise the length of a bone in the forearm or to fuse the bones in the wrist. This is decided at the time of the operation when the doctor can see inside the wrist.

Kienböck’s disease is most common in men who are manual laborers. It occurs between ages 30 and 40. The exact cause is still unclear. In all cases, there is a loss of blood supply to a bone in the wrist called the lunate.

At first, doctors thought this was the result of a sprained wrist. The blood vessels to the lunate go through the ligament. Damage to the ligament disrupts the blood supply. Later, doctors noticed that most of the patients with Kienböck’s also had one bone (ulna) in the forearm shorter than the other.

The lunate is in the center of the wrist. In this position, it gets a lot of force and stress with everyday activities. The forearm has two bones that connect to the lunate: the ulna and the radius. If the ulna is shorter than the radius, then even more force is placed on the lunate. This increases the risk of fracture and loss of blood supply.

More recently, this change in the ulna has been seen as a risk factor, not the cause. It increases the chances of Kienböck’s disease, but it doesn’t cause it. It’s more likely that a fracture in the area of the lunate cuts off the blood supply. As medical technology improves, researchers will probably find the exact cause.

A Colles fracture is a break in the last inch or inch and a half of the radius bone. The radius is one of the two bones in the forearm that meets the small bones of the wrist to form the wrist joint.

Colles fractures are the most common break in adults over the age of 50. The wrist is a place where bones frequently get weak from osteoporosis. The typical Colles fracture occurs when a person slips or trips and lands on an open hand with the palm down. Other causes of this fracture include car accidents and sporting activities.

A wrist injury of this type can lead to death of the bone, a process called avascular (without blood) necrosis (death). The bone in the center of the wrist (called the lunate) is only supplied with blood on one side. Anything that stops the blood to this bone can cause this condition.

Other treatment options include surgery. One new method removes the dead or dying bone and inserts a new piece of bone (bone graft) in its place. Doctors do not usually pin the bone in place in order to avoid damaging the bone graft and its blood supply.

Fractures are not all the same. Each one must be treated individually. With wrist fractures, there is the danger of the bone and joint getting shorter. This can cause many other hand and wrist problems. Damage to the ligaments, tendons, and other soft tissues around the fracture must also be treated. Improper treatment can result in significant arthritis later.

The use of a fixator has replaced casting in many cases. These devices allow the surgeon to pin the bones together and hold them in place during healing. The fixator also allows movement of the hand, wrist, and arm. This helps prevent problems with stiffness and loss of motion.

Unfortunately, there are some problems that can occur with these fixation devices. Nerve and tendon damage, finger fractures, and complex pain patterns can develop. Your doctor should be made aware of your problems. Treatment with medication and physical therapy may help.

Make a fist with your thumb inside. Make sure the thumb is far enough inside the fist to touch the little finger. Now move your wrist in the direction of the little finger. This stretches the thumb side of your hand. Does it hurt? A little or a lot? This is Finkelstein’s test. It helps diagnose a condition called de Quervain’s disease.

De Quervain’s disease is a painful tendinitis commonly caused by repeated motion of the wrist and hand. The condition is often seen in people who grip tools or play musical instruments for hours and hours. Many people are potentially at risk, but women seem to have the highest rate of de Quervain’s.

X-rays usually come out normal for this condition. Finkelstein’s test can confirm the diagnosis. The “hitchhiker’s test” is also used. For people with de Quervain’s disease, putting pressure on the thumb in a hitchhiker’s position causes extreme pain in the wrist. Comparing thumb motion on the painful and normal sides usually shows a decrease in motion on the painful side.

Washerwoman’s sprain was used to describe a painful condition of the hand and wrist 100 years ago. Women who made their living washing clothes developed painful swelling caused by a form of tendinitis. Today, this condition is called de Quervain’s disease. It can affect anyone who repeatedly uses the wrist and hand in a sideways or wringing motion.

De Quervain’s disease is an inflammatory condition that affects two tendons of the thumb where they cross the wrist. The tendons are covered by a lining and tucked inside a canal that allows them to glide back and forth during movement. When the tendons are used over and over, irritation leads to inflammation. This leads to a thickening of the tendons and their coverings. Pain, swelling, and loss of thumb motion are the primary symptoms.

Women are the most susceptible to this problem. Jobs that require a repetitive sideways motion of the wrist with the hand and thumb in a gripped position also lead to de Quervain’s. Hairdressers, musicians, carpenters, skiers, and assembly line workers are especially at risk.

Anyone who has a job that requires repeated hand motions is at risk for a variety of problems. One of the most common is tendinitis. Musicians are susceptible to a specific kind of tendinitis called de Quervain’s disease.

When tendons are used repetitively or excessively, pain, swelling, and limited thumb motion can develop. With these come inflammation and an eventual thickening of the tendons and their coverings. This makes it even more difficult for the tendons to move.

For most people, anti-inflammatory medications, rest, and wearing a thumb splint help ease the symptoms. For musicians, these steps may take too long or interfere with work. An alternate form of treatment is the single injection of a steroid medication into the area. This allows the musician to return to work within three to five days.

Some additional tests may be required. In young gymnasts with wrist injuries, the growth plate at the end of the wrist bones may be injured. This will not show up on a plain X-ray and could require a bone scan or MRI (magnetic resonance imaging). Bring your concerns to your doctor’s attention.

Evaluation of wrist pain can be very difficult. A careful history and thorough examination are required. Even with today’s best imaging technology and diagnostic studies, some wrist problems remain mysterious. Sometimes even exploratory surgery does not answer the question of what’s wrong.

In cases like these, treatment consists of pain management. Usually medications and physical therapy are recommended. Sometimes the patient seeks out alternative treatment such as acupuncture, chiropractic, and herbal therapies.

You may want to seek a second (or third) opinion to find out what’s wrong. Try to find a physician or clinic that specializes in the treatment of wrists and hands.

Treating wrist injuries can be very difficult. Early and careful treatment is important. The choice of treatment depends on the location and severity of the injury. A long arm cast is usually used to avoid stress to the repaired ligament. The doctor will place your forearm in a specific position (sometimes with the hand facing up or facing down), depending on the location of the tear.

Four to six weeks is about how long it takes for soft tissues to heal with enough strength to withstand the forces of everyday movement. Don’t be surprised by any stiffness in your wrist and forearm when the cast comes off. Usually, a short course of physical therapy with range of motion and strengthening exercises will help you get back to normal.

TFCC stands for triangular fibrocartilage complex and describes a cartilage pad that rests where the ulna bone of the forearm meets the “pinky” side of the wrist.

The name this injury gets depends on which part of the cartilage has been damaged. Class 1A refers to tears right in the middle. Class 1B tells the surgeon that the ligament has torn away from the end of the ulna bone in the forearm. Classes 1C and 1D identify two other places where this tough, fibrous material has been torn.

There are additional ways to classify or name this particular injury. When the damage occurs as a result of degenerative changes from aging, both the location and the severity are named. These names may not mean much to patients, but they are important for doctors when surgery is required.

There is a surgery that has been used in a small number of children with this condition. The two bones of the forearm are joined, or fused, together. The two forearms are connected into one bone. The new position of the forearm puts the hand in a position ready for a handshake or with the palm facing slightly downward.

Researchers followed up on six children who had this type of surgery. The surgery enabled the children to be able to use their hand to pick up objects and to hold items. Your niece’s doctor can decide if this type of fusion will make a difference and help find a specialist.

Sometimes human error does mean taking an extra X-ray. This can happen if the patient moves during the procedure or the technician makes a mistake.

There is concern about the effects of radiation accumulated over a lifetime. But the amount of radiation patients are exposed to in X-rays is minimized by today’s modern technology.

Actually, doctors who study X-rays (radiologists) are asking this same question. Most positions for X-rays have been determined by studying the bones of cadavers (human bodies preserved for study). With live humans, there may be a significant effect of the muscles acting on the bones.

Perhaps slight differences in position aren’t that important. But until this question can be cleared up, it’s necessary to follow standard procedures and keep the wrist “just so” during X-rays.

X-ray techniques are not always standard from place to place. It’s possible that the X-ray technician used the wrong wrist position. Small differences in hand placement on the machine can make big differences in what the X-ray shows. Your doctor probably ordered one more X-ray in order to get the exact picture he or she needed.

Kienbock’s disease occurs when blood stops flowing to the lunate bone in the wrist. The bone on the thumb side of the forearm (the radius) may be longer than the bone on the little-finger side (the ulna). These bones control rotation in the wrist. Surgeons have often treated Kienböck’s disease by “leveling” or evening out these bones–shortening the radius or lengthening the ulna to reduce pain in the wrist.

A group of doctors from Argentina suggested a new surgical treatment to “decompress” the wrist. They’ve had good results from making small “windows” in the radius and/or ulna for blood to flow through. In a group of 22 patients, this procedure reduced pain 91 percent of the time. Pain relief was often immediate, which is thought to be due to a change in blood pressure within the bone. Ten years later, most of the patients (72 percent) had no pain in their wrists.