FAQ Category: Wrist

A scaphoid fracture that doesn’t heal within several months is considered a nonunion. If the injury is fairly recent, your doctor might recommend more time in the cast. He or she might also prescribe an electrical stimulator. The electrical stimulator is a device that sends a small electrical current to your scaphoid bone. You wear it like a large bracelet for ten to twelve hours a day. Electrical current has been shown to help the bones heal. If the nonunion is quite old, or if the cast and the electrical stimulator fail to heal the fracture, your surgeon will probably suggest surgery.

If the fracture is identified immediately and is in good alignment, the chances are good the bone will heal. Patients generally wear a cast that covers the forearm, wrist, and thumb for up to twelve weeks. The doctor takes X-rays at least once a month to check the progress of the healing. Once your doctor is sure the fracture has healed, the cast will be removed. Even with this type of treatment, however, there is still a risk that the fracture may not heal well and will become a nonunion.

The symptoms of a fresh fracture of the scaphoid bone usually include pain in the wrist and tenderness in the area just below the thumb. You may also see swelling around the wrist. The swelling occurs because blood from the fractured bone fills the wrist joint. Thin people will see a bulging of the joint capsule. The joint capsule is the watertight sac that encloses the joint.

Symptoms of a nonunion of the scaphoid bone are more subtle. You may have pain when you use your wrist. However, the pain may be very minimal. It is fairly common for doctors to see a nonunion of the scaphoid bone on X-rays, but the patient doesn’t remember an injury. These people probably suffered a wrist injury years ago that they thought was a simple sprain. Still, the most common symptom of a nonunion is a gradual increase in pain. Over several years the nonunion can lead to degenerative arthritis in the wrist joint.

The primary symptoms of Kienbock’s disease are pain in the wrist and limited wrist motion. Pain may vary from slight discomfort to constant pain. In the early stages there may be pain only during or after heavy activity using the wrist. The pain usually gets slowly worse over many years. The wrist may swell. The area over the back of the wrist near the lunate bone may feel tender. You may not be able to move your wrist as much as normal or grip objects as well.

Patients often have the condition for months or years before seeking treatment. Typically, the patient will report an injury to the wrist in the past or have a history of repetitive heavy use of the wrist. Kienbock’s disease most frequently affects men twenty to forty years old. It rarely affects both wrists.

If immobilizing the wrist doesn’t help, then surgery will probably be required. Attempts to restore the blood flow to the lunate are most likely to be successful at this point. The procedure to restore blood flow is called revascularization. During the operation, the surgeon moves a small section of blood vessels (and also possibly bone) from elsewhere on the patient. The segment is attached to the deteriorating lunate bone. This is done to restore blood flow to the lunate and halt its deterioration. This is a newer procedure to treat Kienbock’s disease and is not always successful.

Other treatment options at this stage include operations designed to take some of the pressure off the lunate bone. Doing this may allow the bone to heal and revascularize – or it may slow the progression of the disease. Operations to do this include a radial shortening osteotomy. In this operation, removing a small section of the bone near the wrist shortens the radius bone, allowing the bone to heal together in this shortened position. Some surgeons prefer a capitate shortening (known as the Almquist procedure) which shortens a carpal bone on the other side of the lunate.  Both operations help reduce the force on the lunate.

Guyon’s canal syndrome is much less common than carpal tunnel syndrome (CTS), yet both conditions can occur at the same time. The numbness caused by these two syndromes affects the hand in different locations. When the median nerve is compressed in CTS, pain and numbness spread into the thumb, index finger, middle finger, and half of the ring finger. Compression of the ulnar nerve in Guyon’s canal syndrome usually causes numbness in the pinky and half of the ring finger. 

Symptoms usually begin with a feeling of pins and needles in the ring and little fingers. This is often noticed in the early morning when first awakening. This may progress to a burning pain in the wrist and hand followed by decreased sensation in the ring and little fingers. The hand may become clumsy when the muscles controlled by the ulnar nerve become weak. Weakness can affect the small muscles in the palm of the hand and the muscle that pulls the thumb into the palm. Gradual weakness in these muscles makes it hard to spread your fingers and pinch with your thumb.  

You’re not the first golfer to experience this problem. The wrist bone commonly broken from a ground-slamming divot is the hamate bone. It is near the wrist on the pinky side of the palm of the hand.

The hamate bone forms one side of Guyon’s canal, the small passageway that surrounds the ulnar nerve as it travels into the hand. In the hand, the ulnar nerve goes to the ring and pinky fingers, the small muscles in the palm of the hand, and the muscle that pulls the thumb into the palm of the hand.

A fractured hamate bone in the wrist can pinch the ulnar nerve inside Guyon’s canal and produce symptoms of weakness as you’ve described. Be sure to let your doctor know about these symptoms.

In rare cases, the ulnar artery that travels right beside the ulnar nerve may be damaged and form a blood clot. The symptoms caused by the clot mimic problems of Guyon’s canal syndrome (pinching of the ulnar nerve in the wrist). The clot is believed to shut off the blood supply to the nerve, which in turn causes symptoms.

Any kind of injury to the wrist joint can alter how the joint works. After a wrist injury, ligament damage may result in an unstable joint. Any time an injury changes the way the joint moves, even if the change is very subtle, the forces on the articular cartilage increase. It’s just like a machine–if the mechanism is out of balance, it wears out faster.

Over many years, this imbalance in joint mechanics can damage the articular cartilage. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint can no longer compensate for the damage, and the wrist begins to hurt. Like other joint injuries, it is possible the altered joint will develop osteoarthritis.

At first, the only sign of trouble may be soreness on the thumb side of the forearm, near the wrist. If the problem isn’t treated, pain may spread up the forearm or further down into the wrist and thumb.

As the friction increases, the two tendons may actually begin to squeak as they move through the constricted tunnel. This noise is called crepitus. If the condition is especially bad, there may be swelling along the tunnel near the edge of the wrist. Grasping objects with the thumb and hand may become increasingly painful.

Kienbock’s disease is a condition in which one of the small bones of the wrist loses its blood supply and dies, causing pain and stiffness with wrist motion. In the late stages of the disease, the bone collapses, shifting the position of other bones in the wrist. This shifting eventually leads to degenerative changes and osteoarthritis in the joint. While the exact cause of this uncommon disease isn’t known, a number of treatment options are available.

Repeatedly performing hand and thumb motions such as grasping, pinching, squeezing, or wringing may lead to the inflammation of tenosynovitis. This inflammation can lead to swelling, which hampers the smooth gliding action of the tendons within the tunnel. Arthritic diseases that affect the whole body, such as rheumatoid arthritis, can also cause tenosynovitis in the thumb. In other cases, scar tissue from an injury can make it difficult for the tendons to slide easily through the tunnel.

Doctors have not determined exactly what causes Kienbock’s disease. A number of factors seem to be involved. Usually the patient has injured the wrist. The injury may be a single incident, such as a sprain, or it can be from repetitive trauma. But the injury alone does not seem to cause the disease.

The way that blood vessels supply the lunate bone of the wrist is thought to play a role in Kienbock’s disease. Some bones in the body simply have fewer blood vessels that bring in blood. The lunate is one of those bones. A bone with a limited blood supply may be more at risk of developing the disease after an injury. The reduced blood supply might be the result of a previous injury to the blood vessels

Other bones around the lunate may play a role in the disease, too. The length of the ulna, the bone of the forearm on the opposite side of the thumb, may be a factor. When the ulna is shorter than the radius, the lunate bone absorbs more force when the wrist is used for heavy gripping activities. Over time, this extra force may make it more likely for a person to develop Kienbock’s disease, since the person may be more likely to injure the lunate or the blood vessels around it as a result.

Kienbock’s disease is also sometimes found in people with other medical conditions that are known to damage small blood vessels of the body. Whatever the cause, the lunate bone develops a condition called osteonecrosis. In osteonecrosis, the bone dies, usually because it’s not getting enough blood.

The wrist joint is replaced with an artificial joint (also called a prosthesis) much less often than other joints in the body, such as the knee or the hip. Still, when necessary, this operation can effectively relieve the pain caused by wrist arthritis. When severe arthritis has destroyed the wrist joint, an artificial wrist replacement can help restore wrist strength and motion for many patients.

Intersection syndrome is a painful condition of the forearm and wrist. It can affect people who do repeated wrist actions, such as weight lifters, downhill skiers, and canoeists. Heavy raking or shoveling can also cause intersection syndrome.

The pain from intersection syndrome is usually felt on the top of the forearm, about three inches above the wrist. At this spot, two muscles cross over–or intersect–two underlying wrist tendons.

The friction on the wrist extensor tendons causes pain and swelling in the tenosynovium that covers these tendons. The friction hampers the smooth gliding action. You may hear a squeaking sound and feel creaking as the tendons rub against the muscles. This is called crepitus. You may have swelling and redness at the intersection point. Pain can spread down to the thumb or up along the edge of the forearm.

A wrist problem common among downhill skiers is called intersection syndrome. The pain from intersection syndrome is usually felt on the top of the forearm, about three inches above the wrist. At this spot, two muscles cross over–or intersect–two underlying wrist tendons.

The wrist extensor tendons are strained by activities that cause the wrist to curl down and in, toward the thumb. These wrists movements are especially common in downhill skiers when they plant their ski poles deeply in powder snow. Skiers also stretch these tendons when dragging their poles in the snow.

This is a problem due to overuse. Repeated actions of the forearm, wrist, and thumb causes rubbing where two thumb muscles cross over the top of two wrist extensor tendons. When the area becomes inflamed, you feel pain when you move your wrist because the swollen tendons are rubbing up against the thumb muscles.

Wrist extensor tendons work like the bow used by violin players. The wrist extensor tendons are like the bow, and the thumb muscles are like the strings. As the wrist curls down and in, the wrist tendons rub back and forth against the thumb muscles. The friction builds up, much like the effect of rubbing two sticks together. This leads to irritation and inflammation of the tenosynovium covering the wrist extensor tendons.

The wrist extensor tendons are strained by any activities that cause the wrist to curl down and in, toward the thumb. These wrists movements are especially common in downhill skiers when they plant their ski poles deeply in powder snow. The same movement is involved when pulling a rake against hard ground. Racket sports, weight lifting, canoeing, and rowing can also stress the wrist extensor tendons.

A ganglion is a small, harmless cyst, or sac of fluid, that sometimes develops in the wrist. Doctors don’t know exactly what causes ganglions, but a ganglion that isn’t painful and doesn’t interfere with activity can often be left untreated without harm to the patient. However, treatment options are available for painful ganglions or ones that cause problems.