FAQ Category: Wrist

In Kiebock’s disease, the blood supply doesn’t reach a tiny bone in the hand, called the lunate. The bone cells, just as all your other body cells, need the fresh blood to be nourished and stay alive. Without the blood, the cells die and the bone dies. If the disease has progressed, some surgeons do a surgery that shortens the bone, by removing the dead part of the bone. This ensures that the live parts aren’t separated by dead tissue, and allows the blood to flow through.

Your question of how does vitamin C work to prevent colds and flu as well as speed up bone healing is one that many scientists are studying to solve. Experts in this area aren’t entirely sure the exact mechanism by which vitamin C accomplishes both things. We do know that it is an antioxidant that can boost the immune system to help fight bacteria and viruses associated with upper respiratory infections and the flu.

What is an antioxidant? To understand antioxidants, we have to look at oxidation and free radicals. Oxidation is the process by which an oxygen atom loses an electron forming an unstable molecule called a free radical. Electrons like to be paired and the loss of one in the pair making the oxygen atom unstable must be repaired before further harm is done.

Vitamin C comes in and gives up an electron without becoming unstable itself. That’s what makes vitamin C an antioxidant. Without antioxidants to quench the free radical’s need for an electron, the free radical goes around stealing an electron from other oxygen atoms making yet another free radical. A destructive chain of reactions occurs as more free radicals are formed. Apples and bananas that turn brown when left unprotected is a visible example of oxidation. So is rust on the body and fenders of a car exposed to salt used on the roads during the winter.

Just the act of breathing and daily cellular functions create free radicals. Any type of stress can result in extra free radicals that the immune system must deal with as well. With enough stress and the formation of enough free radicals, the immune system can get overwhelmed by microbes that cause cold and flu symptoms.

Vitamin C is also important in the formation of collagen, the basic building block of soft tissue and bone. When a fracture occurs, the body mounts an immediate inflammatory response to start the healing process. Inflammation results in the free oxygen radicals we just talked about — often, more than the body can handle effectively. Vitamin C may reduce the number of free radicals that form as a result of the fracture and subsequent inflammatory healing process. The final outcome is a faster healing response like what you evidently experienced.

Vitamin C is a safe, effective, and relatively inexpensive way to speed up healing and recovery when there aren’t complicating factors. It’s not a magic cure — patients must still wear a splint or cast and receive follow-up hand therapy when needed.

Many athletes at all levels from high school to professional players face the pressure to play when it might not be in their own best interests in the long run. High school athletes who have a chance at a scholarship opportunity or to play at the college level are not immune to these pressures.

Putting off treatment to repair soft tissue damage is referred to as deferred treatment. For some athletes and some sporting events, supporting or immobilizing the painful area with tape, splinting, or bracing is possible. Additional conservative (nonoperative) care utilizing nonsteroidal antiinflammatory drugs (NSAIDs), steroid injections, and/or physical therapy may be helpful as well.

The player can be encouraged by parents, coach, and surgeon to weigh the short-term and long-term risks and benefits of this approach (versus surgery) before making a final decision. The player’s health should never be compromised by pressures to perform now if it could mean permanent disability or chronic problems later.

Pain along the ulnar side of wrist during activities that require a strong grip and especially grip with ulnar deviation can be a signal of ligamentous damage or injury. Ulna refers to the bone in the forearm closest to the little finger side of the hand. Ulnar deviation is any movement of the hand toward the ulnar side.

There are many ligaments, bones, and cartilage interconnected to form the wrist. Pain could be coming from a wide range of problems. But a common injury in sports athletes who need and use a strong grip is the triangular fibrocartilage complex (TFC) tear. The triangular fibrocartilage complex (TFC) suspends the ends of the radius and ulna bones of the forearm over the wrist. It is triangular in shape and made up of several ligaments and cartilage. The TFC makes is possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side).

Sometimes a change in racquet can help with wrist pain but there are other factors to consider, first. Where you grip and how you grip the handle can make a difference. Strengthening exercises, taping, and stretching may be helpful. The first thing to do is consult with your coach and/or athletic trainer. You may need an orthopedic evaluation to pinpoint the problem. If there is an injury visible on X-ray, CT scan, MRI, or other imaging, then the most appropriate treatment can be applied.

Because of the risk for an acute problem to become a chronic one, experts advise athletes to pay attention and respond to any and all painful symptoms and potential injuries. Timing for getting the help you need is important — and sooner is usually better than later.

For years and years, the main treatment approach for anyone over 65 with a wrist fracture was immobilization. Plaster casting was used for a long time. Then lighter materials were developed. And now sometimes, a removable rigid splint-like cast is used to allow for periods out of the cast such as when bathing.

Immobilization of any kind is acceptable when the break is simple, nondisplaced, and without fragments of bone. In other words, the fracture is stable. It’s a different story when the bone is broken into many tiny pieces. More rigid fixation with plates, screws, pins, or wires inside the arm may be needed. Sometimes external fixation (pins through the bones with connecting rods outside the arm) is required.

Over time what the surgeons have found is that casting an unstable wrist fracture often results in the collapse of the bones. This means a loss of function for the patient. And that could be devastating for a senior who is trying to maintain his or her independence as long as possible. They also observed that the time it takes to heal a stable wrist fracture in a cast (four to six weeks) often leads to a stiff wrist and subsequent loss of motion and function.

That’s why more surgeons are turning to surgery to repair unstable fractures. Newer technology and techniques have made it possible to speed the rate of recovery with surgical fixation. The goal is to preserve the elderly’s ability to live independently, something most seniors are very interested in.

The volar plating system is used to treat complex fractures of the distal radius. Distal refers to the farthest end of the bone. The radius is one of the two bones in the forearm that make up one side of the wrist joint.

Distal radial (wrist) fractures are far too common in adults over age 65. They can be very disabling, so treatment decisions are important to preserve function. Closed reduction (immobilization with a cast, no surgery) is an acceptable approach when the fracture is non-displaced and stable. In other words, the bone is broken but the broken ends haven’t shifted.

However, there is come concern about treating older adults with closed reduction. It doesn’t realign the bones if they are separated or misaligned. The senior heals (if at all) with what’s called a malunion. This can result in stiffness, loss of motion, and decreased functional use of that hand.

That’s why when the new volar locking plating system came on the market in 2000, more surgeons took advantage of this technique to get a better fracture healing and function in this age group. Volar just refers to the side of the arm the plates are put in (palmer side rather than the back of the hand/wrist side).

The plating system is a contoured stainless steel implant that looks like a wrench with multiple holes in the rounded top end and all the way down the stem. It is used when there are complex fractures with multiple bone fragments. The system is laid flat against the bone. Screws can be placed in any of the holes where extra stability is needed.

The implant can be slipped under the skin and placed where it’s needed, so it’s an internal fixation device that doesn’t require wide open incision and dissection of all the soft tissues. Studies done so far show the plating system speeds up recovery and reduces the amount of time immobilized. That’s important in an age group that is at risk for osteoporosis (brittle bones), joint stiffness, and loss of function and independence with a wrist fracture on top of it.

Discharge planning can be difficult with septic arthritis because of the many and varied complications that are possible. If all goes well and there is no evidence of pus within the first 24 to 48 hours, then the patient may get the thumbs up for a quick and speedy discharge to home.

The method used in carrying out this type of surgery can make a difference, too. For example, surgeons usually treat septic arthritis of the larger joints (hip, shoulder, knee) with arthroscopic irrigation and débridement. Open incision surgery remains the standard for the wrist.

Arthroscopic surgery allows the surgeon to make tiny incisions that don’t endanger the ligaments or cartilage. There is less pain and no open, draining wound. On the other hand, an open incision gives the surgeon a full view of the wrist anatomy making it easier to avoid cutting blood vessels or damaging other tissues such as nerves.

After surgery, if there is any sign of persistent infection (fever, pus, red streaks in the skin, swelling), then the procedure may have to be repeated (sometimes more than once). Intravenous antibiotics aimed at the specific bacterial microorganism will be required. Most often, the cause of the infection is staphylococcus aureus, otherwise known as a staph infection. The length of his hospital stay may be determined by the need for continued intravenous antibiotics.

So you can see why the staff can’t really give you a straight answer. It isn’t that they are avoiding your question. It’s more likely they simply don’t know what will happen. Be patient and ask the team to keep the lines of communication open.

You may be asking the question: does treatment for wrist fracture vary depending on where you live? Others have asked if it makes a difference how old you are, your race, or sex? Researchers from Dartmouth Medical Center noticed that there aren’t a lot of studies on the optimal treatment for distal radial (wrist) fractures. So, they used Medicare records to answer a few questions about the current state of affairs. They answered all of these questions by analyzing a sample of Medicare Part-B claims across the United States.

They found that older adults with balance problems and osteoporosis (brittle bones) seem to be the group with the largest rate of fractures in general. Wrist fractures of the distal radius occur in white women most often. In fact, women are almost five times more likely than men to break their wrists. White women are twice as likely as non-whites to fracture their wrists. Most of this was due to the higher rates of osteoporosis in white women.

But when it comes to the type of treatment provided, location seemed to make a difference, too. There are three basic types of fracture treatment including 1) putting a cast on the arm, 2) slipping a wire through the skin to hold the bones together, a procedure called percutaneous fixation, or 3) open surgery to repair the fracture with metal plates and/or screws. This last category of surgery is referred to as open reduction and internal fixation (ORIF).

Since treatment is billed by a Medicare procedural code, the Dartmouth researchers could use these codes to tell who had what kind of treatment. Patients treated by their primary care physicians in an outpatient (clinic) setting and those who were treated in a hospital or emergency department were all included. Over 300 hospital referral regions were identified by zip code and used to map out regions in the U.S.

It turns out that the rate of wrist fracture goes up with age. The oldest group (over age 80) had the highest rate of wrist fractures. Most patients (83 per cent) could be treated nonoperatively. The remainder had surgery. Older patients are less likely to have surgery. And the rate of surgery increased (doubled) during the time of this study (between 1998 and 2004).

But the most striking finding was that the kind of treatment you might receive for a wrist fracture varied greatly depending on where you lived. Nonoperative care was more common in places like Kentucky (compared to California). Open surgery varied from 0.4 per cent in Pennsylvania to 25 per cent in Great Falls, Montana. Some of the differences noted were likely due to whether patients lived in an area where there is a high density of orthopedic surgeons and the type of hospitals available (e.g., teaching hospitals versus rural hospitals).

The biggest factor on whether or not surgery was done was the presence of comorbidities (other health problems). The more compromised the patients health was, the less likely they would have surgery. Race did not seem to be a major factor in the choice of treatment. Concern about cosmetic appearance might have had an effect on the type of operation performed.

The authors of that particular study concluded that although they were able to conduct a comprehensive overview on the incidence and type of treatment for wrist fractures, they still couldn’t really say why there is such a difference in how it’s treated from one region to another. There could be a wide range of variables such as physician training, cultural beliefs, or even personal or even religious preferences.

More studies are needed to determine the most appropriate care for distal fractures in this age group.

Septic arthritis is the invasion of a joint by an infectious agent that produces arthritis. It can affect any of the joints in the body but has a tendency to settle in the large joints. This includes the hip, knee, and shoulder. The infectious agent starts someplace else (often a skin infection like cellulitis or from a urinary tract infection. It travels to the joint directly by local spread or through the blood system.

Risk factors for septic arthritis include joint replacement, cancer, kidney failure, or other chronic diseases. For example, chronic alcoholism, diabetes, rheumatoid arthritis, or other connective tissue disorder have been linked with septic arthritis. Taking medications that can suppress the immune system (e.g., prednisone, other immune modulators such as current or recent chemotherapy) is another potential risk factor for developing septic arthritis.

Treatment is with intravenous antibiotics and surgery. The surgical procedure is called irrigation and débridement. That means once the surgeon gets to the area of infection (either through an open incision or arthroscopically), saline fluid is used to flush the area clean (irrigation). In a second step (débridement), any fluid and any loose tissue or fragments of cartilage is removed.

There are some potential complications of surgery. Sometimes the infection is not stopped successfully and a second surgery is required. It’s also possible that more than one repeat procedure will be needed. After surgery, the pain is often gone, but normal joint movement isn’t always restored.

One distressing complication is death. Septic arthritis can lead to sepsis and multisystem organ failure. Sepsis refers to total body infection. People who have septic arthritis in multiple joints, who have other significant (chronic) health problems, and who are immunosuppressed are at greatest risk for sepsis.

But lest we leave you with such a grim picture, treatment for single joint involvement (just the wrist) can be very successful. Arthroscopic surgery reduces the length of hospital stay and thereby reduces your costs as well.

The bone at the base of the thumb, by the wrist, is called the scaphoid bone. It’s a small bone that can be broken if you fall onto your outstretched hand. The treatment for the break depends on how severe the break is and if the bone was moved out of place. Usually, if the bone has moved and the broken ends don’t meet each other, surgery is needed. If the bones aren’t moved, doctors are torn as to which method is best.

It sounds like your children broke the scaphoid bone, which is the bone at the base of the thumb side on the thumb’s of the wrist. It’s not very big and can be easily broken given the right conditions.

The bone is most vulnerable when the thumb is extended, as in the hitch-hiking position. A common way to break it is if you fall, most often you throw your hand out to protect your body from hitting the ground. But, as you put out your hand, your palm opens and your fingers spread out; your weight lands on the palm of your hand.

The scaphoid fracture is seen more often in active young people and certain activities, like skate boarding and roller blading, can result in such fractures. The do seem to be less common among people who use wrist guards for these types of sports.

Most of the studies of scaphoid wrist fractures that don’t heal have been done on small numbers of patients. But there has been one study from the Department of Orthopaedics and Sports Medicine at the University of Washington in Seattle that included 30 patients. All had scaphoid fractures that didn’t heal with immobilization.

One surgeon performed a surgical procedure that included fixation of the bone fragments with a screw to hold them in place. A second step was taken to restore an adequate blood supply to the area using a branch of the radial artery to the wrist.

Total wrist range-of-motion did not change but they did have improved grip strength from before surgery. Patients were very happy with the overall improvement they experienced after surgery and successful healing. Almost everyone returned to work or sports activity at a level equal to their preinjury level.

Patients can expect a four to five month period of time before complete bone healing occurs. This can vary depending on the patient’s general health, age, or other risk factors such as tobacco use (which is known to delay healing).

Immobilizing a broken bone in a cast is needed to keep the bone fragments from moving around while the body tries to heal itself. But when union of the bone fragments doesn’t happen, then it’s time to look at what’s causing this delay in bone healing.

It could be a problem called avascular necrosis. Avascular means without blood and necrosis refers to the death of bone. Sometimes the blood supply to the bone gets cut off as a result of the injury. Without an adequate source of blood, healing won’t occur.

Surgery to restore blood flow and hold the bone together until it does heal may be the next step in treatment. But first, the surgeon must identify what’s causing this delay. Patients with diabetes, heart disease, or peripheral vascular disease have a known delayed time in wound healing.

Anyone who uses tobacco products of any kind is also at increased risk for failure to heal or delayed healing. In the case of a bone fracture, the result can be a nonunion of the bone. Some surgeons not only advise their patients to quit smoking before surgery, they insist on it. They know that’s what it will take to ensure a successful result. A urine nicotine test is done before surgery to confirm smoking (or tobacco-use) cessation.

Your surgeon will help you identify any risk factors that might be preventing healing. Immobilizing the wrist isn’t likely the problem.

Treatment for gout has improved steadily over the years. As new information and understanding of the disease process is revealed, better drugs and treatment have been developed. As a result, gout affecting the wrist or hand is fairly rare. And if your main symptoms of gout have been under control, the physicians will naturally look elsewhere for a cause of your new wrist symptoms.

However, it is possible that your wrist pain is a direct result of urate crystals from the gout in the wrist. Studies have confirmed that these crystals not only attach to the wrist cartilage but also form on ligaments stabilizing the wrist joint.

There are ways to evaluate this. Tenderness over the scapholunate ligament of the wrist is a red flag. Your regular doctor can test the integrity of that particular ligament. There’s also a test called the scapholunate ligament shift test. A positive test indicates wrist instability because the ligament isn’t holding the bones steady. The two bones shift or move more than they should.

X-rays and MRIs can be ordered. Your doctor will look at the X-rays for signs of scapholunate advanced collapse (SLAC). In this condition, the cartilage of the two wrist bones (the scaphoid and the lunate) is worn away from the cartilage wear. The bones started to deteriorate and collapse.

Arthroscopic surgery may be needed to find out what is really happening. The surgeon inserts a long, thin probe with a tiny TV camera on the end into the wrist. The scope gives the surgeon a clear view of what is going on. They can see if there are urate crystals deposited on and around the scapholunate ligament. The scope will show if the ligament is disrupted (torn). The size of the tear can be assessed.

The next step is to make a follow-up appointment with the physician who normally treats your gout. It may be better to rule out (or confirm) gout as the underlying cause of your wrist pain before further damage is done to the joint or ligaments supporting the wrist. Early diagnosis and treatment can prevent an acute condition from becoming a chronic one.

Pseudogout means false gout. Like gout, pseudogout is a form of rheumatoid arthritis. It has a similar clinical presentation as gout (red, swollen, painful joints), but the underlying causes are different.

In the case of gout, the body produces too much uric acid (a condition called hyperuricemia). Hyperuricemia causes urate crystals to form and get dumped in the bloodstream. The crystals of monosodium urate (MSU) or uric acid are then deposited on the articular cartilage of joints, tendons and nearby tissues.

People with gout experience painful attacks of arthritis when these crystal deposits build up forming pockets of crystals or nodules called tophi (singular form: tophus). The body sets up an inflammatory response to these crystals. The big toe is affected most often, but other joints can become swollen and painful.

Like gout, pseudogout causes sudden, severe pain in a joint, triggered by crystals in the joint lining. But the type of crystals involved are different between these two conditions. Pseudogout occurs when calcium pyrophosphate dihydrate (CPPD) crystals are deposited in the connective tissues. Gout tends to primarily affect the big toe. Pseudogout usually affects the large joints such as the hips and knees.

Surgery is often done to remove the cysts, but that doesn’t always guarantee that they won’t come back. Also, some people avoid surgery because they’d rather not have the scarring that they fear may result. Because of this, some doctors will try nonsurgical methods first. This usually involves splinting the joint to reduce movement and limit the irritation to the cyst. It’s hoped that this will reduce the inflammation and the cyst will go away. Many cysts end up going away on their own, in fact.

Other treatments involve inserting a needle into the cyst and pulling out the fluid, and/or injecting a steroid to help reduce the inflammation.

There is some debate about how aggressive (or conservative) to be following surgical repair of the wrist triangular fibrocartilage (TFC). The little band of tissue may be small, but it is tough and serves a wide range of purposes.

It holds the bottom part of the radius and ulna (bones of the forearm) together while also providing a buffer between the ends of these bones and the wrist bones. The TFC includes a thin, egg-shaped fibrous disc for the wrist joint. It helps spread the forces put on the connecting surfaces of wrist bones during repetitive or forceful wrist motions.

Besides increasing the stability of the joint, the TFC also helps move synovial fluid to areas of the joint cartilage that have the most friction. So you can see why a strong TFC is needed for athletes who rely on their wrists for strength, stability, and/or motion.

A typical conservative approach is to immobilize patients for six weeks after surgery. After that, range of motion and strengthening exercises can be started. Usually, athletes work with a physical therapist who is familiar with the type of surgery done and the healing process. There’s no point in stressing a surgically repaired structure beyond what it can handle. You can end up with a reinjury.

Full return-to-sport at the end of three months gives the athlete time to specifically train for his or her particular sport. Sports-specific exercises often include proprioceptive activities to retrain the joint’s sense of its own position. Proprioceptive training will help your wrist respond faster to the slightest change in position or pressure. Most athletes depend on this more than they realize.

Surgeons say it is very important to stay out of the game until full recovery has taken place. If you just had débridement (cleaning the area out of any frayed edges or fragments of loose cartilage), faster return to sport could be allowed without increasing your risk of reinjury. But it sounds like you might have had a full repair procedure, which is a different situation.

To find out for sure, make a follow-up appointment with your surgeon and ask directly. It could be you really are ready to get back into action. But that decision must be made in conjunction with the surgeon who knows your history, severity of injury, course of treatment, and any potential risks you may be facing with early return to sports.

Wrist pain from a triangular fibrocartilage (TFC) tear can be very disabling for the athlete. The TFC is a thin, oval plate of fibrous cartilage. It is sometimes referred to as the articular disc or radioulnar disc because of its location between the distal radius and ulna (bones of the forearm). Distal refers to the bottom ends of these two bones where they meet the wrist.

This triangular-shaped soft tissue structure binds the distal radius and ulna together while also providing a buffer between the ends of these bones and the wrist bones. The articular disc also creates an even spread of forces between the connecting surfaces of bones.

Besides increasing the stability of the joint, the TFC also helps move synovial fluid to areas of the articular cartilage that have the most friction. Several wrist ligaments interconnect with the TFC to form a stable but pliable wrist. All of these features are important in sports that require strong, repetitive wrist motions such as golf, soccer, tennis, and volleyball.

Many athletes at this level are able to rehab without surgery. A carefully planned approach is needed that will get the athlete back into competition as soon as possible. Some experts advise a combination of antiinflammatories and immobilization in a cast or splint. Physical therapy is often helpful. Steroid injections may be tried if these other methods don’t work.

But if conservative (nonoperative) care fails to change symptoms or improve function, then surgery may be needed. There aren’t very many studies following high-level athletes who have surgical repair of a torn TFC. Results from a small study from Stanford University was recently published. High-level athletes with TFC tears had good success with surgery after failed nonoperative care.

Results were very positive with most of the athletes returning to their sport within three months. Pain was reduced. Full wrist motion and improved function were achieved. They were able to fully participate at a high-level. Ulnar-sided repairs had slightly better results. This may be because there is more blood supply on that side of the wrist.

Your surgeon likely has some information about the type of injury and extent of damage in your case that may affect your prognosis. Don’t hesitate to ask more questions to help you understand your own situation and what can be done about it. You may want to seek a second or even third opinion in plotting out your fastest way to return to the court with the fewest problems.

There are many disorders that can affect the wrist, from common diseases like arthritis to less common ones, such as Kienbock’s disease. The wrist is made of very small bones and a small canal through which nerves go through to access the hand. If anything happens to any of the structures, the bone, ligaments, muscles, nerves, and soft tissues, you can end up with a good bit of pain and restricted movement and function of the hand.

Carpal tunnel syndrome and Kienbock’s disease are two different disorders. Carpal tunnel syndrome is a repetitive stress disorder that causes irritation of the nerves that go from the forearm into the hand. Kienbock’s disease is a disease of a bone in the wrist called the lunate. With Kienbock’s disease, blood doesn’t reach the bone to provide it with nutrients and the bone cells begin to die.

Doctors do wonder if there is some role to repetitive motions with Kienbock’s disease, but nothing has been proven yet.