The wrist is part of the upper limb, it connects the hand with the forearm and allows the hand to be moved. The bones of the proximal wrist row connect to the bones of the forearm, and the bones of the distal row - to the metacarpals. Made of many small components, it is exposed to injuries and diseases. What factors predispose to wrist damage? Can they be prevented, what is the treatment?

The wristis part of the upper limb and consists of 8 bones. It is made up of many tiny joints, nerves, muscles, bones and tendons. They create a fairly delicate structure, which is why the wrist is susceptible to various types of injuries.

Wrist - construction

The wrist bones are arranged in two rows. Each row consists of four dice. From the radial side, these are:

  • navicular bone,
  • moon bone,
  • triangular bone
  • and lying on the palmar surface of the latter - a pea-like bone.

From the radial side, the series consists of:

  • major trapezius,
  • minor trapezius,
  • head bone,
  • hook bone.

These are short bones with six faces - with the exception of the pea bone. The further row is wider than the closer one.

The following surfaces are distinguished:

  • closer,
  • distal, radial,
  • ulnar,
  • palmar
  • and dorsal.

The proximal surfaces of these bones connect with the three bones of the closer row, and the more distal surfaces - with the metacarpal bones.

There are elevations on the greater trapezoid bone and on the scaphoid bone, these are respectively: the tubercle of the greater trapezius and the hook of the hook bone.

The specific structure of the wrist bones allow them to connect with the adjacent bones with the help of articular surfaces, and numerous irregularities are the site of attachment and the course of ligaments and muscles.

The dorsal surface of the wrist is slightly convex, which can be seen on the back of the hand. The palmar surface, on the other hand, is concave and forms a furrow in the wrist, in which the tendons of the flexor muscles of the fingers are located.

We can distinguish the radial prominence of the wrist, formed by the tubercle of the scaphoid bone, the tubercle of the greater trapezius and the elbow prominencethe wrist consisting of the pea bone and the hook of the hook bone.

Wrist - joints

The radiocarpal joint connects the forearm with the hand. It is a complex, elliptical, biaxial joint. Only the radius bone connects directly to the wrist, while the ulna is separated from the bones of the proximal row by an articular disc. The articular head is made of the bones of the proximal order, except for the pea-like bone.

The radiocarpal joint is strengthened with numerous ligaments. It performs bending, straightening, adduction and abduction movements.

The mid-carpal joint connects both ranks of the wrist bones. The head and the acetabulum form the articular surfaces of the adjacent bones of the wrist. The fissure of the joint runs sigmoidally from the radial edge to the edge of the elbow of the wrist.

The carpal-metacarpal joints are formed by the articular surfaces of the distal bones of the second row of the wrist and by the articular surfaces proximal to the metacarpal bones.

How do bones connect with each other?

All wrist bones are connected to each other, with the bones of the forearms and the metacarpals by strong ligaments. Such a strong connection constitutes one functional whole. Thanks to this, we can make precise movements.

Additionally, the joint bags connecting the bones are reinforced with the palmar and dorsal intercarpal ligaments. There is also a radial ligament of the wrist that extends on the palmar side from the capillary bone to the surrounding wrist bones and the bases of the metacarpal bones.

The dorsal arcuate ligament of the wrist runs exclusively between the wrist bones from the scaphoid to the triangular bone, without attaching to the bones of the forearm.

The ligaments connecting the bones of the forearm with the bones of the hand are:

  • dorsal and palmar radiocarpal ligament,
  • elbow-carpal palmar ligament
  • and radial and ulnar collateral ligaments.

How do we bend and straighten the wrist?

The strongest wrist flexor is the wrist flexor. How to test the functioning of this muscle? With one hand you need to hold the forearm, while with the other hand you need to grasp the hand directed towards the examined person. The patient then tries to bend the immobilized wrist.

When the patient has difficulties with this task, we may suspect:

  • damage to the ulnar nerve
  • median nerve damage
  • elbow tendinitis

The most powerful rectifierThe wrist is the extensor muscle of the wrist. The examination should be performed in a similar way, but the patient's hand should point towards the examiner. With the elbow bent, the patient tries to straighten the wrist.

Difficulty may suggest:

  • nerve root damage C6-C8
  • inflammation of the lateral epicondyle of the humerus - tennis elbow

Wrist - disease diagnosis

Helpful research to determine the cause of pain:

  • X-ray image
  • ultrasound USG
  • magnetic resonance imaging
  • nerve conduction research
  • laboratory tests

Wrist - diseases, injuries, fractures

Dislocation of the lunate bone, dislocations and fractures around the lunate

Breakdown of injuries around the wrist:

  • dislocation of the lunate bone
  • dislocation of the lunate and scaphoid bones
  • dislocation of the lunate bone and the proximal half of the fractured scaphoid bone

Symptoms are not always typical of fractures and sprains. Swelling and soreness may appear, but no distortion of the wrist is observed. It is imperative to check that the median nerve is functioning properly.

Treatment consists of resetting a fracture or sprain. Under general anesthesia, a finger lift is performed, then the displaced bones are brought into the correct position. In the case of dislocation, the plaster cast lasts 4 weeks, while in the case of dislocation with a fracture, this time is extended to 8-12 weeks. If 24 hours have passed since the dislocation, adjustment by non-operative methods may not be possible.

The indications for surgical treatment are old dislocations, impossible to adjust, fractures (transubular dislocations) and recurrent dislocations, i.e. recurring dislocations. The correct attitude is a good prognostic factor.

Occasionally, however, there is aseptic necrosis of the lunate. The causes may be: dislocation of the lunate bone, but also local vibrations, e.g. in people using jackhammers. The treatment consists in removing the dead bone and implanting a silicone prosthesis.

Fracture of the scaphoid bone

This is the most common wrist fracture. The main symptom is pain. It intensifies with the movement of the wrist, when grasping objects and putting pressure on the place of the anatomical snuffbox - you can see this place when you lean your hand to the side and straighten your thumb. Additionally, there is a likelihood of the appearance of edema andhematoma.

A fracture of the scaphoid bone usually occurs as a result of a fall on an arm that is straightened and extended towards the elbow. At first, the fracture fissure may not be visible, so it is easy to overlook it. A fracture fissure may appear even after a month. Persistent pain should prompt the patient to visit the doctor's office again.

Differences in the diagnosis of fractures occur in children, because the scaphoid bone sometimes develops from two ossification nuclei, and then a comparative photo of both hands should be made. It should be remembered that up to the age of 4, radiological diagnostics is difficult due to the cartilaginous structure of the scaphoid bone.

Nonsurgical treatment consists of immobilizing the wrist for 6-24 weeks in a plaster cast covering the metacarpophalangeal joint of the thumb from the elbow flexion to the metacarpal heads.

Rehabilitation after the fracture is healed and the immobilization is removed allows you to regain full functionality of the wrist.

Complications include:

  • delayed union, pseudo-joint formation,
  • necrosis of proximal fragment,
  • degenerative changes in the radial-scaphoid joint,
  • Does damage to the median nerve.

However, over 90% of scaphoid fractures heal without complications. The method of treatment depends on the fracture site, the presence of displacement and other damage. The indications for the procedure are lateral and rotational displacement of the fragments, oblique course of the fracture fissure, or prolonged bone union.

Lunate bone necrosis

Kienbock's disease is a rare condition in which the lunate bone becomes necrotic due to lack of vascularity and increased stress. It appears most often in people between the ages of 20 and 45.

Cases have also been observed in children and the elderly. It affects men more often and occurs unilaterally. It is usually associated with previous trauma or cyclical microtraumas. Most people have two vascularized arteries for the lunar bone, but sometimes there is only one, which carries a higher risk of necrosis.

The course of the disease was divided into four stages (according to Lichtmann):

  • Iacute phase, changes are not visible on X-ray, but the process can be visualized on scintigraphy
  • IIX-ray shows an increase in bone density, but its shape is retained, clinically painful and usually swollen wrist
  • IIIthe collapse of the lunate bone is visible on the X-ray, the capillary bone moves inthe direction of the row closer to the wrist
    • A.the scaphoid remains in its position
    • B.Navicular bone in flexion (rotational subluxation)
  • IVX-ray shows secondary arthrosis of the radiocarpal joint

Magnetic resonance imaging allows you to recognize the disease in the first phase.

Fresh lesions are treated with immobilization, taking non-steroidal anti-inflammatory drugs and physical therapy. Otherwise, surgical treatment is required, consisting of bone grafts, bone removal, and the use of an endoprosthesis.

Read more: Aseptic bone necrosis or bone tissue necrosis

Wrist pain - what to do?

If hand or wrist pain occurs:

  • sore joints should not be overloaded
  • if you are in pain, you can take a non-steroidal anti-inflammatory drug or paracetamol
  • you can apply cold compresses or warm compresses instead of pain
  • see a doctor if the pain persists or worsens, if there is a disturbed or weakened feeling, swelling or stiffness in the joints
  • Why does my wrist hurt? Causes of wrist pain
  • Carpal tunnel syndrome: symptoms, treatment and rehabilitation
  • Unrecognized wrist bone fractures may lead to pseudo-joint formation

Category:

Anatomy