Wrist Ligament Reconstruction
What is Wrist Ligament Reconstruction?
Wrist ligament reconstruction refers to the use of cutting edge techniques to repair acute ligament injuries as well as more complex and chronic cases.
Wrist ligaments are the structures that hold together the small bones of the wrist and unite them to both the hand and the forearm. There are 8 wrist bones that form small joints with each other and the distal radius and ulna (the two forearm bones), and with the hand. These joints need to be in the correct alignment for the wrist to move smoothly and without pain, and the ligaments provide the primary stabilizing forces.
Wrist Ligament Reconstruction may be necessary when a wrist ligament injury (WLI) is a severe or high grade tear, meaning that the ligament is completely torn or severely stretched.
Different types of minimally invasive surgery are incorporated into the treatment algorithm including:
- Internal fixation devices
- Bioabsorbable anchors
- Thermal shrinkage
Wrist Ligament Injuries
Falling onto an outstretched hand (FOOSH) can lead to a Wrist Ligament Injury and is often seen in sports like Tennis, Baseball, Football, Skiing, Basketball and Martial Arts.
One patient that Dr. Mark Pruzansky treated was a fellow doctor and pediatric oncologist, Joel Brochstein. Dr. Brochstein had an accident while skiing, continuing skiing for one week afterwards and then experiencing severe pain in his left wrist.
Dr. Mark Pruzansky diagnosed a triangular fibrocartilage complex tear (TFCC), a common injury with skiers who fall on a hyperextended wrist as well as severe ligament tears in Dr. Brochstein, destabilizing the wrist leading to debilitating pain and weakness.
Dr. Pruzansky was able to reconstruct the ligaments and repair the TFCC tear through an arthroscopically assisted outpatient procedure using regional anesthesia.
Some of the most important and most commonly injured wrist ligaments are the Scapholunate Ligament (SLL), which connect the scaphoid and lunate bones, as well as the Triangular Fibrocartilage Complex (TFCC) which is on the side of the wrist by the ulna, connecting the radius and the ulna.
Why is Wrist Ligament Reconstruction Performed?
Mild cases involving a partial tear of the ligament, such as the SLL, may be treated conservatively with splinting, anti-inflammatory medication and therapy.
However, a Wrist Ligament Injury involving a complete tear of the SLL or TFCC, for example, generally benefits from surgery to repair the torn structures. This is usually accomplished through arthroscopically assisted minimally invasive surgery.
Pain and swelling are the most common symptoms after a Wrist Ligament Injury. Moving the wrist may worsen the pain and a “click” may be heard due to the abnormal motion of the wrist bones, or a torn ligament or a piece of cartilage caught between the bones. In chronic cases the pain may subside and the wrist may feel weaker and have limited motion due to the underlying Wrist Ligament Injury. It is best checked by a qualified hand surgeon to determine the extent of the injury and whether wrist reconstructive surgery is necessary.
What to Expect with a Wrist Ligament Reconstruction surgery?
We begin with a history and physical and completely assess your needs and symptoms . X-rays are used to evaluate the alignment of the bones in the wrist. We may request an MRI as this is often helpful to visualize some of the wrist ligaments, especially when there is concern about a complete tear.
A Wrist Ligament Reconstruction procedure may be performed as same-day surgery under regional anesthesia, just numbing the arm and with some sedation if you choose.
Arthroscopy may be combined with a small incision. Temporary or permanent pins, screws, and anchors may be used with local tendon and ligament grafts to stabilize the bones, while the reconstruction heals.
Wrist Ligament Surgery Recovery
After surgery the wrist will be immobilized in a plastic cast or splint for several or more weeks. Patients are instructed to keep the wrist elevated to reduce swelling and pain and to improve their ultimate flexibility. Antibiotics and other medications may be prescribed to reduce pain and aid recovery.
The patient can expect to participate in occupational and physical therapy to optimize function and return to athletic activities.
Wrist ligaments suffer a wide range of injury, are painful and swollen. The wrist after an accident may be mistaken for a “just a sprain” but could represent significant underlying damage.
Call hand surgeon, Dr. Pruzansky, at 212-249-8700 to schedule an appointment to keep your wrist healthy.