Wrist/ Ligamentous Sprain

According to my Injury classification system, Wrist sprains is considered Level 3 Injury, as per the three structures compromised, the alignment, muscles/tendon, and the ligaments. The overall alignment of the wrist and hand are key structures involved and responsible for maintaining the health and resilient of the ligamentous support. When the wrist misaligned or a visible deformity is presence, certain ligaments becomes overstretched, and in an attempt to maintain the joint apposition leads to further deformation and injury.

Wrist sprains tends to cause significant pain and inflammation as per the number of tissues being damage and compromised from the trauma. Morning stiffness and reduced joint overall movement are common symptoms reported by patients.

Wrist ligamentous sprain and the corresponding level of wrist misalignment

Triangular Fibrocartilage Tear is a condition that causes significant pain on rotation of the wrist with a marked exacerbation during stress loading with the wrist in pronation and supination. The main predisposing factor for the development of this condition is a chronic misalignment of the distal radial and ulna bones

Scapholunate Ligament Sprain causes pain at the base of the thumb which is aggravated by ulnar deviation of the wrist and tightly clenching the fist. The predisposing factor is a compromised of the lateral arch of the wrist resulting in a hypermobility of the scaphoid and lunate joint overstressing the associated ligaments and evolving in this specific sprain

Lunotriquetral Instability causes pain on ulnar or radial deviation of the wrist with pain worsened by having the patient clenching the fist. The predisposing factor is a compromised of the transverse and medial lateral arch of the wrist resulting in a hypermobility of the lunate and triquetral joint overstressing the associated ligaments and evolving in this specific sprain.

Wrist Chronic Instability is a condition that is predisposed by the presence of chronic ligamentous injuries which leads to a deformation of the elastic properties of the ligaments resulting in compromised bone apposition causing the overall instability.

Is important to note that for the ligament to become injured, the previous defence mechanism have to have failed to allow the biomechanical stress to damage the ligament, therefore, the treatment care must aim to restore the health of the entire shoulder complex protective structures.

Assessment Protocol

The entire upper extremity biomechanical chain must be evaluated as per the neurological and mechanical influences of the spine, shoulder and elbow.

Clinical assessment to identify the key dysfunctions of the wrist and hand that have contributed to this condition. Soft tissue analysis to pinpoint the level of irritation in the ligaments and fascia.

X-ray

Anterior – Posterior (AP) X-ray wrist view is essential for proper diagnosing the master joint of the wrist (Radial – Ulna) and the alignment of the scaphoid and triquetrum.

Lateral Xray view is important to check the degree of the total arch compromised and the direction of misalignment of the lunate bone

MRI

Wrist MRI is essential for visualizing the extent of injury on the muscle/tendon and ligamentous layers.

Locate the exact injury point; Allows the treatment to be more specific during the application of the treatment modalities

Identify the extent of tissue damage and the presence of scar tissue; Provides valuable information regarding prognosis and the application of friction soft tissue modalities to aid on scar tissue removal.

Treatment protocol

Specific wrist adjustments followed by a rehabilitation regime to strengthen the entire soft tissue support of the wrist and hand .

Application of Low-level Laser and PEMF to aid on the cellular level of heling as well as improving the microcirculation for the area.

Friction soft tissue therapy helps to reduce dysfunctional scar tissue

Specific selected essential oil application to enhance healing

Depending on level of misalignment and chronicity a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this deformity.