What causes cartilage and ligament tears of the wrist?

Ligament tears usually result from a fall on the wrist.

What are the symptoms?

• Localized pain if isolated ligament tear
• Limited motion
• Swelling
• Weakness

How to diagnose it?

Acute pain after an accident or injury is typical. X-rays are essential. A MRI may be required for an accurate diagnosis.

Functional treatment

It is recommended to try a regimen of immobilization with a splint and a course of anti-inflammatory medications for a few weeks. A specialized medical evaluation is recommended.

Surgery

If the lesion is severe, surgery with open reduction and internal fixation may be required. Surgery can sometimes be performed arthroscopically. After surgery, a period of immobilization is required to allow healing and will be followed by wrist therapy. When the injury is older than three months, it is considered chronic and repair can no longer be an option. Arthroscopic debridement can then be performed to treat symptoms.

Most common ligament injuries

Scapho-lunate ligament tear

The scapho-lunate interosseous ligament is a key ligament in the wrist as it stabilizes the foundation of the wrist: the scapho-lunate joint. This injury is serious and can result in instability of the wrist, with loss of power, motion and pain. Eventually, this will lead to a painful arthritis of the wrist. The tear can be partial or complete, stable or unstable.

Treatment must be diligent and precise. If delayed, primary repair can be compromised. Arthroscopic debridement and pinning can still be an option but sometimes ligament reconstruction with a tendon graft will be required to stabilize the wrist. Alternatively, a partial wrist fusion or a wrist arthroplasty may be required.

Luno-triquetral ligament tear

This ligament stabilizes the ulnar and medial side of the wrist and is also commonly torn. The tear can be partial or complete and cause pain and instability. Arthroscopic treatment and pinning can be successful for acute injuries and therapy will be required. For chronic lesions, debridement may help as well but additional procedures may be needed.

TFCC tears

The triangular fibrocartilage complex is similar to a meniscus in the knee. It has marginal vascularization and central lesions do not heal. Peripheral tears can be amenable to surgical arthroscopic fixation. Chronic lesions (older than three months) are often treated with arthroscopic debridement. Sometimes, when the ulna is too long, a shortening procedure is also performed to decrease the pressure in the medial aspect of the wrist and allow healing.