Treatment options for wrist ligament injuries depend on whether the injury is detected early—that is, within the first few weeks after the accident—or only later.
A wrist sprain can occur after falling onto an outstretched hand. It is not uncommon for such injuries to occur as associated injuries with wrist fractures, such as in the case of a fracture of the radius near the joint (known as a radial fracture). Magnetic resonance imaging plays a crucial role in the diagnosis of ligament injuries. In some cases, however, these injuries can only be diagnosed through an arthroscopy of the wrist.
Not all injuries require surgery. Partial injuries, in particular, can be treated with several weeks of immobilization and hand therapy. In surgical treatment, the affected carpal bones are repositioned to allow the ligament to heal. Until the ligament itself is strong enough again to hold the bones in their correct position, the bones must be temporarily secured in the correct position with wires. Once the ligament has healed, this immobilization can be removed and mobility restored.
If ligament injuries are treated within the first few months, they can either be sutured directly or reattached to the bone and further reinforced by suturing them to the joint capsule. Nowadays, these procedures can be performed gently and safely using minimally invasive techniques, such as arthroscopy.
However, after a prolonged period, the ligaments have already begun to degenerate, and the chances of success for such a surgery decrease. If a ligament is not treated until several months or years after the injury, reconstruction using other ligaments or even tendons is usually necessary.
Depending on which ligament is affected, partial joint fusion may also be considered in this situation to ensure that the individual bones remain in the correct position and to prevent improper loading. As a general rule, ligament repairs and reconstructions are only appropriate if there is no significant cartilage damage yet. In such cases, the existing osteoarthritis is the primary focus of treatment.
After any ligament repair or reconstruction, the wrist must be immobilized in a splint for six to eight weeks so that the ligaments can heal. During this time, the fingers should be moved freely without any strain. As long as the bones are still temporarily secured with wires, full range of motion cannot be achieved, and weight-bearing exercises cannot be performed.
The wires are removed after eight to ten weeks. This requires a second surgery, which can usually be performed under local anesthesia on an outpatient basis. Next, we begin with wrist mobilization and strength training. This is done under the guidance of the hand therapy team and, occasionally, with the help of supportive splints.
Even with consistent follow-up treatment involving hand therapy, a slight limitation in wrist mobility often occurs.
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