We use our wrists for so many things.
Imagine if we did not have wrists, we won’t be able to eat or drive or lift objects or even write. The wrist plays a major role in our daily activities from using our phones, to eating to writing to driving to counting money and so many other things.
In this article, we will be learning about the wrist joint, its dislocation and how it is treated.
What Is A Dislocated Wrist?
To have a dislocated wrist means that one of the bones that form the wrist joint has been shifted out of place. A tear or injury to ligaments can lead to the bones being out of place. The wrist is formed by so many bones that are joined together by ligaments.
What Are The Bones In The Wrist Joint?
The bones that make up the wrist joint are:
- The Radius Bone
- The Ulnar bone
- The Carpal bones which are arranged in two rows. The bones in the row closer to the forearm are the:
And the second-row carpal bones are the:
- 5 metacarpal bones (bones that join the fingers to the wrist or the bones found in the hand)
A tunnel is formed by the carpal bones through which blood vessels and nerve pass through to supply the fingers. The median nerve is the only nerve that passes through the carpal tunnel and it supplies the muscles responsible for taking the thumb away from the hand and bending the index finger and middle finger.
Types of wrist dislocation
The wrist is made up of a lot of bones. The dislocation can happen at any site. The common wrist dislocations are:
1. Lunate dislocation
This involves the lunate carpal bone. In this type of dislocation, the lunate bone shifts from its original position without affecting the other carpal bones. The lunate is the most dislocated carpal bone because it is located between the radius and ulna bone.
2. Perilunate dislocation
This dislocation separates the capitate bone from the lunate bone. This also involves the tear or sprain of surrounding ligaments around the lunate bone. The capitate is almost directly on the lunate bone.
3. Galeazzi Fracture
This involves the dislocation of the ulna bone which is associated with a fracture of the radial bone.
4. Monteggia Fracture
This involves the dislocation of the radial bone which may accompany a fractured ulna bone.
Causes Of Wrist Dislocation
When you miss a step while walking, there is a tendency for us to use our arms to break our fall. This can cause a dislocation in the wrist joint.
2. Ligament Sprain
Ligaments join bones to each other. A ligament sprain is an injury that pulls the ligament beyond its elastic limit. If the ligament that joins the radial bone to one of the carpal bones, for example, is sprained, it can lead to wrist dislocation.
A broken bone at the forearm (fractured radius or ulna) may lead to a dislocation of one of the carpal bones.
4. Heavy Lifting
Lifting heavy objects with our hands places a lot of pressure on our wrist joints and can cause a dislocation in the process.
5. Occupational Injuries
Different jobs require a lot of work from some major parts of our body. Being a typist, for example, will require a lot of wrist movement and neck movement. Overusing your wrist in the wrong position may lead to swollen tendons or over-stretching of some ligaments that hold the bones which may lead to wrist dislocation.
How Do I Know My Wrist Is Dislocated?
- Pain is felt immediately at the wrist once the injury happens.
- Tingling and Numbness
- Reduced Movement At The Wrist
Wrist Dislocation First Aid
Some tips to do when you have an injured wrist are:
1. Do not move it
Do not move the joint to check if it is broken or try and “snap” it back because of other major vessels around the wrist joint which may cause more injury.
2. Ice it
Ice should become a major necessity in our homes, school clinics, and hospitals. Ice reduces swelling and relieves pain as well. Ice should be crushed in a damp towel and carefully wrapped around the injured wrist.
3. Do not massage!!!
When someone sustains an injury, the first thing that comes to mind is to “rub” it. Well, DON’T! This is because massaging the injured wrist increases the inflammation process that has already begun which leads to increase in swelling and may push the dislocated bone further away from its initial position which can injure other anatomical structures around the wrist joint.
4. Bandage It
Wrap an elastic bandage carefully around the wrist joint. make sure it is not too tight. This reduces any form of movement that may occur from the wrist while on your journey to the hospital.
How Will It Be Treated At The Hospital?
A doctor will recommend an X-ray to be done to know the bones that have been dislocated and to rule out fractures. The X-ray will also show the bones that are dislocated to help aid the reduction process.
This is a process in which a doctor or an orthopedist returns the dislocated bone to its normal position. This can be done with or without surgery.
The reduction is usually done under anesthesia which numbs the pain as the bone is relocated.
A closed reduction is done without surgery while an open reduction requires surgery. The open reduction usually requires pins or screws to place the bones in the right position. An open reduction is recommended if there are other anatomical structures that might have been affected by the dislocated bone.
Anti-inflammatory drugs are prescribed to relieve pain and reduce any form of swelling. Antibiotics are also recommended especially if an open reduction is done to prevent infections.
After the reduction, the wrist is placed in a cast for roughly 6 – 8 weeks. A re-check x-ray is done at this point to ensure that the dislocated bone is in place before the cast is removed. Once the cast is removed, a referral is written to the physiotherapist for rehabilitation of the wrist.
As soon as the cast is removed, rehabilitation starts with the physiotherapist. The cast reduces movement at the wrist and there may be a tendency to have joint stiffness and muscle weakness because of 8 weeks of inactivity.
The physiotherapist will assess the range of movement at the wrist joint, muscle weakness, tingling or numbness at the fingers and grip strength.
After the assessment, the physiotherapist will use modalities depending on their assessment. If there is still a bit of pain and joint stiffness, ice or heat may be placed at the wrist joint. A nerve stimulator can be used to relieve the tingling and numbness at the fingers. Ice can be used in case there is any form of swelling.
Exercises are prescribed by the physiotherapist to strengthen weak muscles and increase movement at the wrist joint. Some of these exercises are:
Grip Strengthening Exercises
This can be done using a soft ball or a rolled up towel. Squeezing this strengthens the muscles in the hand and the wrists.
- Squeeze the ball in your palm
- Hold for 15 seconds
- Release and repeat
Wrist Flexion Exercises
- Place your hand on a table or on your thigh with your palm facing the ceiling and wrist hanging at the edge of the knee or table
- Bend your wrist till your palm is facing you
- Return to the original position
To strengthen the muscles, a canned drink or any comfortable weight or resistance band can be held in the palm.
Wrist Extension Exercises
This is basically the reverse of the wrist flexion exercises.
- Place your arm on a table or on your thigh while sitting with your wrist hanging at the edge of the table with your palm facing the floor
- Bend your wrist up till the back of your hand faces you
- Return to the original position.
Side Bend Exercises
This involves moving the wrist from side to side.
- Place your arm on a table or thigh while sitting with your wrist on the side with your thumb pointing towards the ceiling
- Move your wrist up and then take the wrist down towards the ground and pass the initial position
- Return to the original position.
How Long Will It Take To Heal?
This actually depends on the severity of the dislocation and how soon treatment is carried out. A wrist dislocation usually takes 2 to 3 months to heal if a closed reduction is done while a wrist dislocation with open reduction takes at least 6 months to heal.
If a wrist dislocation is not well treated, Complications may arise which may make the wrist not to be functional. Physiotherapy, once the cast is removed, is very important in the rehabilitation treatment. A wrist brace is also recommended after the cast has been removed to protect and prevent the wrist from further injury. Some of these complications are:
If the bone is not returned to its original position, the ligaments joining the bones may heal wrongly which can lead to a deformity popularly known as dinner fork deformity.
Ape Hand Deformity
Because the median nerve might be affected, the muscles that the nerve supplies may not start to get weak leading to ape hand deformity. In this deformity, there is difficulty in bending the index and ring fingers to form a fist and not being able to do a “thumb’s up” sign.
When a dislocation heals wrongly, other anatomical structures may be affected which may lead to re-occurring swelling at the wrist joint especially while carrying out our various day to day activities.
When the dislocation is not well reduced, pain may prevent the movement of the wrist and also the dislocated bone can get in the way of the movement of the wrist and this can lead to joint stiffness or reduced movement at the wrist.
When there is an obstruction in movement, the muscles tend to get weak because they are not being used as they are meant to. This gradually leads to muscle weakness and also a reduction in the size of the muscles at the hand and wrist.
The wrist joint is a complicated joint with a lot of bones. A wrist dislocation must be well treated to avoid re-injury or loss of function of the wrist and fingers.