The wrist is formed by many bones that are joined together by ligaments. A dislocated wrist means that one or more of the bones that form the wrist joint has been shifted out of place. A tear or injury to ligaments can cause the bones to be out of place.
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 a wrist dislocation.
Symptoms of Wrist Dislocation
- 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. Don’t massage
When someone sustains an injury, you should avoid massaging the affected part. Massaging an injured wrist increases the inflammation process that has already begun leading to an increase in swelling and may push the dislocated bone further away from its initial position which can injure other structures around the 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 Is It Treated?
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.
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 the 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
- Wrist Flexion Exercises
- Wrist Extension Exercises
- Side Bend Exercises
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.
Because the median nerve might be affected, the muscles that the nerve supplies may not start to get weak leading to a 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.
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