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Physiotherapy & Wrist Injuries

The anatomy of the wrist is complex and patients presenting with wrist pain can be difficult to diagnose. The wrist is composed of many articulations. The carpal bones are arranged into the proximal Scaphoid, lunate, triquetrum), and distal row (trapezium, trapezoid, capitate and hamate). Most of the ligaments are intracapsular. The extrinsic ligaments connect the radius and ulnar to the carpals. The intrinsic ligaments connect two or more carpal bones.

Normally a clinician’s priority is to rule out fractures / bony injuries and ligament injuries are often overlooked. Ligament injuries can lead to instability resulting in ongoing pain that does not settle within the expected time frames.

X-rays are the mainstay for all diagnosis however they will not pick up ligament injuries. If despite a negative x-ray, a patient continues to present with persistent wrist pain that is not responding to conservative treatment, an MRI should be considered to help guide further management.

Some of the common causes of wrist pain are injuries to:

The Schapholunate Ligament provides carpal stability. Injuries are caused by a force to the hand in extension and ulnar deviation. Patients complain of a dorsal, radial sided wrist pain on loading and clunking in the wrist.

The Dorsal Radiocarpal Ligament is functionally important as it provides stability to the proximal carpals and provides stability to the scaphoid in flexion.

The TFCC (Triangular Fibrocartilage Complex) stabilises the Distal Radioulnar Joint. Injuries are caused by a fall on an extended wrist with arm in pronation.

Patients complain of ulnar sided wrist pain with clicking and grinding and reduced grip strength.

Lunotriquetral Ligament is an intrinsic ligament which stabilises the proximal carpal row. Injuries occur with the wrist extension and radial deviation. Patients complain of Ulnar sided wrist pain worse with pronation and ulnar deviation.

Physiotherapists are trained to assess and treat wrist pain. Good Country Physiotherapy can assist with treatment and management of patients with wrist pain.

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