Trauma to your hand and wrist can result in injury to any of the tendons, ligaments, or nerves crucial for control of movement of your wrist, fingers, and thumb. Such injuries are caused by a variety of reasons, including repetitive overuse, falls or other high-impact events, sudden forceful twisting, or in association with another condition such as arthritis. Trauma to the nerves, ligaments, and tendons of the hand and wrist can range from a mild sprain to an injury requiring surgical intervention to restore proper function.
Tendons are the strong cords of tissue anchoring muscles to the underlying bones while ligaments provide stability around joints, connecting separate bones. Sprains, strains, and full or partial tears of tendons and ligaments can result in pain and weakness in your hand, loss of finger or wrist control, instability of the affected joint, and overall reduced function. In some types of traumatic injuries, a fragment of bone may be pulled away at the point where the tendon connects to the bone, known as an avulsion fracture.
Mallet finger involves a tear of the extensor tendon, which runs along each finger to straighten the fingertip at the furthermost joint, known as the distal interphalangeal joint (DIPJ). This type of injury is particularly common in sports where fingers are at risk of coming into contact with high-velocity objects, such as in basketball or cricket, but can also be a result of an accident like getting a fingertip caught in a closing door.
The classic sign of mallet finger is the one that earned it the name – a drooping fingertip (resulting in the finger resembling a mallet) and the inability to straighten the finger from the DIPJ. Other signs and symptoms of mallet finger include:
An X-ray of a suspected mallet finger injury can identify whether only the extensor tendon has been affected or whether there is an accompanying avulsion fracture. Mallet finger treatment with an orthopaedic hand and wrist surgeon like Dr Fleming can help to prevent long-term complications, including permanent deformity and limited function of your hand, and osteoarthritis in the DIPJ.
An injury to the ulnar collateral ligament in the thumb is often known as skier’s thumb, as the typical grip on a ski pole makes this particular ligament susceptible to injury during a fall. The ulnar collateral ligament is responsible for stability of the thumb, involved in movements such as gripping and pinching. Pulling the thumb away from the hand forcefully enough can overstretch the ligament or cause a partial or full rupture.
Signs and symptoms of skier’s thumb can include:
A Stener lesion is a more complicated ulnar collateral ligament injury where the torn ligament becomes displaced from its normal position. Unlike a regular skier’s thumb injury, which may be suitable for conservative treatment, a Stener lesion will always need surgery to correct the placement of the ligament so it can heal properly.
The scapholunate ligament joins two of the carpal bones in your wrist – the scaphoid and the lunate – and plays an important role in wrist stability by keeping these bones in alignment and protecting against over-rotation. A tear of the scapholunate ligament is one of the most common soft tissue wrist injuries, often seen in people who engage in contact sports, gymnastics, or other activities that frequently involve excessive pressure on the wrist. A fall onto an outstretched hand (FOOSH) injury is also often responsible for causing trauma to this ligament.
Similar to other ligament trauma, signs and symptoms of a scapholunate ligament injury can include:
A wrist arthroscopy with an orthopaedic surgeon is the gold standard for accurately diagnosing a ruptured scapholunate ligament. A small camera is inserted via an incision in your wrist to directly view the ligament and surrounding structures. Timely diagnosis and treatment of this type of wrist injury is crucial for avoiding complications such as chronic wrist instability or scapholunate advanced collapse, where the scaphoid and lunate bones become misaligned.
The TFCC is a system of cartilage, ligaments, and tendons in your wrist, involved in stabilising the wrist joint where it connects to the two long forearm bones during movements such as flexing, extending, and rotating. A TFCC tear can be caused by trauma such as a FOOSH or repetitive wrist movements, or from degenerative changes to the tissue with age.
Symptoms of TFCC wrist injury include:
An untreated TFCC tear may lead to chronic pain and instability in the wrist, which may develop into arthritis over time due to abnormal wear and tear on the joint. It is best to seek specialist treatment early for a suspected TFCC tear as this can help to avoid long-term problems and optimise outcomes with treatment, whether conservative or surgical.
The choice between a conservative management approach or surgical intervention is made through a shared decision-making process with Dr Fleming and yourself. It can depend on factors such as which ligament or tendon is involved, the severity of your injury and whether the surrounding bone has also been affected, how long ago the injury occurred, whether you have other medical conditions, and even how your occupation or hobbies affect how you use your hand and wrist.
Non-surgical treatment for soft tissue injuries in the hand and wrist is often recommended as the first step in management, particularly for partial tears or injuries resulting in mild instability. These conservative treatment options may include:
Surgical intervention is typically considered for severe injury or if your symptoms have not been resolved through conservative measures. Certain types of soft tissue trauma, such as a Stener lesion, are not likely to be fixed with non-surgical means, so will often proceed straight to surgical treatment.
Surgical treatment options for hand or wrist trauma include:
After surgery follows an important period of rehabilitation with a hand therapist, aimed at restoring full range of movement and strength to the affected part of your hand or wrist.
