The wrist is made up of 10 bones including two bones of forearm namely radius and ulna and eight other small bones. The weight small bones found in the wrist are Scaphoid, Pisiform, Trapezium, Lunate, Trapezoid, Capitate, Triquetrum, and Hamate. Carpal bones of wrist and bones of hands together form the wrist.
Dislocated wrist is the term given to dislocation of any of bones of wrist which may be the ulna, radius, or carpal bones in the wrist. Usually, it is caused due to a fall on outstretched hands so as to prevent the fall, which usually stresses the wrist bone and causes a dislocation.
Dislocated wrist is quite common in sports like soccer, wrestling, basketball, rugby etc., but it may occur with recreational activities like skateboarding, skiing etc.
Types of Wrist Dislocation
Different types of injuries lead to different types of dislocations of carpal bones. However, most of the dislocations involve the lunate bone. Wrist dislocation usually involves severe damage to the ligaments and if left untreated this can lead to permanent disability.
The two most common types of wrist dislocations are anterior lunate dislocation and perilunar dislocation. Given below are some types of dislocations of wrist.
- Lunate Dislocation: Dislocation of the lunate bone.
- Perilunate Dislocation: Dislocation of the capitate bone from the lunate bone.
- Galeazzi’s Fracture: Dislocation of the ulna along with fracture of radius.
- Monteggia’s Fracture: Dislocation of radius along with fracture of ulna.
Causes of Wrist Dislocation
- Generally, dislocated wrist can occur as a result of a fall on outstretched hands.
- Dislocation of wrist may often occur in the contact sports where there is lot of risk to the players of colliding with one another.
- Falls suffered during sports like football, diving, basketball, etc.
- Weightlifting can sometimes also cause dislocation to wrist.
- Falls during skating.
- If there is any previous wrist injury, then applying force on it while falling down could also cause dislocated wrist.
- Dislocated wrist may also occur due to automobile accidents.
- Occupational injuries.
Signs and Symptoms of Wrist Dislocation
- Instant pain after injuring the wrist.
- Tenderness with palpation.
- Wrist gets deformed.
- Tingling of index and middle finger, and thumb.
- Pain is also exacerbated with movements.
- Diminished range of motion of wrist.
- Exacerbation of pain with gripping.
- Thumb and finger stiffness.
Treatment for Wrist Dislocation
The most important thing for this condition is that it needs to be treated at the earliest possible time. Any delays may result in malalignment of bone/joint. which hinder the functionality of hand/wrist. Treating the condition early also minimizes future recurrences.
Nonsurgical Treatment: Usually, conservative measures are enough for treatment of wrist dislocation since it is just movement of bone from the usual position. This is done by closed reduction along with casting of wrist and hand. It may take about a couple of months to recover.
Surgical Treatment: In acute cases where conservative measures fail and the bone gets deformed to a degree that it becomes difficult to treat it manually then surgery is carried out. Carpal dislocation may cause severe damage to the ligaments.
The surgical procedure is done by joining the bones together in their normal position, repairing any impairment caused to ligaments or any other structures and keeping them in place till they are healed.
The procedure is done by making a nick to expose the bone and bring it back to its usual place. It in some cases requires hardware usage like pins, screws, external fixator etc. It also has risk of infection, bleeding, hardware failure etc.
Physical Therapy: This is imperative in order to hasten the recovery process and get the wrist back to its normal function. It includes the following:
- Joint mobilizations.
- Soft tissue massages.
- Ice or heat.
- Exercise for increasing strength.
- Activity modifications.
- Suitable planning to return back to normal activities.
Exercises for Wrist Dislocation
The patient needs to stretch and strengthen the muscles in the recovery stage so as to make the wrist normal.
Stretching Exercises for Wrist Dislocation
Flexion: To perform this exercise, the wrist is bent forward until there is painless stretch felt. It is required to be done for six seconds and performed in three sets of 10 each.
Extension: In this, the wrist is bent backwards until there is painless stretch felt and needs to be done for at least six seconds and performed in three sets of 10 each.
Side-to-Side: In this, the wrist is bent from one side to other till it is painless for about five seconds in each direction and is performed in two sets with 15 times in each set.
Wrist Extension Stretching: It can be done by keeping elbow straight and placing fingers on an object with palms looking down. Then, the body weight is put forward and the position is held for about 20 seconds.
Wrist Flexion Stretching: It can be done by keeping elbow straight and placing fingers flat on an object with palms looking up. Then the body weight is put forward and the position is held for about 20 seconds.
Pronation and Supination of Forearm: In this exercise, the elbow is bent at a right angle. The palm is then rotated up and it done for about 10 seconds. Now, the same thing is done in the opposite direction for 10 seconds. It should be done thrice with 10 times each without aggravating symptoms.
Strengthening Exercises for Wrist Dislocation
Wrist Flexion: In this, a can is held with palm looking upwards. Then the wrist is bent upwards. Slowly, the weight is decreased. It is done twice 15 times each. The weight can be increased with time.
Wrist Extension: In this, a can in held with palm looking downwards. Then the wrist is bent upwards. Slowly, the weight is decreased. It is done twice 15 times each. The weight can be increased with time.
Tennis Ball Squeeze: This is done by squeezing a soft spongy object like a ball as much as possible without aggravating symptoms for about 10 seconds and this should be done for about 10 times.
Resistance Band Wrist Flexion: In this exercise, a resistance is placed over fingers with palm facing upwards. The elbow is kept at side of body and is bent at a right angle with the support of the other hand. The next thing to do is to slowly curl fingers and wrist upwards adjoining the resistance so as to make the muscles of forearm tight. One can repeat as long as there is no exacerbation of symptoms.
Resistance Band Wrist Extension: In this exercise, a resistance is placed over fingers with palm facing downwards. The elbow is kept at side of body and is bent at a right angle with the support of the other hand. The next thing to do is to slowly curl fingers and wrist upwards adjoining the resistance so as to make the muscles of forearm tight. One can repeat as long as there is no exacerbation of symptoms..
Resistance Band Radial Deviation: In this exercise, a resistance is placed over fingers with thumb facing upwards. The elbow is kept at side of body and is bent at a right angle with the support of the other hand. The next thing to do is to slowly curl wrist upwards adjoining the resistance so as to make the muscles of forearm tight. One can repeat as long as there is no exacerbation of symptoms.
Investigations for Wrist Dislocation
The physician may conduct a detailed examination and perform tests that can include:
- CT scan rarely.
- MRI rarely.
- Bone scan.