Wrist Ligament Injuries

What Are Wrist Ligament Injuries?

Ligaments are tough bands of tissue that connect bones to each other and provide stability to joints. Your wrist contains many small bones held together by a complex network of ligaments. When these ligaments are injured, the wrist can become unstable and painful. Two of the most commonly injured ligaments in the wrist are the scapholunate ligament and the triangular fibrocartilage complex, known as the TFCC.

The scapholunate ligament sits in the middle of the wrist, connecting the scaphoid and lunate bones. This ligament is critical for normal wrist motion and stability. When it tears, the bones can separate and move abnormally, leading to pain and eventually arthritis if left untreated. The TFCC is located on the small finger side of the wrist and acts as both a stabilizer and a cushion between the end of the ulna bone and the small wrist bones. It can tear from injury or degenerate over time from wear.

Symptoms

With a scapholunate ligament injury, pain is typically felt on the back of the wrist, especially when bending the wrist backward or with gripping activities. The wrist may feel weak or give out during use. You might notice swelling over the back of the wrist, and bruising can develop in the days following injury. Some people hear or feel popping, clicking, or grinding in the wrist with certain movements.

TFCC tears cause pain on the small finger side of the wrist, particularly with twisting motions like turning a doorknob or wringing out a towel. You may experience clicking or popping when rotating your forearm or moving your wrist from side to side. The wrist can feel unstable or weak with gripping activities. Some TFCC tears cause no symptoms at all and are found incidentally on imaging studies done for other reasons.

Both injuries can cause persistent pain that develops over days or weeks after the initial trauma. Some people notice symptoms immediately, while others experience a gradual onset of pain and dysfunction. The pain may improve somewhat after the acute injury but then persist at a lower level that interferes with activities.

Causes & Risk Factors

Most wrist ligament injuries occur from falls onto an outstretched hand. When you fall and catch yourself with your hand, the force transmitted through the wrist can tear ligaments. The position of your wrist at the time of impact determines which ligaments are most at risk. Scapholunate ligament tears often happen when the wrist is bent backward forcefully. TFCC tears can result from falls or from twisting injuries, like when a drill bit catches and suddenly rotates your arm.

Some ligament injuries develop gradually without a specific traumatic event. Chronic inflammation from conditions like rheumatoid arthritis or gout can weaken ligaments over time. The scapholunate ligament can stretch out with age or from repeated strain. TFCC tears become more common as we age due to natural degeneration of the tissue. People whose ulna bone is longer than their radius at the wrist tend to have thinner TFCC tissue that is more prone to tearing.

Sports that involve falling or putting stress on the wrists, such as gymnastics, football, hockey, and skiing, increase the risk of these injuries. Work activities that involve repetitive wrist motions or forceful gripping can contribute to ligament problems over time. Previous wrist fractures can also damage ligaments or make them more susceptible to future injury.

Diagnosis

Diagnosing wrist ligament injuries can be challenging because the ligaments themselves don't show up on regular X-rays. Your hand surgeon will start with a detailed history of how the injury occurred and a physical examination. Specific maneuvers can stress different ligaments and help identify which structures are injured. Your surgeon will compare the injured wrist to the uninjured side and assess for areas of tenderness, swelling, and abnormal motion.

X-rays are important even though they don't show ligaments directly. When ligaments are torn, the bones they normally hold together can separate or move into abnormal positions. Special stress views or comparison views of both wrists can reveal these subtle changes. An MRI provides detailed images of the ligaments and can show tears, though sometimes even MRI misses ligament injuries. MR arthrography, where dye is injected into the wrist joint before the MRI, can improve the accuracy of detecting tears.

Sometimes wrist arthroscopy is needed to definitively diagnose ligament injuries. This involves inserting a small camera into the wrist joint through tiny incisions, allowing the surgeon to directly visualize the ligaments. Arthroscopy can be both diagnostic and therapeutic, as some injuries can be treated during the same procedure.

Treatment Options

Treatment depends on which ligament is injured, how severe the tear is, and how long ago the injury occurred. For acute injuries, initial treatment focuses on pain control and protecting the wrist while watching to see if symptoms improve. A wrist splint or cast can provide support and limit motions that stress the injured ligament. Rest, ice, and anti-inflammatory medications help manage pain and swelling.

Many partial ligament tears and some TFCC tears respond well to conservative treatment. You may need to wear a splint for six weeks or longer, avoiding activities that aggravate the wrist. Hand therapy can be helpful after the immobilization period if stiffness develops. Cortisone injections can provide temporary relief and help determine if the pain is indeed coming from the suspected area.

Surgery is considered when conservative treatment fails, when the injury is severe, or when the wrist remains unstable despite adequate healing time. For acute scapholunate ligament tears, surgery aims to repair the ligament and restore normal bone alignment. This can be done arthroscopically or through an open incision, depending on the severity. If the injury is chronic and the ligament cannot be repaired, reconstruction using nearby tendons or partial wrist fusion may be necessary.

TFCC tears have several surgical treatment options depending on the location and type of tear. Some tears can be repaired arthroscopically. Others require open surgery to reattach the TFCC to bone or reconstruct damaged portions. If the ulna is too long relative to the radius, a procedure to shorten the ulna may be performed to reduce stress on the TFCC.

Surgery: What to Expect

Wrist ligament surgery is typically performed as an outpatient procedure under local anesthesia, with sedation available for select cases if needed. Arthroscopic procedures involve making two or three small incisions around the wrist and using a camera and small instruments to repair the ligament. Open procedures require a larger incision to directly access and repair the damaged structures. Most operations take one to two hours.

For scapholunate ligament repair, the bones may be temporarily held in place with wires or screws while the ligament heals. These are typically removed after eight to twelve weeks. Ligament reconstruction procedures use tendon grafts to create a new ligament or reinforce a damaged one. For TFCC repair, sutures are used to sew the torn tissue back together or reattach it to bone.

After surgery, your wrist is placed in a splint or cast. The type of surgery determines how long you need to wear the splint and when you can begin moving the wrist. Following your surgeon's postoperative instructions carefully is critical for success.

Recovery

Recovery from wrist ligament surgery requires patience. You'll typically wear a splint or cast for six to twelve weeks, depending on the procedure performed. Once the splint is removed, stiffness is common and expected. Hand therapy plays an important role in regaining motion and strength. You'll receive a home exercise program with specific exercises to improve wrist flexibility and gradually rebuild strength.

Most people can manage their recovery with these home exercises, though formal therapy sessions may be beneficial if you develop significant stiffness or have trouble following the program independently. The therapist can also provide treatments like ultrasound or manual therapy to help restore motion. Progress is gradual, and it's important not to push too hard too soon.

Full recovery typically takes three to six months, though some people continue to see improvement for up to a year. Return to sports or heavy labor is usually allowed around three to four months after surgery, depending on the procedure and your healing progress. Some stiffness compared to the uninjured wrist is common, but most people regain enough motion for normal activities. The goal is a stable, pain-free wrist that allows you to return to your regular activities, even if it doesn't feel exactly like it did before the injury.

When to See a Specialist

If you have persistent wrist pain after a fall or injury, especially if the pain is on the back of your wrist or the small finger side, it's worth getting evaluated. Wrist ligament injuries can be missed initially and may lead to chronic problems if not addressed. Even if X-rays look normal, ligament damage can still be present and causing your symptoms.

Dr. Lackey specializes in diagnosing and treating complex wrist ligament injuries. Early evaluation and appropriate treatment can prevent progression to arthritis and help you maintain wrist function for the long term.