Wrist Ligament Injuries Info
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Wrist ligament injuries—common causes, symptoms, diagnosis, and treatment options (conservative vs surgery).
What you're feeling
Wrist ligament injuries often start with a sudden pop or sharp pain, usually after a fall onto an outstretched hand. You might feel a sense of instability, as if your wrist is "giving way" or slipping out of place. The pain is typically located on the back of the wrist, near the base of the thumb, and can worsen when you grip objects or push yourself up from a chair.
Many people notice that simple tasks become difficult. You might struggle to turn a doorknob, open a jar, or push open a heavy door. The pain can be dull and achy at rest, but it often flares up with activity. If the injury is not treated, the pain may persist for months, and you might develop a chronic ache or stiffness that limits your daily life.
What's actually happening
Your wrist is made up of eight small bones called carpals, arranged in two rows. These bones are held together by a network of strong bands of tissue called ligaments. The most commonly injured ligament is the scapholunate ligament, which connects the scaphoid bone (near the thumb) to the lunate bone (in the center of the wrist). This ligament acts like a bridge, keeping these two bones aligned as you move your wrist.
When this ligament tears, the scaphoid and lunate can separate slightly. This gap allows the bones to move abnormally, a condition known as carpal instability. Over time, this abnormal motion can lead to wear and tear on the joint surfaces, causing arthritis. In some cases, the lunate bone may lose its blood supply and begin to collapse, a condition called Kienböck’s disease. This can happen if the injury is severe or if the bone’s blood flow is compromised.
There are different types of instability. In dynamic instability, the bones look normal on standard X-rays but shift out of place when you apply stress, such as when you make a fist. In static instability, the bones are permanently misaligned, even when your wrist is relaxed. Another type, called carpal instability nondissociative, occurs when the entire row of wrist bones shifts together, often due to damage to the outer ligaments rather than the ones between the bones.
What we can do about it
Your surgeon will discuss several treatment options depending on the severity of the injury and how long it has been present.
Non-surgical treatment is often the first step for mild injuries or dynamic instability. This may involve wearing a cast or brace to immobilize the wrist and allow the ligament to heal. Physical therapy can help strengthen the muscles around the wrist to provide better support. Activity modification, such as avoiding heavy lifting or pushing motions, can also reduce pain and prevent further damage.
Surgical repair is typically recommended for complete tears, especially if they are caught early. The surgeon will reattach the torn ligament to the bone using small anchors or sutures. This procedure aims to restore the normal alignment of the bones and stabilize the joint. In some cases, a dorsal capsulodesis is performed, which involves tightening the joint capsule to provide additional support.
Reconstruction may be necessary if the ligament is too damaged to repair or if the injury is chronic. In this procedure, the surgeon uses a graft from another part of your body or a donor to replace the torn ligament. This helps to restore stability to the wrist.
Salvage procedures are considered for advanced cases where arthritis has developed. These may include partial wrist fusion to reduce pain by limiting motion in the most affected joints, or proximal row carpectomy, which involves removing the damaged bones to allow the remaining bones to move more freely. In severe cases, total wrist fusion may be required to eliminate pain, though this results in a loss of wrist motion.
When to see someone
You should see a clinician if you experience any of the following:
- Sudden, severe pain in the wrist after a fall or injury.
- A feeling of instability or "slipping" in the wrist.
- Pain that persists for more than a few days despite rest and ice.
- Difficulty performing daily tasks, such as gripping or turning objects.
- Swelling or bruising that does not improve with time.
Early evaluation is important to prevent long-term complications, such as chronic pain or arthritis. If you suspect a wrist ligament injury, seek medical attention to get an accurate diagnosis and appropriate treatment plan.
