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Wrist Pain or more specifically Wrist Fractures

Wrist Pain or more specifically Wrist Fractures. Robert H Drennan MS-IV August 30, 2007. Normal Anatomy. Wrist is formed by articulation between the radius, ulna, and carpal bones There are 8 carpal bones distributed in proximal and distal rows

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Wrist Pain or more specifically Wrist Fractures

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  1. Wrist Painor more specificallyWrist Fractures Robert H Drennan MS-IV August 30, 2007

  2. Normal Anatomy • Wrist is formed by articulation between the radius, ulna, and carpal bones • There are 8 carpal bones distributed in proximal and distal rows • Proximal – scaphoid, lunate, triquetrum, pisiform • Distal – trapezium, trapezoid, capitate and hamate

  3. Normal Anatomy

  4. Wrist Bone Pneumonic • Some (Scaphoid) • Lovers (Lunate) • Try (Triquetrum) • Positions (Pisiform) • That (Trapezium) • They (Trapezoid) • Can’t (Capitate) • Handle (Hamate)

  5. Normal Anatomy

  6. DDx of Wrist Pain • Trauma • Fracture, Sprain, Dislocation, etc • Nontraumatic • Radiocarpal arthritis (OA, RA, Crystal-induced, septic) • Dorsal Ganglion • Carpal Tunnel • Referred Pain from Thumb (de Quervain’s, Carpometacarpal osteoarthritis)

  7. CASE # 1 • History – 30 yo female reports falling on outstretched hand • Physical • Pain is localized to the radial aspect of wrist • Grip strength is reduced • Swelling is not noticed and there is normal range of motion

  8. CASE # 1 XRAY

  9. TREATMENT • Thumb spica splint • Re-XRAY in 7-10 days

  10. CASE # 1 – XRAY (AGAIN!)

  11. CASE # 2 • 80 yo with h/o normal pressure hydrocephalus complaining of wrist pain

  12. CASE # 2 XRAY

  13. CASE # 3 • History – 25 yo falls backwards on outstretched hand • Physical • pain on active motion • decreased strength of wrist flexion • Swelling noted

  14. CASE # 3 XRAY

  15. CASE # 3 • Most common ligament injury is one disrupting the ligaments stabilizing the lunate and scaphoid • A large force can dislocate the bones around the lunate dorsally and can cause compression of the median nerve

  16. CASE # 4 • 25 yo male complaining of progressive right wrist pain, pt is employed as a jackhammer operator • Physical • Decreased range of motion • Weakness

  17. CASE # 4 XRAY

  18. CASE # 4 • Kienböcks disease • Avascular necrosis of the lunate • Generally follows repetitive microtrauma or an acute wrist injury that goes undiagnosed

  19. CASE # 5 • History – Patient complaining of wrist pain which was interfering with his golf game • Physical • Pain noted over the hypothenar eminence • Decreased grip strength • No decrease range on motion noted • No swelling or erythema noted

  20. CASE # 5 XRAY

  21. CASE # 5 XRAY

  22. WRIST STRONG! Stephen Colbert: Exclusive Cast on EBAY! Current bid:US $16,900.00  End time:Sep-02-07 21:00:00 PDT (3 days 13 hours) (100% of final sale price will benefit the Yellow Ribbon Fund)

  23. THE END! References available on request

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