What is the treatment for ulnar wrist pain due to polo?

Treatment for Ulnar Wrist Pain Due to Polo

The treatment for ulnar wrist pain due to polo should begin with conservative management including immobilization, followed by appropriate imaging if symptoms persist, with surgical intervention reserved for specific cases of instability or persistent symptoms despite conservative measures. 1, 2

Diagnostic Approach

Initial Imaging

• Start with plain radiographs of the wrist to evaluate for fractures, alignment issues, or arthritis 1
• Include specialized views:
  • Posteroanterior in ulnar deviation
  • Pronated oblique views
  • Comparison views of the contralateral wrist if needed 3

Advanced Imaging (if radiographs are normal/nonspecific)

• MRI is the preferred next study for ulnar-sided wrist pain 1

  • Highly accurate for triangular fibrocartilage complex (TFCC) lesions, especially in the radial zone
  • 3.0T MRI may provide better accuracy than 1.5T systems

• MR arthrography may be considered if:

  • Regular MRI is inconclusive
  • There is suspicion of complete or incomplete ligament tears
  • Better visualization of peripheral TFCC attachments is needed 1

• CT arthrography is an alternative when:

  • MRI is contraindicated
  • Metallic implants would cause significant artifact
  • Detailed evaluation of articular cartilage is needed 1

Treatment Algorithm

Phase 1: Conservative Management (First-line)

1. Rest and activity modification

   • Temporary cessation of polo activities
   • Avoid gripping and rotational movements of the wrist

2. Immobilization

   • Wrist splint or brace in neutral position
   • Duration: 4-6 weeks for acute injuries 2

3. Pain management

   • NSAIDs for pain and inflammation
   • Ice application for 15-20 minutes several times daily

4. Gradual rehabilitation

   • Progressive wrist strengthening exercises
   • Focus on forearm rotational strength and stability
   • Proprioceptive training

Phase 2: Interventional Approaches (If conservative management fails)

1. Corticosteroid injections

   • Ultrasound-guided injection for precise placement
   • Particularly useful for inflammatory conditions 1

2. Physical therapy

   • Focused rehabilitation program
   • Wrist strengthening and stabilization exercises
   • Sport-specific exercises to prepare for return to polo

Phase 3: Surgical Management (For refractory cases)

Indicated for:

• Persistent DRUJ (distal radioulnar joint) instability
• Symptomatic non-union with functional limitations
• Large displaced fractures with joint instability 2
• Confirmed TFCC tears unresponsive to conservative treatment 4

Surgical options include:

• Arthroscopic debridement or repair of TFCC tears
• Repair of ligamentous injuries
• Stabilization of the distal radioulnar joint 4

Special Considerations for Polo Players

• Polo places unique stresses on the wrist due to repetitive gripping, rotational forces, and impact 4, 5

• Common pathologies in stick-handling athletes include:

  • TFCC tears (most common cause of ulnar wrist pain)
  • Ulnotriquetral ligament injuries
  • Extensor carpi ulnaris subluxation
  • Distal radioulnar joint instability 4, 5

• Return to play considerations:

  • Gradual return with modified grip techniques
  • Protective taping or bracing during play
  • Modification of equipment (grip size, weight distribution)
  • Progressive increase in duration and intensity of play

Pitfalls and Caveats

• Ulnar-sided wrist pain is frequently misdiagnosed as TFCC injury when other structures may be involved 6
• Even with non-union of certain fractures (like ulnar styloid), good functional outcomes can still be achieved 2
• Avoid unnecessary repeat imaging if it will not change management 1, 2
• Consider the "storey concept" for examining the ulnar side of the wrist to systematically evaluate all potential pain sources 6

Following this structured approach will optimize outcomes for polo players with ulnar wrist pain by addressing both immediate symptoms and underlying pathology while facilitating safe return to sport.