What treats wrist injuries?

Treatment of Wrist Injuries ("Mommy's Wrist")

The initial treatment for wrist injuries should begin with radiographic evaluation, followed by conservative management including immobilization and physical therapy, with surgical intervention reserved for specific cases of instability or persistent symptoms despite conservative measures. 1

Diagnostic Approach

Initial Imaging

• Radiography is always indicated as the initial imaging for suspected wrist trauma 2
• A standard 3-view examination should include:
  • Posteroanterior (PA)
  • Lateral
  • 45° semipronated oblique view 2
• Adding a fourth projection (semisupinated oblique) can increase diagnostic yield for distal radius fractures 2

Secondary Imaging (if radiographs are negative or equivocal)

• MRI without IV contrast is highly sensitive for detecting:
  • Occult fractures
  • Ligamentous injuries
  • Triangular fibrocartilage complex (TFCC) lesions 2, 1
• CT without IV contrast is useful for:
  • High-detail imaging of bone cortex and trabeculae
  • Identifying radiographically occult fractures
  • Shorter acquisition times compared to MRI 2
• Ultrasound can be useful for:
  • Examining extra-articular soft tissues
  • Diagnosing abnormalities of flexor and extensor tendons
  • Guiding therapeutic injections 2

Treatment Algorithm

Conservative Management (First-Line)

1. Immobilization:

   • Short arm cast or splint for 10-14 days for suspected occult fractures 2
   • Wrist braces for sprains and mild injuries

2. Pain Management:

   • Acetaminophen for pain relief 3
   • NSAIDs for pain and inflammation
   • Corticosteroid injections (ultrasound-guided) for inflammatory conditions 1

3. Physical Therapy:

   • Gradual rehabilitation
   • Progressive increase in duration and intensity of activities 1
   • Modified grip techniques and protective taping/bracing during recovery 1

Surgical Intervention (for specific indications)

Surgical options are indicated for:

• Persistent distal radioulnar joint (DRUJ) instability
• Symptomatic non-union with functional limitations
• Large displaced fractures with joint instability
• Confirmed TFCC tears unresponsive to conservative treatment 1

Surgical procedures may include:

• Arthroscopic debridement or repair of TFCC tears
• Repair of ligamentous injuries
• Stabilization of the distal radioulnar joint 1

Special Considerations

Fracture Management

• Distal radius fractures require restoration of radial length, inclination, and tilt 2
• Operative fixation is indicated when there is:
  • Coronally oriented fracture line
  • Die-punch depression
  • More than three articular fracture fragments 2
• Residual articular surface step-off should be <2mm to avoid long-term complications like osteoarthritis 2

Return to Activities

• Implement a gradual return to activities with:
  • Modified grip techniques
  • Protective taping or bracing
  • Equipment modifications as needed 1

Common Pitfalls to Avoid

1. Delayed diagnosis - Distal radius and scaphoid fractures may be radiographically occult initially 2
2. Unnecessary repeat imaging - Avoid if it will not change management 1
3. Premature return to activities - Can lead to re-injury or chronic problems
4. Missing associated injuries - Carpal instabilities often accompany fractures

By following this evidence-based approach to wrist injuries, most patients can achieve good functional outcomes with appropriate treatment tailored to their specific injury pattern.