According to statistics of traumatology, the brush is damaged most often. The most common sprain of the wrist joint. It occurs at the time of landing when falling on an outstretched arm with excessive bending or over-bending of the hand.
Very often this phenomenon occurs in contact, power or extreme sports - hockey, football, handball, wrestling, barbell lifting, gymnastics, etc. The sprain of the right wrist joint occurs more often than the left, and is explained by the fact that 85% of people are right-handed .
Essence of injury
Ligament sprains are damage to a bundle of tissue fibers that provide articulation of joint bones. It occurs when the load is excessive, when the strong tension of the ligament exceeds its physical strength. According to ICD-10, the wrist joint ligament has the code S63.
Ligament tissues in most cases remain intact, but for a certain time they cannot perform their functions. It can be damaged or several ligaments at the same time.
A bit of anatomy and physiology
Ligament tissues contain collagen and elastin fibers that are parallel. Collagen is responsible for their strength, and elastin - for elasticity. The wider the ligament across, the stronger it is, and the ability to resist deformations is determined by its length. It turns out that the narrow and short ligaments of the brush are precisely the most vulnerable.
Sprain of the left wrist joint occurs more often in left-handed people, which make up 15% of the population. The anatomy of the wrist is different from other joints:
- The joint is complex because it has more than 2 articular surfaces.
- Inside the articular bag there is an additional cartilaginous triangular disk for congruency of the joint.
- The shape of the joint is ellipsoidal (one surface is concave, the other is convex). This provides him with 2 axes - horizontal and vertical, as well as the possibility of rotation.
More than a quarter of the bones of the hand (8 of 27) are concentrated in the wrist and connected by ligaments. The ligaments of the wrist are strong and flexible, but this does not determine their ability to continuous loads. There are 6 ligaments; lateral (collateral) - radial and ulnar injuries more than others.
Such a complex structure provides subtle movements, however, this circumstance gives a high level of injuries.
Damage reasons
Wrist sprain according to ICD-10 belongs to the class S3-S63.6 - tears and sprains of different sections of the hand. All traumatic injuries to the wrist are included.
The most common causes of sprain of the wrist joint:
- landing on hand in the fall or strong impact;
- falling with emphasis on the wrists;
- dislocations;
- fractures
- sudden movements;
- weight lifting with a jerk;
- lifting weights on outstretched arms;
- holding body weight with hands without support.
No one is safe from such factors: neither athletes nor ordinary people.
The ICD sprain of the wrist joint is assigned code S63.5. This item includes the following injuries - sprain and overstrain of the capsule-ligamentous apparatus at the level of the wrist, wrist joint and ligaments.
There are risk factors for some segments of the population:
- physical inactivity and hypokinesia;
- advanced age when ligament tissue is disturbed;
- tendon anomalies from birth;
- arthritis and arthrosis;
- poor muscle development and their untrained due to poor physical fitness.
This exacerbates the stretching of the ligaments, since under such conditions they become inelastic and become thinner.
Wrist sprain (ICD-10 code - S63) includes the above sprain, overstrain of the ligamentous apparatus, dislocations of the wrist and wrist.
Also, the ligaments can stretch when:
- joint diseases
- injury by severity;
- with displacement of bone fragments as a result of fractures;
- hanging on the horizontal bar without foot support.
Symptomatic manifestations
Symptoms of wrist sprain and treatment are interrelated. With strong sprains, the tendons rupture and a loud crack is heard. The joint in such cases is not restrained by anything and becomes dangling. There is a sharp sharp pain, redness of the skin, a bruise (hematoma) quickly occurs at the site of damage, and swelling increases. There comes a complete immobility of the brush.
According to ICD-10, the code S63.3 applies to sprain of the wrist joint:
- traumatic rupture of the ligament of the wrist and metacarpus;
- lateral ligament of the joint;
- palmar ligament.
Joint injury goes through 3 stages, but pain is present in each.
- The first stage is easy. Most often there are no symptoms, the patient leads a normal lifestyle. Sprain of the wrist joint in stages 1 and 2 may not have symptoms. The pain is slight. The damage area is minimal.
- Second degree, moderate. Partial rupture of fibers. The pain is severe, there is inflammatory edema. Joint mobility is reduced, a person goes to the doctor.
- The third degree, heavy. Symptoms of sprain of the wrist joint are pronounced sharply, brightly. There is a break in the entire ligament with a characteristic crunch. The pain is unbearable, bruises and swelling immediately occur. If assistance is not provided, blood is poured into the joint bag and a joint hygroma is formed. After 1-2 hours, a fever occurs, which indicates the start of an inflammatory reaction. The torn ligaments of the joint do not hold, and it becomes excessively mobile.
The wrist joint ligament is quite simple to distinguish from more serious injuries: it is uncharacteristic of the protrusion and deformation of the articular and bone fragments as in a dislocation or fracture. And one more feature: unlike fractures of the hand, when stretched, mobility is detected at the site of the lesion, with increased amplitude.
First aid
Algorithm of actions:
- remove jewelry from the brush, if any, and unbutton the sleeve of the shirt;
- provide complete rest of the limb;
- exclude any load;
- immobilize the brush;
- apply a cold compress;
- in case of dislocation and rupture of ligaments, splint;
- give an analgesic;
- transport to the emergency room.
Ice wrapped in rags can become a cold compress; its application time is 30 minutes, after a half-hour break, you can repeat it. Ice will narrow the vessels, relieve pain and reduce swelling. Of the analgesics, Paracetamol, Analgin, Ibuprofen can be used.
A tight bandage is applied with an elastic or regular bandage. Immobilization of the brush will be better done not on weight, but on a flat surface.
Also, to relieve swelling and stagnation of blood at the site of injury, it is better to keep a fixed arm above the level of the body. It is better to do this in special beds in the trauma unit. Moreover, outpatient treatment is possible only with 1 degree. If the ligaments are broken, the therapy is carried out in a hospital.
Diagnostic measures
For diagnosis, x-rays, ultrasound and MRI are used. With MRI, tissue images are obtained in layers, with different angles. This method is especially valuable in children.
An experienced traumatologist can make a diagnosis right away by examining, interviewing and palpating. And only with suspected fracture, an instrumental examination may be required. Ultrasound is often used to assess the condition of ligaments before and after treatment.
The most famous and affordable is x-ray. The doctor from the picture can confidently and without a long wait determine the type of injury - a fracture or sprain.
Signs of damage on x-ray:
- With bruising or sprain, there are no changes on the x-ray.
- With dislocations, the articular surfaces are not compared.
- With fractures, a fracture line is visible, there may be a displacement of bone fragments.
Possible complications of sprains
Stretching can be complicated by the following pathologies:
- long non-healing in case of incorrect treatment or its absence;
- transition to arthritis or arthrosis;
- instability in the joint and its weakness;
- stiffness;
- predisposition to repeated stretching;
- decreased athletic opportunities in the area where the brush is involved.
Treatment principles
Treatment of sprain of the wrist joint can be conservative, surgical, non-traditional.
Conservative Method:
- taking medication;
- local treatment;
- physiotherapy;
- massage;
- Exercise therapy.
A recovery period is required for any treatment.
Drug therapy
Drug treatment is necessary at any stage of the injury. First of all, NSAIDs (anti-inflammatory non-steroids) and analgesics are prescribed: Diclofenac, Indomethacin, Voltaren, Ketonal, Nise, Ortofen, etc. They are used in tablets and injections.
Anti-inflammatory ointments are also prescribed: Fastum Gel, Voltaren Gel, Nise Gel, etc. Ointments relieve swelling and pain at the site of damage, and will help hematomas resolve quickly.
To strengthen the joint, it is good to take calcium preparations and multivitamin complexes. The first 5 days after the injury, you need to take antithrombotic agents.
With dislocations, a langet is applied, and it is worn for at least two weeks. With a moderate degree of injury, after 2 weeks the process of rehabilitation in the diseased limb begins. These days, they are moving on to performing special exercises. This speeds up the recovery process in the wrist joint. In this case, it is important not to strain the affected ligaments.
Physiotherapy
More often than others, the following procedures are prescribed:
- phono- and electrophoresis;
- paraffin and ozokeritotherapy;
- UHF treatment;
- laser and magnetotherapy;
- balneotherapy.
Physiotherapy eliminates the symptoms of stretching, restores the motor functions of the hand. In this case, blood flow normalizes faster, muscle spasms of the wrist joint go away, tissues are better saturated with oxygen, and metabolism is restored.
Rehabilitation exercises
Exercise will restore the mobility of the fingers. Among them:
- finger movements with imitation of playing the piano;
- circular rotation with a brush;
- brush movements to the sides;
- to improve fine motor skills, the collection of small objects from the surface (matches, beads, buttons) is shown;
- palm rolling on the ball table.
The load increases gradually. It is better to carry out exercises under the supervision of a specialist.
You can combine exercise therapy with massage. It is even better to massage the healing ointment during the massage to enhance the therapeutic effect.
Massage will contribute to the fastest rehabilitation. With the right approach, joint mobility is fully restored.
Surgery
It is performed with a complete break in the ligaments. During the operation, damaged tissue is sutured and its functionality is fully restored. Then a seam is applied, and the hand is fixed with plaster. After its removal, local treatment with ointments and physiotherapy are also prescribed.
If there is a risk of secondary infection, antibiotic therapy is prescribed for up to 10 days.
What are the forecasts
With timely pre-medical care, adequate treatment and the implementation of medical prescriptions, the healing period is significantly reduced, and the functioning of the hand can be fully restored. There will be no complications in this case.
When can a hand be given a full load?
Loads can only be given when the hand is completely healed. In the opposite case, the situation will only worsen.
So, the load is possible if:
- if there is no pain in the arm at rest and with a small load;
- sensations of strength in an injured hand do not differ from those in a healthy one;
- there is a permission of the attending physician for the active use of the brush.
Prevention
Of course, no one is safe from periodic falls, and it is impossible to prevent a stretching of the arm. 85% of sprains occur in everyday life. But you can still follow some precautions. These include cautious and accurate handling of the injured hand for the next 6 months after the injury, the use of fixatives, bandages, taping to protect the wrist during sports training, and the constant strengthening of the wrist muscles with exercises.
Before any physical activity, the ligaments and muscles of the hand must be kneading and warming up with a warm-up. Weight gain and proper nutrition should also be avoided.