Soft Tissue Injuries of the Wrist

MANUAL MINORS

Soft tissue injuries of the wrist involve damage to non-bony structures such as tendons, ligaments, nerves, and muscles, which are responsible for the movement and stability of the wrist. These injuries can result from acute trauma, such as falls or sudden movements, or from chronic overuse, as seen in repetitive activities. Common symptoms include pain, swelling, weakness, and, in some cases, functional limitation or loss of sensation.

Diagnosis

The diagnosis is based on the patient’s clinical history, a thorough physical examination, and imaging studies. Ultrasound may be useful for tendon injuries, while MRI is key for assessing ligaments and detecting associated injuries. Provocation tests, such as the Finkelstein test for De Quervain’s tenosynovitis, help to identify specific injuries.

Differential Diagnosis

Condition	Key Characteristics
De Quervain’s Tenosynovitis	Pain on the radial side of the wrist, worsened by thumb movement.
Carpal Tunnel Syndrome	Pain and numbness in the thumb, index, and middle fingers, especially at night.
Wrist Sprain	Pain and swelling after trauma, without dislocation visible on X-rays.
Triangular Fibrocartilage Complex (TFCC) Injury	Pain on the ulnar side of the wrist, worsened by twisting or weight-bearing.

Emergency Management

Initial management includes immobilisation of the wrist to prevent further damage and the use of analgesics or non-steroidal anti-inflammatory drugs (NSAIDs). Ice and rest are crucial in the first 48 hours. In cases of suspected severe ligamentous injury, such as a ligament or tendon rupture, prolonged immobilisation and urgent referral to a specialist may be required.

Definitive Treatment

Definitive treatment depends on the severity of the injury. For mild injuries, such as sprains or tendinitis, physiotherapy, temporary immobilisation, and conservative measures like NSAIDs and cold or heat compresses are recommended. For severe injuries, such as tendon or ligament tears, surgical repair may be necessary. Rehabilitation is essential afterwards to restore wrist mobility and strength.