Wrist Dislocation in Sports Medicine Treatment & Management

Updated: Feb 26, 2015
  • Author: Kadeer M Halimi, DO; Chief Editor: Sherwin SW Ho, MD  more...
  • Print
Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

The rehabilitation of wrist injuries can be divided into 5 phases, as follows [6] :

  • Phase I: Control inflammation and edema by using rest, ice, compression, and elevation (RICE).
  • Phase II: Restore the normal soft-tissue environment by using modalities such as scar massage, whirlpool therapy, and elastomer application.
  • Phase III: Increase range of motion (ROM).
  • Phase IV: Increase strength.
  • Phase V: Work on hardening and/or conditioning.

Proper pain control and anti-inflammatory medication are the cornerstone of all phases of rehabilitation.

Occupational Therapy

Occupational therapy can be an essential part of rehabilitation, depending on the expertise of the therapist and the motivation of the patient.

Medical Issues/Complications

An expected outcome of surgical reduction of a wrist dislocation is some loss of motion (see Treatment, Acute Phase, Surgical Intervention). The goal of surgery and rehabilitation is to minimize the loss of motion in the athlete (see Maintenance Phase, Rehabilitation Program).

Surgical Intervention

Closed reduction of the wrist dislocation can be attempted after a complete neurovascular examination is performed and proper radiographs are obtained. The patient should be adequately anesthetized by means of an axillary block or general anesthesia. Closed reduction may be difficult if not impossible; the patient should be advised that open reduction may be needed.

For a perilunate dislocation, initial dorsiflexion is followed by gradual volar flexion. Pronation is then used to reduce the capitate back into the lunate. [6]

For a lunate dislocation, the steps of perilunate reduction are followed by the operators stabilizing the lunate with their thumb as the capitate is brought into palmar flexion. The initial stages of reduction reproduce the perilunate dislocation before the final reduction.

With a scapholunate dislocation, the wrist is dorsiflexed and radially deviated.

Once closed reduction is attempted, PA and lateral radiographic images are obtained to confirm adequate reduction. The carpal bones are then pinned with Kirschner (K) wires because closed reduction is rarely effective by itself. If closed reduction is not successful, the surgeon must attempt open reduction. The wrist is then placed in a cast for 4-6 weeks.

Early diagnosis and anatomic reduction was noted to be essential in a report by Martinage et al [14] ; they can also provide satisfactory functional results. Thus, emergency surgical treatment is required. The investigators preferred a dorsal approach and did not perform primary closed reductions. [14]

A study to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation concluded that the use of this treatment is associated with satisfactory midterm functional and radiographic outcomes. [15]

Consultations

Promptly consult an orthopedic specialist.

Other Treatment

Most complications can be avoided with prompt diagnosis and treatment.

Next:

Recovery Phase

Rehabilitation Program

Physical Therapy

The type of physical therapy depends on the needs of the individual patient. Therapeutic modalities may be continued throughout the recovery phase, in addition to ROM and strengthening activities as needed.

Previous
Next:

Maintenance Phase

Rehabilitation Program

Physical Therapy

The goal of the maintenance phase is for the patient to regain full strength and ROM of the wrist to enable him or her to complete functional daily activities and to gradually return to sports participation or work. The patient independently functions in a work-hardening or sport-specific training program during this phase to continue strengthening to the affected upper extremity.

Previous