WRIST DISLOCATION, RADIUS OR ULNA |
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General Information
DEFINITION--An injury to one of the joints in the wrist so that adjoining bones no longer touch each other. SUBLUXATION is a minor dislocation. Joint surfaces still touch but not in normal relation to each other.
BODY PARTS INVOLVED
Lower arm bones (radius and ulna).
Bones in the hand.
Ligaments that hold the bones in place.
Soft tissue surrounding the dislocation site, including periosteum (covering to bone), nerves, tendons, blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Excruciating pain in the wrist at the time of dislocation.
Loss of hand and wrist function, as well as severe pain when attempting to move them.
Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising at the injury site.
Numbness or paralysis below the dislocation from pressure, pinching or cutting of blood vessels or nerves.
CAUSES
Direct blow to the wrist--usually a fall on an extended hand.
End result of a severe wrist sprain.
Congenital abnormality, such as shallow or malformed joint surfaces.
RISK INCREASES WITH
Contact sports such as football, basketball, soccer or hockey.
Previous wrist dislocation or sprain.
Repeated wrist injury of any sort.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
HOW TO PREVENT
Build your overall strength and muscle tone with a long-term conditioning program appropriate for your sport.
Warm up adequately before physical activity.
After healing, use protective devices such as wrapped elastic bandages or tape wraps, to prevent reinjury during participation in sports.
Consider avoiding contact sports if treatment does not restore a strong, stable wrist.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This will include manipulation of the joint to reposition the bones.
Surgery (sometimes) to restore the joint to its normal position and repair torn ligaments and tendons. Acute or recurring dislocations may require surgical reconstruction or replacement of the joint.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the wrist, hand and elbow.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure or damage to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissue.
AFTER TREATMENT OR SURGERY:
Excessive internal bleeding around the wrist.
Impaired blood supply to the dislocated area.
Death of bone cells due to the interruption of blood supply.
Infection introduced during surgical treatment.
Prolonged healing if activity is resumed too soon.
Recurrent wrist dislocations.
Unstable or arthritic wrist following repeated injury.
PROBABLE OUTCOMEAfter the wrist dislocation has been corrected, the joint may require immobilization with a cast or splint for 4 to 8 weeks. Complete healing of injured ligaments requires a minimum of 6 weeks.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing if possible, but don't move the injured area to remove clothing.
Immobilize the wrist joint and arm with padded splints.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
IF A CAST IS NOT NECESSARY:
Use ice soaks 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
After 48 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling. Stroke from the fingers toward the heart.
Wrap the injured wrist with an elasticized bandage between treatments. IF A CAST OR PLASTER SPLINT IS NECESSARY:
See Appendix 2 (Care of Casts).
Actively exercise all muscle groups in the arm and hand that are not immobilized. Muscle contractions promote proper alignment and hasten healing.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen to relieve moderate pain.
Narcotic pain relievers for severe pain.
Antibiotics to fight infection if surgery is necessary.
ACTIVITY
Begin reconditioning the wrist after clearance from your doctor.
If surgery is necessary, resume usual activities and reconditioning gradually after surgery. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a dislocated wrist, especially if the arm becomes numb, pale, or cold. This is an emergency!
Any of the following occur after treatment or surgery:
Nausea or vomiting.
Swelling above or below the cast or splint.
Blue or gray skin color, particularly under the fingernails.
Numbness or complete loss of feeling below the dislocation site.
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Constipation.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Wrist dislocations occur repeatedly that you can "pop" back into normal position.
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