LIGAMENT INJURIES
Ligaments are short, stout, fibrous bands of tissue that join bones together at joints for stability during motion. Injuries to these ligaments can occur at any level throughout the wrist and hand. Most commonly, they occur as the result of a blunt trauma, such as a fall, or forceful lifting or twisting injury. If the impact is the result of a high energy load, such as a fall from a significant height or an auto accident, the ligaments may be damaged so severely that a dislocation of the joint may occur. This forces the bones out of their normal anatomic alignment and producing pain and deformity. Dislocations are confirmed by x-rays, and need immediate attention in an emergency facility to re-align the bones back to normal position. Sometimes surgery is required. A laceration located over a joint can also cause a direct injury to the ligament.

Wrist ligament injuries can initially present with swelling, pain, and decreased motion. In the early stages after an injury, this can often be treated with splinting, ice, elevation, anti-inflammatory medication and hand therapy. However, close clinical follow-up is required, since if the ligament damage is significant, instability of the wrist joint may occur. This may cause a persistent aching pain, stiffness, weakness, clicking and snapping of the wrist. Radiographs and extremity MRI studies may be required to help diagnose specific ligament tears or injuries.

If the symptoms of ligament injury to the wrist become chronic or disabling, surgical reconstruction may be required to address the problem or instability. These procedures should be performed on an outpatient basis at an ambulatory surgery center. Postoperative care usually requires a period of casting or splinting followed by formal hand therapy to maximize recovery of mobility and restoration of hand function. Untreated cases of chronic ligament problems have a high probability of developing post traumatic degenerative arthritis, which can eventually necessitate more complex reconstructive procedures.

Digital ligament injuries are commonly the result of jamming type sports injuries or falls that force the finger into a bent backward or sideways position. The collateral ligaments, which stabilize the finger joints along the sides, are most commonly injured. This can present with various degrees of severity, ranging from stretching, partial tears, or complete tears. Injuries are sometimes associated with fractures about the joint surface. These usually present with swelling, bruising, pain and decreased range of motion. Radiographs and extremity MRI can assist in making the diagnosis of ligament damage as well as determining the severity of the soft tissue injury.

In the absence of an open wound, which usually requires surgical attention promptly, the vast majority of digital ligament injuries can be treated conservatively. This usually entails appropriate splinting, ice, elevation, and anti-inflammatory medication. Hand therapy may be required to help control swelling and regain mobility and function of the digit. Small joint ligament injuries often cause persistent swelling and aching discomfort with stiffness for many months after the initial injury. Surgery is only rarely required and is reserved for cases of complete ligament tears with instability and for chronic problems with severe restriction of mobility.

Gamekeeper's or Skier's Thumb is a condition that most commonly arises from a fall onto the outstretched thumb. This can happen in a motor vehicle accident, while skiing or as a result of a sports injury. This causes in a tear of the ulnar collateral ligament at the metacarpal-phalangeal joint. Symptoms include swelling, pain, and bruising. Three grades of injury to this ligament can occur depending on the severity of the impact, and each is determined by the stability of the joint.

Grade I injuries are a sprain of the ligament, and can often be treated by splinting for a four to six week period. Grade II level injuries indicate a partial tear of the ligament that is more severe, but no instability is noted on stress testing of the ligament. These can also be treated with either cast or splint immobilization, but generally require a longer period of protection, and possibly hand therapy afterward. On very rare occasions, a Grade II injury that fails to heal may require surgery.

Grade III injuries indicate the highest level of trauma with a complete tear of the ligament, sometimes associated with a fracture of the joint surface. These injuries are unstable and there can be significant pain and swelling. Stress radiographs and extremity MRI are often useful in determining the extent of the ligament damage. Prompt surgical intervention is required for repair or reconstruction of the torn ulnar collateral ligament, which is done on an outpatient basis. Post operative immobilization and rehabilitative hand therapy is necessary to maximize functional recovery. Prognosis for recovery from this injury is usually good with proper surgical treatment, but untreated cases can lead to chronic instability and the development of painful debilitating arthritis of the joint.

The doctors of Central Jersey Hand Surgery are experts in the treatment of ligament injuries.





Related Information
carpal tunnel syndrome
The arrow points to a gap between the scaphoid and lunate bones, indicating a complete tear of the Scapho-Lunate ligament.

carpal tunnel syndrome
X-ray after surgical repair demonstrating closure of the Scapho-Lunate gap with temporary pins.

carpal tunnel syndrome
Skier's or Gamekeeper's thumb. There is a complete tear of the ulnar collateral ligament with gross instability of the thumb metacarpophalangeal joint.