Hand and wrist ligament reconstruction

What is hand and wrist ligament damage?

The hand contains numerous bones articulating through very precisely shaped joints. These bones are held in specific position relative to each other, even when subjected to significant stress, by ligaments. These are strong bands of tough tissue which permit movement in some planes but restrict it in others. Loss of ligament integrity leads to pain as the bones no longer fit or move smoothly and, eventually, this leads to permanent damage of the joint as the cartilage wears.

Damage to these ligaments may be caused by trauma, such as a fall on to the outstretched hand or some sports such as rugby or skiing. Ligaments may also be damaged by certain inflammatory conditions such as rheumatoid arthritis and this too leads to instability.

When a ligament tear is diagnosed the main question to be answered by your surgeon is whether this has led to instability i.e. is the ligament still performing its function despite the tear, which would be partial.

This question can be answered by clinical examination, by x-ray, ultrasound and/or more elaborate tests such as MRI or CT scans.

What does treatment involve?

Partial ligament tears are often managed conservatively i.e. the ligament is protected until it heals naturally. This is achieved by limiting the movement which will stress the ligament, using a splint or, in certain situations, using a pin inserted across the joint, and is later removed. In some situations, the muscles surrounding the joint will also be strengthened with specific exercises so as to stabilise the joint.

Full ligament tears generally need surgery and it is important to operate early. These ligaments are short and tight and will, if neglected, shrink and be difficult to re-attach.

Repair of ligaments generally requires some weeks of physiotherapy and also splinting to protect the repair.

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