Condition |
Location |
Clinical features |
Radiographic findings |
Associated activities |
Simple sprain |
Dorsal |
Mild pain or stiffness at full wrist flexion or extension or both, normal range of motion; resolves in two weeks |
Wrist series is normal |
|
Distal radius fracture |
Radial |
Common during adolescent growth spurt; point tenderness, swelling, ecchymosis, decreased grip strength |
Fracture on standard wrist series |
Impact sports; fall on extended wrist |
Scapholunate instability |
Radial |
Swelling, focal pain and tenderness, decreased range of motion, decreased grip strength, positive scaphoid stability test (but may not be able to tolerate) |
Increased scapholunate distance on AP view; increased scapholunate angle on lateral view; but may be normal |
Impact sports; racquet, stick, and club sports; fall on extended wrist |
Scaphoid (navicular) fracture |
Radial, dorsal |
Tenderness in anatomic snuffbox; decreased range of motion in flexion and extension; positive scaphoid compression test |
Fracture may be seen on AP view with ulnar deviation; may need scaphoid series. Initial radiographs may not demonstrate fracture. When suspected, thumb spica splinting and repeat radiographs in 7 to 10 days should be performed. Bone scan or MRI can demonstrate fracture sooner when earlier diagnosis is necessary (eg, elite athletes). |
Impact sports, particularly football; fall on extended wrist |
Midcarpal instability |
Ulnar |
Sulcus in the dorsal ulnar wrist border; painful clunk with active ulnar deviation |
Dislocaton on standard wrist series |
|
Distal ulnar fracture |
Ulnar, dorsal |
Usually occurs with distal radius fracture; associated with TFCC injury |
Fracture on standard wrist series |
Impact sports |
Triquetral fracture |
Ulnar, dorsal |
Point tenderness over the triquetrum or on the ulnar border, distal to the ulnar styloid |
Fracture on standard wrist series |
Impact sports |
Lunotriquetral ligament instability |
Ulnar, dorsal |
Tenderness of the lunotriquetral ligament in the ulnar snuff box; positive lunotriquetral shear test |
Usually normal; may be step-off along proximal carpal row; associated with positive ulnar variance |
Impact sports |
Triangular fibrocartilage complex (TFCC) tears |
Ulnar, dorsal |
Point tenderness over the lateral wrist just distal to the ulnar styloid; pain with forced ulnar deviation or TFCC compression test |
Associated (but not diagnostic) findings: widening of DRUJ space, positive ulnar variance, fracture of ulnar styloid on AP; dislocation or subluxation on lateral. MRI with intra-articular contrast is most sensitive means of identifying TFCC injury |
Impact sports; racquet, stick, and club sports; gymnastics |
Distal radioulnar joint (DRUJ) injury |
Ulnar, dorsal |
Pain with supination and pronation; positive DRUJ compression or piano key tests |
Dislocation can be seen on plain radiographs and these should include AP and lateral views of the forearm to assess for an associated radial fracture (Galeazzi fracture); MRI may be necessary to identify instability |
Impact sports; racquet, stick, and club sports; gymnastics |
Hamate hook fracture |
Ulnar, palmar |
Pain with sports but not daily activities; point tenderness over the hook of the hamate |
Fracture best seen on 45° supination oblique or carpal tunnel view or with CT |
Racquet, stick, and club sports |
Pisiform fracture |
Ulnar, palmar |
Pain with palpation of the pisiform and hypothenar eminence |
Fracture on standard wrist series |
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