Common wrist injuries ( scapholunate ligament tear + ganglion/ TFCC/ dequevain's tenosynovitis )

Definition of DeQuevain’s tenosynovitis

Stenosing tendinopathy  Structures involved:  APL + EPB tendons in first extensor compartment in wrist

MOI + symptoms ( DeQuevain’s tenosynovitis )

MOI	Onset: gradual  Causes:  Overuse → post partum  Post-traumatic
Symptoms	Severity:  Acute onset severe  Moderate/ recent onset Moderate chronic onset  Other structures affected: superficial branch of radial nerve

Clinical tests ( DeQuevain’s tenosynovitis)

1. True Finkelstein → irritable 

2. Eichoff → false positive 

3. What → best sensitivity 

4. EBP resisted 

5. AbPL resisted 

6. Palpation: first extensor compartment

Advice + edu / splint (DeQuevain’s tenosynovitis)

	Details
Advice + education	MOI: overuse  Timeframe Identify provocative activity  Task modification
Rest w/ splints	Immobilisation forearm based thumb splint  Severe: thermoplastic  Mild: neoprene  Regression: taping   —> stopping excessive thumb E + abd → consider: duration of splinting

Therapeutic ex + other (DeQuevain’s tenosynovitis)

Therapeutic ex	Radial nerve glides  Pain free tendon glides
Other	Heat/ massage  Local application of non-steroidal creams  Ultrasound guided HCLA injection

Definition + clinical presentation of scapholunate interval

	Detail
Definition	Herniation arising from SL capsule
Clinical presentation	Common in young females  Variable size

Mx of scapholunate interval

Conservative: 

Symptomatic: splint 

Avoid WB 

Ergonomic/ training advice

Surgical if needed

MOI ( scapholunate ligament tear )

• MOI = FOOSH OR  acute stress load of the wrist in extension and ulnar deviation OR repetitive trauma while the wrist is in extension

Classfication ( scapholunate ligament tear )

	Integrity of SL ligament	Other ligaments/ structures damaged	Aggravating movements	X ray
Pre-dynamic	Partial tear	May have RSL tear	Load	Normal
Dynamic	Incompetent	Partial extrinsic ligament damage	X move smoothly w/o sudden carpal motion	Normal  Stress view: diagnostic
Dissociation	Complete tear	Extrinsic ligament damage	Mechanical instability	Abnormal

Presentation + test ( scapholunate ligament tear )

Presentation	Palpation:  SL interval tenderness  Pain + clicking in wrist Observation: swelling; dorsal wrist
Test	Movement exam:  ↓ RoM + grip + WB  Clicking  Special test: Watson’s scaphoid shift → positive: painful clunk  Imaging: MRI

Mx ( scapholunate ligament tear )

Goals	Mx methods
Reduce symptoms	Early: splint
Restore pain free functional RoM	Dart throwing motion  Functional RoM  Avoid E
Promote neuromuscular control	Strengthen SL friendly muscles  ECRL  APL  FCR  → avoid working in supination

*surgical Mx: higher demand young adult 

MOI (TFCC Injury)

Traumatic:  Fall on extended wrist w/ pronation  Degenerative:  Positive ulnar variance  Repetitive ulnar deviation

Presentation ( TFCC Injury )

Location of pain: Ulnar side wrist pain 

Provocative test: 

1. Palpation of ulnar fovea 

2. TFCC grind/ load: tears/ ulnocarpal abutment 

3. Relocation/ pisiform boost test

Diagnosis (TFCC Injury )

Clinical presentation + MRI

Mx (TFCC Injury)

Conservative: splinting

Therapeutic ex:

Purpose: dynamic stability

Pronator q: resistance w/ elbow F —> hold end of theraband w/ foot

Extensor carpi ulnaris —> do w/ theraband + stabilise wrist overhead

—> start isometric + add resistance