Wrist Injuries

I have two colleagues that unfortunately didn’t stick to their day jobs as physicians and have taken up boxing. Both have the same instructor. Both within a short time span each tore the major ligaments in their wrists, one from hitting a heavy bag and one from just a focus mitt. Also at the same time I had a professional heavy weight boxer from an uppercut, also rupture the main ligaments in his wrist. All three underwent minimally invasive surgery to correct their problems. After several months of recovery, my colleagues to my dismay have recovered and returned to full sports activity, even boxing. The professional boxer has had two bouts winning both, the first a knockout 45 seconds into the match with the injured wrist landing the decisive blow.

The key to wrist pain is that if the pain does not subside in a week, you may have a serious injury. Wrist injuries must be evaluated by an orthopedic wrist specialist. The key is to determine if just a minor strain or tendonitis that will get well with time or a ligament or cartilage tear that has a time period of about 3 months to treat with minimally invasive surgery to hopefully return you to a full function.

As a fighter, the key is proper wrapping/taping and proper punchingtechniques as well as maintaining flexibility. This is the key to preventing most hand and wrist injuries in combat sports.

Anatomy

The wrist joint is comprised of eight small bones that are arranged in two rows between the forearm bones (radius and ulna) and the hand bones (the metacarpals). The row closest to the forearm is the proximal row and the one closest to the hand is the distal row. The joint between the forearm and proximal row is the radio-carpal joint/ ulno-carpal joint and the joint between the proximal and distal rows is the mid-carpal joint. The three bones in the proximal row that are most susceptible to injury are the scaphoid (S), lunate (L), and triquetrum (T). There are short ligaments, intrinsic, that span between these bones, the scapho-lunate (SL) and the luno-triquetral ligaments (LT). These ligaments are relaxed most of the time allowing some movement between adjacent surfaces and become taut during strenuous activities such as power grasping. Larger ligaments, extrinsic, are at the anterior or palmar aspect of the wrist and span between the radius or ulna and the proximal and distal rows. The triangular fibrocartilage (TFC) is a triangular-shaped cartilage disc that attaches at the edge of the radius bone at the base of the triangle and attaches to the end of the ulna at the apex of the triangle. This provides a sling for the adjacent surfaces of the triquetrum and lunate.

Causes

With significant injuries, the intrinsic and extrinsic ligaments become torn leading to obvious separation of bones on plain radiographs. The most common injuries occur to the intrinsic ligaments with a resulting tear with or without instability (abnormal shifting of bones can cause discomfort and with time traumatic arthritis). This instability usually occurs with stressful activity of the wrist following the original injury. The scapho-lunate ligament injury can result from a fall on an outstretched forward or backward bent wrist or from violently gripping an object or from punching or striking with the wrist in an awkward position. Injuries to the luno-triquetral ligament tend to occur from a fall on an outstretched wrist with a force directed toward the palmar ulnar aspect of the wrist or from forceful forearm rotation. The TFC injuries usually occur from torquing injuries or a fall on an outstretched wrist.