Ligament Injury of the Wrist in Vienna
After a fall on the hand or a twist during sport, a pain often stays behind that no X-ray explains: when you lean on the hand, when you turn the forearm. Behind it there is frequently a ligament injury — of the articular disc (TFCC), of the scapholunate ligament or of the thumb. I find out which structure is affected.
In short
When the ligaments of the wrist tear, the joint loses its guidance. Pain on the little-finger side when turning the forearm points to a TFCC tear, pain in the middle of the back of the hand with a sense of giving way rather to a tear of the SL ligament; skier's thumb affects the collateral ligament at the base joint of the thumb. I examine clinically and with ultrasound, and arrange an X-ray or an MRI where needed. Stable injuries I treat conservatively; if the joint stays unstable, arthroscopy with refixation or a ligament reconstruction come into question.
What is a ligament injury of the wrist?
The wrist is not a single joint but a composite of radius, ulna and carpal bones. Ligaments and a cartilage and ligament complex on the little-finger side guide the movement and distribute the load. If one of these structures tears — through a fall, an abrupt twist or overload — the bones no longer run cleanly on one another.
TFCC tear (triangular fibrocartilage)
Between the end of the ulna and the carpal bones lies the TFCC, a complex of a cartilage disc and ligaments. It cushions load and stabilises the connection between ulna and radius. A tear arises through a fall, an abrupt twist under load or gradual wear. If the ulna is built somewhat longer (ulna plus variant), more pressure rests on the disc — more on this under ulnar impaction syndrome; after a distal radius fracture it is often affected as well.
Tear of the SL ligament (scapholunate ligament)
The scaphoid and the lunate form the centre of the carpus, and the scapholunate ligament holds them together. If it tears, the two no longer move in step: the wrist hurts in the middle of the back of the hand and gives way when you lean on it. If the tear stays unrecognised, the distribution of load changes for good and osteoarthritis of the wrist can develop (SLAC). Because the same fall can break the bone, I always check for a scaphoid fracture as well.
Skier's thumb (tear of the collateral ligament of the thumb)
If the thumb catches in the loop of a ski pole or is forced outwards in a ball sport, the collateral ligament at the base joint of the thumb tears. The thumb swells and the pinch grip loses its strength. What matters is whether the ligament is only partly torn or detached completely: if the end of the ligament comes to lie over a tendon sheet (Stener lesion), it no longer heals back on its own.
Typical symptoms
- Pain on the little-finger side — when turning the forearm and when leaning on the hand; typical of the TFCC
- Pain in the middle of the back of the hand — when leaning on the hand and gripping firmly; a pointer to the SL ligament
- Clicking or giving way — the joint no longer feels guided
- Loss of grip strength — screw caps and door handles
- Pain at the base joint of the thumb — typical of skier's thumb
- Symptoms that remain after a fall — although the X-ray showed no fracture
How I make the diagnosis
It begins with the conversation with my patients: how the accident took its course, which movement hurts, what work and sport demand of the hand. Then I examine in a targeted way, with pressure points and stability tests for the TFCC, the SL ligament and the collateral ligament of the thumb. Ultrasound is available in the practice; with it I assess ligaments and tendons while they move. Where needed I arrange an X-ray or an MRI.
Treatment: conservative first
Not every ligament injury has to be operated on. If the joint is stable, I begin conservatively:
- Relief and immobilisation — a splint takes tension off the injured structure
- Ultrasound-guided injection — under vision, placed exactly at the painful spot
- Physiotherapy and exercise therapy — in the same building at the Orthozentrum Döbling
- Magnetic field therapy — as an accompanying measure
- PRP therapy — for stubborn irritation at the ligament attachment; I set out openly where it stands
Further conditions are shown by the overview of hand surgery in Vienna.
When an operation is necessary
If the wrist stays unstable, or if symptoms and imaging do not match, I assess the ligaments arthroscopically. Through small approaches I see the disc and the ligaments directly and treat them in the same session: a partly torn TFCC is smoothed or, near its rim, fastened back to the capsule. A freshly torn SL ligament can be refixed; if the injury goes back further, a ligament reconstruction is needed. The collateral ligament of the thumb I treat through a small open approach.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare. Whether an operation is sensible depends on the findings — and that decision I make together with you.
Frequently asked
Frequently asked questions about ligament injuries of the wrist
The typical sign is pain on the little-finger side of the wrist, where the ulna ends. It appears when turning the forearm, when leaning on the hand and when opening bottles; some also feel a click. Whether the disc is affected is shown by the examination with ultrasound and, if necessary, an MRI.
The scapholunate ligament connects the scaphoid and the lunate. If it tears, the bones tilt against each other and the distribution of load in the joint changes. If that goes unnoticed, wear can develop that is known as a SLAC wrist. This is why I rigorously investigate pain in the middle of the wrist after a fall.
Not in every case. If the collateral ligament is only stretched and the thumb stable, immobilisation followed by therapy is often enough. If the ligament is torn through and its end lies over a tendon sheet, it no longer heals back on its own — then I refix it. The decision follows the findings, together with you.
An MRI shows a great deal, but not everything: fine tears and an instability that only appears under load can escape it. Arthroscopy makes it possible to see the ligaments directly and to treat them in the same procedure. I use it where symptoms and imaging do not match.
Fresh ligaments can usually be fastened back to their origin. If the injury has gone unnoticed for longer, the ligament ends are scarred and, at the SL ligament, wear may have set in; a more elaborate replacement is then needed. If the pain after a fall does not settle, an examination is worthwhile — even when the X-ray is unremarkable.
That depends on the structure affected and on the sport. Loads that press on the little-finger side or force the thumb outwards are unfavourable while the injury is fresh; usually an alternative can be found until the joint can take load again. What is possible, I decide together with you after the examination.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. For operations, direct settlement with a supplementary private insurance is possible. Please bring previous reports and images to your first appointment; you do not need a referral.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
Related
This might concern you too
Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.