gms | German Medical Science

Objectives: We reviewed Clients in a medico legal setting with persisting symptoms after wrist injuries.

Method: 68 wrist injuries were seen for the purpose of a medico legal report. Clients with persisting symptoms were identified and included in this review. They had to fulfil criteria of a previous trauma with ongoing pain, positive findings on examination, functional impairments and/or a restricted function. They underwent stress views and Arthro-MRI to identify the underlying cause.

Results: Out of 68 patients, 22 Clients could be identified on average 13 (3 to 36 months) months after their injury. All Clients described a hyperextension type of injury as a result of a fall or an involvement in a road traffic accident (RTA).

All CLients complained of immediate pain and swelling. 20/22 patients had initial X- rays. 5 scaphoid fractures, 3 fractures to the radial styloid, 2 radius fractures, 1 perilunate dislocation, and 1 ulna fracture could be identified. 7 images were normal.

Cast immobilization alone (15/22) took place over a period of 10 weeks (4 to 108 weeks). 16 Clients had physiotherapy that was regarded as helpful in 5/16 patients.

In 13 Clients, further stress views were requested, 11/13 Clients revealed a widening of the SL interval with an average of 2,7 mm (1,8 to 3,8 mm). In the 2 Clients with an SL gap of less than 1,8 mm, a previous scaphoid fracture and degenerative changes of the CMC joint were found. The Kirk Watson Test and tenderness over the anatomical snuffbox correlated with a gap formation (p = 0,9829).

In 12 cases, tears of the SL ligament could be confirmed. 1 Client had a non-union of a scaphoid fracture, 1 degeneration to the CMC joint, 2 a TFC tear. All 12 cases with evidence of an SL ligament involvement correlated with widening of the SL interval of more than 1,8 mm. 3 of them occurred with a scaphoid fracture.

In Clients without MRI, a widening of the SL interval coincided with an ulna styloid fracture, a perilunate dislocation and one unknown cause.

Conclusion: Wrist injuries are common and may produce persisting symptoms. In almost 50%, injuries to the SL ligament can be identified. Clinically, suspicion should be raised in patients with ongoing symptoms with their manual tasks and at least one positive criterion during their physical examination.