Arm, shoulder and hand injuries

Wrist Instability

What is wrist instability?

Wrist stability is when there is normal alignment of these bones so that the wrist forces move through the wrist in harmony and the hand is able to achieve a vast array of activities.  A wrist instability is when there is abnormal motion of the wrist, which is usually due to ligament injury and therefore boney mal alignment.

Wrist instability occurs when one or more of the wrist ligaments have lost their integrity, are lax, or damaged. The common main ligaments in the wrist are the scaphoid-lunate (SL) ligament and the triangulo-fibrocartilage complex (TFCC). The loss of ligament integrity alters the normal wrist mechanics of the eight wrist carpal bones and so consequently affects your normal hand function. You may feel that your wrist is uncomfortable to lift things or that your wrist gives way or clicks/clunks.Over time your wrist becomes quite painful. In general, a complete rupture of the wrist ligaments could result in wrist arthritis if not treated properly.

There are eight carpal bones in your wrist.  These are shown below, along with the scapho-lunate ligament and triangulo-fibrocartilage complex.  You can see they are on both sides of the wrist so essential to bring wrist stability to enable you to be able to lift and use your hand in a myriad of tasks.  The scapho-lunate wrist ligament is relatively thick and runs the full way -from the front to the back of the wrist- between the scaphoid and lunate bones. It is very important as the scaphoid is the fulcrum of the wrist movements, so this ligament helps direct the movements of the other wrist bones, so the wrist can complete a variety of tasks.  The rotation of the scaphoid enables the wrist to achieve full extension.  Therefore, when the scaphoid-lunate ligament is injured or disrupted the wrist is not able to achieve full extension and it is very painful to push down through an extended wrist.  Like when you use your hands to push up from the sitting position.  This ligament also provides wrist stability to lift heavy objects as it holds the wrist stable when forces move from the large radial bone through the wrist.  This ligament contributes to the radial stabilisation of the wrist.  

The triangulo-fibrocartilage complex is on the ulna side of the wrist. It is especially noticeable with rotational movements like turning the steering wheel or opening the door.  It is made up of the fibrocartilage articular disc, the meniscal homologue, the palmar and dorsal radio-ulnar ligaments, the ulnar capsule, the Extensor Carpi Ulnaris (ECU) tendon sub sheath, the distal radio ulnar joint (DRUJ) and the ulnocarpal joint.  The TFCC is injured primarily in twisting positions and often associated with a high mechanical force.  When damaged it may feel like the wrist gives way or there is pain with rotation movements.  This structure contributes to the ulna stability of the wrist.

A wrist ligament injury occurs with a strong force(usually into hyperextension or twisting), with chronic loading of the ligament, or repetitive forceful gripping.

All ligaments are richly innervated with neural receptors and neuromuscular transmitters.  So not only do you experience an unstable wrist when they are damaged, but you lose your ability to know where your hand is in space and your ability to automatically know when and how strongly to move and respond to forces put through your wrist.  This is generally called proprioception.

At The Hands Physio, wrist instability is often treated with very successful results.  We focus on restoring the stability and proprioception to your wrist so the forces align normally to enable your hand to function like before it was injured.  It is very rewarding to see our patients diligently work on their treatment and exercise programs to see stability return to their wrists.

What may I experience?

  • Clunking /clicking of wrist, or wrist feels like it’s ‘giving way’
  • An inability to lift things
  • Pain with palpation over dorsum of wrist
  • Pain with end range or rotation
  • Pain with weight bearing, unable to push down through wrist to stand up
  • Difficulty turning or twisting things - especially when driving or opening a door

What should I do?

Wrist Instabilities are complex in nature and rehabilitation. Initially, your therapist will splint/or tape your wrist. Added to your therapy program are measures to address your pain, swelling, instability, strengthening and proprioception. You will need to be diligent with a home program of exercises to achieve the best result.

Infographic of scapho-lunate ligament and lunate-triquetral ligament

What can I expect?

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