Surgery for Wrist Sprain

While many wrist sprains may be managed with non-surgical treatment methods, others may require surgical procedures.

There are many types of surgeries to treat wrist sprains. Depending upon the injury, wrist surgery may be performed arthroscopically through a small incision, or through open surgical procedures. In the arthroscopic approach, a small tube with a lens and light is inserted into the wrist joint. The lens is connected to a monitor, so the surgeon can view internal structures and tissues. Sometimes, more than one procedure may be performed during a single surgery

• Closed reduction and pinning. In this arthroscopic procedure, a doctor stabilizes the injured ligament by re-aligning the carpal bones, a process called reduction. Once reduction is achieved, special hardware—K-wires or pins are used to stabilize the carpal bones. These wires may be drilled through the bone to hold two bones in place. This hardware may be below or through the skin and is usually removed once healing is complete.
• Thermal shrinkage. Thermal shrinkage involves a specialized radiofrequency probe that uses heat to shrink and tighten a damaged ligament. This treatment results in improved stability.
• Capsulodesis. Capsulodesis is a procedure involving the creation of a flap in the wrist’s joint capsule. The flap is placed over the injured ligament in order to secure it and promote healing. There are many variations to this technique, each suited for a different type of ligament injury.
• Tenodesis. Tenodesis is a procedure used to stabilize a joint by anchoring tendons close to the joint. Stability is achieved by looping the tendon around the joint using sutures or wires. This technique may be used to stabilize carpal bones that may have misaligned due to ligament tears. More than one tenodesis procedure may be performed on various tendons in order to achieve proper stability. Usually, the anchoring wires are removed 8 weeks after surgery.¹Garcia-elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am. 2006;31(1):125-34.
• Ligament reconstruction. In cases involving significant ligament tears, the wrist ligaments may be reconstructed using tendon grafts. Tendon strips are either attached or drilled through the carpal bones to achieve carpal stability.
• Proximal row carpectomy, arthrodesis, and arthroplasty. These procedures are only used when ligament injuries fail to heal, and arthritis develops over several years.

The scapholunate ligament, lunotriquetral ligament, and less commonly unstable triangular fibrocartilage complex (TFCC) tears are treated using surgical procedures in severe wrist sprains.

Recovery and Risks After Wrist Ligament Surgery

Recovery after a wrist surgery depends on the surgical procedure involved. While some surgeries heal in a few weeks, many take a few months for complete recovery. Some surgeries will require wearing a cast or removable brace for several weeks.

A physical therapy program after surgery is usually followed to improve strength and flexibility in the wrist joint. A small degree of reduced flexibility and formation of mild scar tissue is common in all wrist surgeries and is not considered as a complication or risk.²Gella S, Giuffre JL, Clark TA. Management of complications of ligament injuries of the wrist. Hand Clin. 2015;31(2):267-75.

Factors that may influence the restoration of strength and function after a wrist ligament surgery include one or more of the following:

• Severity of injury (whether ligament injury is combined with injury to the bone or cartilage)
• Type of wrist surgery
• Time elapsed before surgical treatment
• Demands made on the wrist after surgery (for example, playing sports)

Wrist ligament surgeries are generally considered safe. However, as with any surgery, certain complications may occur. Failure of ligament healing, loss of ligament and bone alignment, infection, motion loss, weakness, and/or development of arthritis are the potential risks associated with wrist surgeries. In such cases, additional surgery may be needed.