Chronic Wrist Dislocation: Treatment Options and Limitations

The issue of habitual dislocation of the wrist's radial and ulnar joints?

Hello, Director Shi.
Three years ago, I suffered a wrist injury involving the distal radioulnar joint, which has resulted in chronic dislocation and pain.
X-rays show that the ulnar bone is dislocated and misaligned.
I have already undergone reconstruction of the distal radioulnar joint using the palmaris longus tendon, but within six months, I experienced another dislocation, which has been extremely painful and frustrating.
It has significantly impacted my daily life.
A hand surgeon has recommended a joint fusion procedure.
I would like to ask the doctor what activities would be restricted after the fusion surgery.
Will I be unable to rotate my wrist? To what extent will my mobility be limited? Additionally, aside from fusion surgery, what other options are available to prevent recurrent dislocations? I am only 27 years old.

Shu Wei, 20~29 year old female. Ask Date: 2016/08/17

Dr. Shi Guozheng reply Orthopedics

After fusion surgery, there may be some limitations in wrist rotation, but pain will improve, and wrist function will also enhance.
Besides this, there doesn't seem to be a better alternative.

Reply Date: 2016/08/17

More Info

Chronic wrist dislocation, particularly involving the distal radioulnar joint (DRUJ), can be a challenging condition to manage, especially after previous surgical interventions such as reconstruction. Your situation, having experienced a chronic dislocation following a wrist injury three years ago, indicates that the joint has not stabilized despite surgical attempts. The pain and functional limitations you are experiencing are common in such cases.

Understanding the Condition
Chronic dislocation of the wrist can lead to significant pain and dysfunction. The distal radioulnar joint is crucial for wrist stability and function, allowing for the rotation of the forearm. When this joint is dislocated, it can result in pain, swelling, and a decreased range of motion. The fact that you have undergone a reconstruction procedure but are still experiencing dislocation suggests that the underlying stability of the joint has not been adequately restored.

Treatment Options
1. Joint Fusion (Arthrodesis): This is a common surgical option for chronic dislocations that do not respond to conservative treatments or previous surgeries. The procedure involves fusing the bones of the joint together, which eliminates motion at that joint but can significantly reduce pain and improve function.
- Post-Surgery Limitations: After a fusion, you will experience limitations in wrist motion. Specifically, you will lose the ability to rotate your forearm (pronation and supination) at the fused joint. This means activities that require wrist rotation, such as turning a doorknob or using a screwdriver, may be challenging. However, many patients find that the trade-off of reduced pain and improved stability outweighs these limitations.

2. Alternative Surgical Options: If you are hesitant about fusion due to the loss of motion, there are other surgical options to consider:
- Soft Tissue Repair: This may involve repairing or reconstructing the ligaments around the joint to improve stability without fusing the bones.

- Prosthetic Joint Replacement: In some cases, a prosthetic joint can be used to replace the damaged joint, allowing for some motion while providing stability.

- Arthroscopic Procedures: Minimally invasive techniques can be used to clean out the joint, repair ligaments, or even stabilize the joint without a full fusion.

3. Rehabilitation: Regardless of the surgical option chosen, rehabilitation is crucial. Physical therapy can help strengthen the surrounding muscles, improve range of motion in other joints, and adapt to any limitations post-surgery.

Limitations and Considerations
- Activity Restrictions: After fusion, you may need to avoid high-impact activities or sports that put stress on the wrist. Activities that require wrist rotation will be particularly affected.

- Long-term Outcomes: While fusion can significantly reduce pain and improve function, it is essential to have realistic expectations about the loss of motion. Many patients adapt well and find ways to perform daily activities with modified techniques.

- Age and Activity Level: At 27, considering your age and activity level, it is essential to weigh the benefits of pain relief against the potential loss of motion. Engaging in discussions with your orthopedic surgeon about your lifestyle and goals can help tailor the best approach for you.

Conclusion
Chronic wrist dislocation can significantly impact your quality of life, and while joint fusion is a viable option, it is essential to consider all potential treatments and their implications. Consulting with your orthopedic surgeon about the best course of action, including the possibility of alternative surgeries or rehabilitation strategies, will help you make an informed decision that aligns with your lifestyle and functional goals.

Similar Q&A

Managing Chronic Left Wrist Dislocation: Treatment Options and Solutions

Several years ago, my left hand was caught in a machine. At that time, there was only soft tissue injury, and no fractures were found. Later, when I consulted a traditional Chinese medicine practitioner, it was discovered that my hand was dislocated. Since then, my left hand has ...

Dr. Shi Guozheng reply Orthopedics
Consult a physician to determine if surgical treatment is necessary.

Understanding Ulnar Dislocation: Treatment Options and Recovery Time

Hello doctor, I slipped while playing at the swimming pool and instinctively used my hand to brace myself. As a result, I heard a cracking sound. I went to see a doctor and was diagnosed with a dislocated ulnar bone in my wrist. I need to maintain a fixed position to allow the bo...

Dr. Li Yongheng reply Orthopedics
Hello, based on your symptoms, it appears that you have a dislocation of the wrist's distal radioulnar joint. I recommend performing a percutaneous pin fixation surgery, after which the pins can be removed in three weeks during an outpatient visit. Maintaining the position w...

Managing Chronic Wrist Pain: Non-Surgical Options and Insights

Hello Doctor, I have been experiencing pain in my left wrist for over six months. Sometimes it hurts when I check the time on my watch, and I feel weak when lifting heavy objects. Initially, I consulted a doctor who took X-rays and mentioned a subluxation of the distal radioulnar...

Dr. Shi Guozheng reply Orthopedics
Wearing a wrist brace to reduce the intensity and frequency of use, taking some anti-inflammatory medication, and observing for a period of time to see if there is improvement. If there is no progress, then consider undergoing surgery.

Understanding Wrist Ligament Injuries: Diagnosis, Treatment, and Risks

Hello, how can I determine if there is an injury to the wrist ligaments, and what tests should I undergo? What is the difference between a complete ligament tear and a partial tear? What are the different treatment options? If surgery is not performed, what potential complication...

Dr. Chen Xingyuan reply Orthopedics
Dear Netizens, Wrist ligament injuries are very common in the wrist area, but making an accurate diagnosis clinically can be quite challenging. This is due to the complex structure of wrist ligaments, which consist of many ligaments of various sizes. Among wrist ligament injurie...