Habitual Wrist Dislocation: Causes, Risks, and Treatment Options

I would like to inquire about habitual wrist dislocation?

On October 24th of this year, I was involved in a car accident that resulted in a torn ligament in my left wrist and a dislocated bone.
I consulted two hospitals, both of which presented me with two options: 1.
Fixation with steel pins to realign the bone, followed by a six-week recovery period; 2.
Use a rigid brace for protection, and after a six-week recovery period, assess wrist mobility to decide whether surgery is necessary.
I chose option 2 at that time.
A few days later, I went to a third hospital where the doctor took X-rays of my elbow and wrist and performed a "closed reduction" (I signed a surgical consent form) to realign my elbow and wrist.
The elbow was successfully realigned, but the wrist could not be repositioned.
The doctor informed me that surgery was optional; however, if I chose not to have it, I might experience reduced grip strength in my left hand after recovery.
The doctor also mentioned that if I were not left-handed, he would not recommend surgery.
Currently, my wrist can rotate, but it feels like it gets "caught" regardless of how I move it.
Today, I returned to the third hospital where the doctor took X-rays and performed a manipulation on the wrist joint.
I heard a "pop," and afterward, my wrist felt more comfortable, with the "catching" sensation being less pronounced.
However, the doctor indicated that the dislocation issue still persists, which could affect future wrist mobility, limiting it to a certain range and potentially leading to "habitual dislocation." Therefore, he recommended a minor surgery lasting about half an hour to insert two steel pins into the bone, followed by six weeks in a cast, after which the pins would be removed (leaving only two small scars).
He also mentioned that if the surgery were delayed beyond the two-month recovery period, I might indeed need more invasive surgery.
Dr.
Shi, I would like to ask the following questions:
1.
Can habitual dislocation of the wrist be reduced on its own like a typical shoulder dislocation? (I have heard many people can reduce their habitual dislocations themselves.)
2.
Is it possible for the wrist to dislocate while driving (or riding a motorcycle)?
3.
If I do not undergo surgery, can I still engage in vigorous activities? (e.g., playing basketball)
4.
If I do not have surgery, how should I care for my wrist in the future?
Thank you for taking the time to respond, Dr.
Shi.

Xuesheng Jia, 20~29 year old female. Ask Date: 2005/12/05

Dr. Shi Guozheng reply Orthopedics

1.
Wrist joints rarely experience habitual dislocations.
However, severe injuries can lead to instability.
2.
There is no occurrence of sudden dislocation.
3.
If surgery is not performed, immobilization with a cast or splint for about six weeks is also acceptable.
4.
After six weeks, gradually begin rehabilitation, performing movements in all directions and strengthening muscle strength.
Avoid engaging in overly strenuous activities or lifting heavy objects.

Reply Date: 2005/12/05

More Info

Understanding habitual wrist dislocation involves recognizing the underlying causes, risks, and treatment options available for individuals experiencing this condition. Your situation, following a car accident that resulted in a ligament tear and bone misalignment in your wrist, highlights the complexities associated with wrist injuries and the potential for habitual dislocation.

Causes of Habitual Wrist Dislocation
Habitual wrist dislocation often occurs due to a combination of factors, including:
1. Ligamentous Laxity: Some individuals have naturally looser ligaments, making them more prone to dislocations.

2. Previous Injuries: A history of wrist injuries can weaken the joint and surrounding structures, increasing the likelihood of future dislocations.

3. Improper Healing: If a wrist injury does not heal properly, it can lead to instability in the joint, making it more susceptible to dislocation.

4. Repetitive Stress: Engaging in activities that place excessive stress on the wrist can contribute to dislocation.

Risks Associated with Habitual Wrist Dislocation
The risks of habitual wrist dislocation include:
1. Chronic Pain: Recurrent dislocations can lead to ongoing discomfort and pain in the wrist.

2. Reduced Range of Motion: Over time, habitual dislocation can limit the wrist's ability to move freely.

3. Weakness: Individuals may experience decreased grip strength and overall weakness in the affected hand.

4. Arthritis: Chronic instability and dislocations can increase the risk of developing arthritis in the wrist joint.

Treatment Options
In your case, you have been presented with two primary treatment options: surgical intervention or conservative management with a brace. Here’s a breakdown of both approaches:
1. Surgical Intervention: If the wrist continues to dislocate or if there is significant instability, surgery may be recommended. The procedure typically involves stabilizing the wrist joint by inserting screws or anchors to hold the bones in place. This can help prevent future dislocations and restore function.

2. Conservative Management: Using a brace or splint can provide support and limit movement, allowing the wrist to heal. This approach may be suitable if the dislocation is not frequent and if you are willing to modify activities to avoid exacerbating the condition.

Addressing Your Questions
1. Can habitual wrist dislocation be self-reduced like shoulder dislocations?: Unlike shoulder dislocations, which can sometimes be reduced by the individual, wrist dislocations typically require medical intervention for proper alignment. Attempting to self-reduce a wrist dislocation can lead to further injury.

2. Is it possible for the wrist to dislocate while driving?: Yes, it is possible for a wrist to dislocate during activities such as driving or riding a bike, especially if the wrist is subjected to sudden force or impact.

3. Can I engage in vigorous sports without surgery?: If you choose not to undergo surgery, it is advisable to avoid high-impact sports or activities that place significant stress on the wrist, such as basketball, until the wrist is fully healed and stable.

4. How should I care for my wrist if I opt out of surgery?: If you decide against surgery, consider the following care strategies:
- Strengthening Exercises: Once cleared by your physician, engage in rehabilitation exercises to strengthen the wrist and improve stability.

- Activity Modification: Avoid activities that put excessive strain on the wrist, especially those that involve repetitive motions.

- Use of Supports: Wearing a wrist brace during activities can provide additional support and reduce the risk of dislocation.

- Regular Check-ups: Follow up with your healthcare provider to monitor the condition of your wrist and make adjustments to your treatment plan as necessary.

In conclusion, habitual wrist dislocation is a complex condition that requires careful consideration of treatment options. It is essential to work closely with your healthcare provider to determine the best course of action based on your specific circumstances and lifestyle. By understanding the causes, risks, and management strategies, you can make informed decisions about your wrist health and overall well-being.

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