Wrist Pain: Ligament Tears and Radioulnar Separation

The right wrist has a separation of the radius and ulna, with ligament rupture?

Due to weakness in my writing hand, I underwent X-rays, arthroscopy (with contrast), and CT scans of my right wrist at a major hospital.
The X-rays compared both hands (with the left hand being normal) and revealed a wider gap in the bone of my right wrist.
Since the doctor did not explain it clearly, I researched images and medical terminology, discovering that the gap is between the ulnar and radial bones of the wrist.
To confirm the findings, I had further arthroscopy of the right wrist (with contrast).
During the report review, I noticed that the contrast agent leaked out from the gap between the ulnar and radial bones of my right wrist, while other areas appeared normal.
The doctor briefly mentioned that the gap might be the reason for my weakness, but prior to visiting the major hospital, I had also undergone X-rays at a general orthopedic clinic, where a similar condition was noted.
However, the orthopedic doctor at that time stated that this gap would not be the cause of my writing weakness.

I would like to ask if the gap between my radial and ulnar bones in my right wrist (where the contrast agent leaked out) indicates a ligament tear.
In a normal wrist, wouldn’t the contrast agent injected into the wrist leak out due to the gap between the ulnar and radial bones? Currently, I am wearing a wrist brace and observing for three months, and if it does not close, surgery will be considered.
My confusion lies in the fact that I have never experienced pain or numbness; my only symptom is weakness in writing.
The imaging results show a separation in the bone gap—does this imply a ligament tear? If so, is wearing a wrist brace effective (as I have had weakness for over a year, with no other strenuous activities, and my symptoms have not improved)? The weakness in my writing is a significant concern for me, and I hope to better understand my report results to further contemplate treatment options.

Xiao Fang, 10~19 year old female. Ask Date: 2016/02/10

Dr. Hong Ximing reply Orthopedics

The separation of the distal radius and ulnar bones is typically caused by an injury.
If heavy lifting is not possible, it does not affect overall function, but a wrist brace is needed for protection.
Surgical fixation may have some impact on future functionality.

Reply Date: 2016/02/10

More Info

Wrist pain, particularly in the context of ligament tears and radioulnar separation, can be quite complex and often requires a thorough understanding of the anatomy and mechanics of the wrist joint. Based on your description, it seems that you have undergone extensive imaging studies, including X-rays, CT scans, and an arthrogram, which have revealed a widening between the radius and ulna at the wrist joint. This finding raises several important considerations regarding your symptoms and potential treatment options.

Firstly, the widening you observed between the radius and ulna could indeed suggest a disruption in the normal anatomical relationships of the wrist. In a healthy wrist, the distal ends of the radius and ulna should be closely apposed, allowing for proper function and stability. When there is a separation, it may indicate a ligamentous injury, particularly involving the triangular fibrocartilage complex (TFCC), which plays a crucial role in stabilizing the distal radioulnar joint (DRUJ). A tear in the ligaments or the TFCC can lead to instability, which might explain your symptoms of weakness when writing.

Regarding your question about the contrast agent leaking from the space between the radius and ulna, this could indeed indicate a disruption in the integrity of the ligaments or the joint capsule. In a normal wrist, the contrast should remain contained within the joint space. If the contrast is leaking out, it suggests that there is a defect or tear that is allowing the fluid to escape, which is consistent with a ligament injury.

It is also noteworthy that you mentioned not experiencing pain, numbness, or tingling, which can sometimes accompany ligament injuries. The absence of these symptoms does not rule out a significant injury, as some individuals may experience weakness or instability without acute pain. The weakness you describe when writing could be due to the instability of the joint rather than direct pain, as the muscles may not be able to effectively stabilize the wrist during fine motor tasks.

Wearing a wrist brace can be beneficial in providing support and stability to the wrist joint, especially if there is ligamentous injury. The brace can help limit excessive movement and allow the ligaments time to heal. However, if there is significant instability or if the ligaments are completely torn, a brace alone may not be sufficient for long-term resolution of symptoms. In such cases, surgical intervention may be necessary to repair the damaged ligaments and restore normal function.

Given that you have been experiencing weakness for over a year without improvement, it may be prudent to discuss further options with your orthopedic surgeon. They may consider additional imaging or even a surgical evaluation if conservative management does not yield results. It is essential to have a clear understanding of the specific nature of your injury, as this will guide the appropriate treatment plan.

In summary, the widening between the radius and ulna could indicate a ligament tear, particularly involving the TFCC. The leaking of contrast suggests a disruption in the joint integrity. While wearing a wrist brace may provide some support, it is crucial to follow up with your healthcare provider to explore further treatment options, especially if symptoms persist. Understanding the underlying cause of your wrist weakness will be key to determining the most effective course of action.

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