Q: I've been hobbling along for months now with wrist pain -- mostly along the pinky side but the whole wrist hurts. Sometimes it swells up and starts to click. It's starting to affect my bowling score so I guess it's time to do something about it. The question is what? Would an X-ray help? I know it's not broken but I don't know what's wrong.
A: Wrist pain along the ulnar side is the main symptom of a condition called a triangular fibrocartilage complex tear (TFCC). It is triangular in shape and made up of several ligaments and cartilage. The TFCC makes it possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side). It stabilizes the distal radioulnar joint while improving the range of motion and gliding action within the wrist.
This is a simple explanation of a very complex injury. Mild injuries of the TFCC may be referred to as a wrist sprain. As the name suggests, the soft tissues of the wrist are complex. They work together to stabilize the very mobile wrist joint. Disruption of this area through injury or degeneration can cause more than just a wrist sprain. A TFCC injury can be a very disabling wrist condition.
The pain is made worse by any activity or position that requires forearm rotation and movement in the ulnar direction (toward the little finger). This includes simple activities like turning a doorknob or key in the door, using a can opener, or lifting a heavy pan or gallon of milk with one hand. Certainly lifting and throwing a bowling ball forward would trigger similar symptoms.
Other symptoms include swelling; clicking, snapping, or crackling called crepitus; and weakness, which may translate into a lower bowling score. Some patients report a feeling of instability, like the wrist is going to give out on them. You may feel as if something is catching inside the joint. There is usually tenderness along the ulnar side of the wrist.
TFCC injuries can be difficult to accurately diagnose. X-rays may show a difference in length between the two forearm bones (called variance). When one of these two bones is longer (or shorter) than the other, it is considered a risk factor for wrist pain and disruption of the triangular fibrocartilage complex. The surgeon may also be able to see something called the sag sign on X-rays. One of the carpal bones has shifted in position (sagged); this is an indication of instability.
In addition to X-rays, imaging with magnetic resonance arthrography (MRA) may be needed. A special dye is injected into the joint to show areas of damage and especially disruption of the joint. The most accurate way to diagnose TFCC is with arthroscopic examination.
Treatment for wrist problems like yours requires accurate diagnosis first. Make an appointment with a hand surgeon or other available orthopedic surgeon and get the process started. The sooner treatment is started, the sooner healing can begin. Until you know for sure what's going on, you may want to stop bowling or any repetitive tasks that aggravate the problem.
Reference: Kevin Roenbeck, MD, and Joseph E. Imbriglia, MD. Peripheral Triangular Fibrocartilage Complex Tears. In The Journal of Hand Surgery. October 2011. Vol. 36A. No. 10. Pp. 1687-1690.
