Wrist Subluxation: Causes, Symptoms, Diagnosis, and Treatment Options

What is Wrist Subluxation?

Wrist subluxation refers to a partial or incomplete dislocation of a joint within the wrist, where the joint surfaces are no longer perfectly aligned but still maintain some contact. Unlike a full dislocation, which involves complete separation, subluxation implies a degree of instability and functional impairment without total displacement.

Understanding Wrist Anatomy

To grasp wrist subluxation, it's essential to understand the intricate anatomy of this complex joint. The wrist is not a single joint but a complex series of articulations involving eight carpal bones, along with the distal ends of the radius and ulna (forearm bones).

• Bones: The radius (thumb side) and ulna (pinky side) articulate with the carpal bones. The eight carpal bones are arranged in two rows:
  • Proximal Row: Scaphoid, Lunate, Triquetrum, Pisiform
  • Distal Row: Trapezium, Trapezoid, Capitate, Hamate
• Joints: Key joints include the radiocarpal joint (between radius and proximal carpal row), midcarpal joint (between proximal and distal carpal rows), and the distal radioulnar joint (DRUJ) (between the radius and ulna).
• Ligaments: Numerous strong ligaments intricately connect these bones, providing stability and guiding motion. These ligaments are crucial for maintaining proper joint alignment. When these ligaments are stretched or torn, it can lead to instability and subluxation.

What is Subluxation?

In a general sense, subluxation refers to a partial displacement or misalignment of a bone within a joint. It's less severe than a full dislocation, where the bones are completely separated from each other. In the context of the wrist, subluxation means that one or more of the carpal bones, or the radius/ulna, have shifted out of their normal anatomical position relative to each other, but still retain some degree of contact. This partial displacement can disrupt the smooth mechanics of the wrist, leading to pain, instability, and functional limitations.

Causes of Wrist Subluxation

Wrist subluxation typically results from forces that exceed the strength and stability provided by the wrist's ligaments and joint capsules. Common causes include:

• Acute Trauma:
  • Falls onto an outstretched hand (FOOSH): This is a very common mechanism of injury, where the force of impact is transmitted through the wrist, potentially tearing ligaments and forcing bones out of alignment.
  • Direct impact: A direct blow to the wrist.
  • Sports injuries: Activities involving high impact, repetitive movements, or falls (e.g., gymnastics, wrestling, football, cycling).
• Repetitive Stress or Overuse: Chronic, repetitive movements that put strain on the wrist ligaments can gradually weaken them, leading to instability and eventual subluxation, even without a single traumatic event. This is more common in occupations or sports requiring sustained wrist motion.
• Ligamentous Laxity: Some individuals have naturally more flexible or "loose" ligaments (generalized joint hypermobility), making them more prone to subluxation with less force. Conditions like Ehlers-Danlos Syndrome can predispose individuals to such injuries.
• Degenerative Conditions: While less common as a primary cause, conditions like osteoarthritis can weaken joint structures over time, potentially contributing to instability and subluxation.
• Congenital Abnormalities: Rarely, structural abnormalities present from birth can predispose someone to wrist instability.

Common Types of Wrist Subluxation

Given the complexity of the wrist, subluxation can occur at several different joints. Some of the more frequently encountered types include:

• Distal Radioulnar Joint (DRUJ) Subluxation: This occurs when the distal ends of the radius and ulna lose their proper alignment. It's often associated with injuries to the Triangular Fibrocartilage Complex (TFCC), a critical structure that stabilizes the DRUJ. Symptoms often include pain on the pinky side of the wrist, clicking, and instability with forearm rotation.
• Carpal Subluxations: These involve the displacement of one or more carpal bones relative to each other or to the radius.
  • Scapholunate Instability: This is a common and significant injury involving the ligament connecting the scaphoid and lunate bones. A tear in this ligament can lead to the scaphoid and lunate separating and rotating, causing instability and eventual subluxation. It's often seen after FOOSH injuries.
  • Lunotriquetral Instability: Less common than scapholunate instability, this involves the ligament connecting the lunate and triquetrum.
  • Perilunate Dislocation/Subluxation: A severe injury where the carpal bones (usually the lunate) remain aligned with the radius, but the other carpal bones dislocate or sublux around them. This is a high-energy injury.
• Radiocarpal Subluxation: While less common as an isolated subluxation, it can occur in severe trauma, where the entire carpus shifts relative to the radius.

Signs and Symptoms

The symptoms of wrist subluxation can vary depending on the severity and specific joint involved, but commonly include:

• Pain: Often localized to the affected area, but can be diffuse. It may worsen with movement, especially specific wrist or forearm rotations.
• Swelling: Inflammation around the affected joint.
• Limited Range of Motion: Difficulty moving the wrist through its full range, particularly with certain movements like extension, flexion, or rotation.
• Clicking, Popping, or Grinding Sensation (Crepitus): As the misaligned bones move against each other, these sounds or sensations may be present.
• Weakness or Instability: A feeling of the wrist "giving way" or being unable to support weight. Grip strength may be significantly reduced.
• Subtle Deformity: While a full dislocation causes obvious deformity, a subluxation might present with a more subtle bump or abnormal contour.
• Numbness or Tingling: If the subluxation causes compression or irritation of nearby nerves, neurological symptoms might occur.

Diagnosis

Accurate diagnosis of wrist subluxation requires a thorough evaluation by a healthcare professional, typically an orthopedic surgeon specializing in hand and wrist conditions.

• Medical History: The doctor will inquire about the mechanism of injury, past wrist problems, and the onset and nature of symptoms.
• Clinical Examination: This involves:
  • Palpation: Feeling for tenderness, swelling, or abnormal bone positions.
  • Range of Motion Assessment: Evaluating active and passive movement of the wrist and forearm.
  • Special Tests: Specific maneuvers designed to provoke pain or instability in particular ligaments or joints (e.g., Watson's scaphoid shift test for scapholunate instability).
• Imaging Studies:
  • X-rays: Initial imaging to rule out fractures and assess gross alignment. Specific views (e.g., clenched fist views) may be needed to show instability.
  • MRI (Magnetic Resonance Imaging): Highly effective for visualizing soft tissues like ligaments, cartilage, and the TFCC, which are often involved in subluxations.
  • CT Scan (Computed Tomography): Provides detailed bone anatomy and can be useful for assessing complex carpal bone relationships or subtle fractures.
  • Dynamic Imaging: X-rays or fluoroscopy taken while the wrist is moved can reveal instability that might not be apparent in static images.
  • Arthroscopy: In some cases, a minimally invasive surgical procedure where a small camera is inserted into the joint may be used for definitive diagnosis and even treatment.

Treatment Approaches

Treatment for wrist subluxation depends on the specific joint involved, the severity of the subluxation, the extent of ligamentous damage, and the patient's activity level.

• Conservative Management: Often the first line of treatment for less severe cases or chronic instability.
  • Rest and Immobilization: Using a splint, brace, or cast to stabilize the wrist and allow ligaments to heal.
  • Ice and Elevation: To reduce swelling and pain.
  • Pain Management: Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) or prescription medications.
  • Physical Therapy: Crucial for regaining strength, flexibility, proprioception (awareness of joint position), and stability once the initial pain and swelling subside. This may include strengthening exercises for the wrist and forearm muscles, range of motion exercises, and stabilization drills.
• Medical Interventions:
  • Corticosteroid Injections: May be used to reduce localized inflammation and pain, but are not a long-term solution for instability.
• Surgical Intervention: Considered when conservative measures fail, for acute severe subluxations, or for specific types of instability that require direct repair.
  • Ligament Repair or Reconstruction: Directly repairing torn ligaments or using a graft (from another part of the body or a donor) to reconstruct damaged ligaments.
  • Arthroscopy: Minimally invasive surgery to visualize and, in some cases, repair internal joint structures.
  • Partial or Complete Wrist Fusion: In severe, chronic cases with significant degenerative changes and persistent pain, fusing certain bones together can provide stability and pain relief, though it sacrifices some range of motion.
  • Excision Arthroplasty: Removal of small bones (e.g., proximal row carpectomy) to reduce pain and improve motion in specific degenerative conditions.

Rehabilitation and Return to Activity

Rehabilitation is a critical component of recovery from wrist subluxation, whether treated conservatively or surgically. A structured physical therapy program will guide the process.

• Phased Approach: Rehabilitation typically progresses through phases:
  • Protection Phase: Focus on pain reduction, swelling control, and protecting the healing structures.
  • Mobility Phase: Gradual restoration of pain-free range of motion.
  • Strengthening Phase: Progressive resistance exercises for the wrist and forearm muscles to improve stability and function.
  • Proprioception and Functional Training: Exercises to improve joint awareness and prepare the wrist for specific activities or sports.
• Adherence to Program: Consistent adherence to the physical therapy program is paramount for optimal recovery and preventing recurrence.
• Gradual Return to Activity: A carefully planned return to sport, work, or daily activities is essential. This often involves specific drills and a progressive increase in intensity and duration to ensure the wrist is adequately prepared for stress.

Prevention Strategies

While not all wrist subluxations can be prevented, especially those from acute, high-impact trauma, several strategies can reduce the risk:

• Proper Technique: In sports, weightlifting, and occupational tasks, using correct form and technique minimizes undue stress on the wrist joints.
• Strengthening Wrist and Forearm Muscles: Regular exercises that strengthen the muscles surrounding the wrist (e.g., wrist curls, reverse wrist curls, grip exercises) can enhance joint stability.
• Flexibility and Mobility: Maintaining good wrist flexibility can help absorb forces more effectively.
• Protective Gear: Wearing wrist guards during high-risk activities (e.g., snowboarding, rollerblading, gymnastics) can significantly reduce the risk of injury during falls.
• Listen to Your Body: Avoid pushing through pain or discomfort. Persistent wrist pain should be evaluated by a healthcare professional.

When to Seek Medical Attention

If you experience sudden, severe wrist pain, swelling, deformity, or a noticeable loss of function after an injury, seek immediate medical attention. For persistent wrist pain, clicking, instability, or weakness that interferes with daily activities or training, consult a healthcare professional, especially one specializing in orthopedic hand and wrist conditions. Early diagnosis and appropriate treatment are key to preventing chronic pain, instability, and long-term complications.