In today's world where computers are used in every facet of our lives, our wrists are used repetitively for many hours of the day. They are also used in almost every recreational activity such as playing musical instruments, racquet sports, throwing a ball, combing your hair or lifting your children. Driving an automobile is probably the most frequent activity in which most people use their wrists.

The wrist is a frequently injured joint. It consists of the union of the two long bones of the forearm (the radius and ulna) with the first row of the small bones within the wrist. Additionally, it contains many ligaments which are prone to frequent injury. The wrist is crossed in front, behind and on both sides by numerous long tendons coming from the muscles in the forearm. These muscles control the movement of the wrist, hand and fingers. The wrist is capable of many diverse movements.

The long bones of the forearm that make up part of the wrist joint rotate about one another. The bones of the wrist are small, shaped differently, and fit together like a jigsaw puzzle. These bones are arranged in two rows of four bones each. The row of bones closest to the fingertips is referred to as the distal row, and the row of bones nearest to the forearm is called the proximal row. The junction between the proximal row of wrist bones and the two long bones of the forearm forms the true wrist joint. The individual small bones of the wrist are held to one another and to the long bones of the forearm by an intricate network of ligaments. These provide stability while allowing movements both among the individual wrist bones and between the wrist and arm bones.

The multiple movements at the wrist joint together with its supporting ligaments and the tendons which cross the joint makes the wrist vulnerable to many different injuries.

The wrist joint is anatomically designed to bend backwards, forwards, to either side and rotate in a circular motion (cirucumduction). Many activities force the wrist joint to its extreme range of motion and may damage it. For example playing tennis, golf, baseball, bowling and mountain biking to name a few. The wrist joint may also be damaged in such simple, mundane activities such as scrubbing a pot, pushing yourself upwards from a chair, or lifting a small object in an awkward position. Other activities that may damage a wrist are small repetitive motions such as playing a violin or piano or working on a computer.

Many of these activities exhaust the muscles so that they can not always fully control the wrist joint. When this happens the strain often falls on the ligaments. The most commonly injured ligaments in the wrist are located on the thumb side A. illus. (radial collateral ligament) or the little finger side B. (ulnar collateral ligament). Various ligaments may stretch or tear and allow the wrist bones to dislocate. These subluxations may occur between individual wrist bones or between the wrist bones and bones of the forearm (forming the wrist joint).

When a fracture dislocation of the wrist joint occurs it is almost impossible to use the wrist without severe pain. The fracture dislocation should receive immediate medical attention. When there are subluxations of the wrist joint, use of the wrist is possible but there is both pain and limited movement. In both types of subluxations individual bones or the proximal row of wrist bones are malaligned with their adjacent bones. This produces adverse stresses on the controlling tendons of the wrist and fingers as well as on the adjacent stabilizing ligaments.

Subluxation are usually not fully incapacitating, allowing the person to continue to use the wrist. Continued use may produce adverse consequences, such as repetitive strain injuries and carpal tunnel syndrome. The malalignment of the bones forces the adjacent ligaments and tendons to be used at a mechanical disadvantage causing additional damage to these surrounding structures.

© copyright Ben Benjamin 2001