Difficulty Diagnosing Wrist Dorsal Radiocarpal Ligament TearsIt isn't always possible to identify wrist instability from ligamentous tears using imaging studies. Sometimes only an arthroscopic exam can make the final diagnosis. These were the findings of a retrospective (looking back) study of 64 patients with chronic wrist pain.
Thirty-five of the 64 patients had a dorsal radiocarpal ligament (DRCL) tear. The DRCL is a broad ligament along the back of the wrist that helps stabilize the wrist. When it is torn or damaged, wrist pain and instability can occur.
In most of these cases, the patients did not recall a specific injury or traumatic event causing the problem. It's possible that repeated wrist motion could cause fraying or deformity of the ligament. Only five of the patients had an isolated DRCL tear. All the rest had some other damage in the wrist such as another ligament tear.
Without an intact and functioning DRCL, the wrist can become painful and unstable. The results of this study show that there are no clinical signs or tests that can properly identify a DRCL tear. MRIs and X-rays did not show any sign of instability.
The author suggests arthroscopic exam for chronic wrist pain that doesn't respond to conservative care. Once an accurate diagnosis is made, then the correct treatment can be applied.
David J. Slutsky, MD. The Incidence of Dorsal Radiocarpal Ligament Tears in Patients Having Diagnostic Wrist Arthroscopy for Wrist Pain. In Journal of Hand Surgery. March 2008. Vol. 33. No. 3. Pp. 332-334.
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