Adult
Ligament sprains and strains
Fingers and wrist · stability
What it is
Ligaments hold the small joints of the hand and wrist together. A sprain is a stretch or tear of one of them.
Three injuries come up often: the ulnar collateral ligament at the base of the thumb — “skier’s thumb” — the scapholunate ligament in the wrist, and the triangular fibrocartilage complex on the little-finger side of the wrist.
Symptoms
Pain localised to one precise spot, swelling, a feeling of giving way, weakened pinch or grip, sometimes clicking or clunking.
A complete tear of the thumb ligament makes any side pinch painful and unstable: turning a key, opening a lid. It is an example of an apparently minor injury with lasting consequences if it goes untreated.
Non-operative treatment
Most sprains heal with a splint or taping, relative rest, and then a graded return guided by therapy.
The time frame is weeks rather than days, and a partial tear that is properly protected usually does well. The temptation to go back too soon is the main cause of lingering pain.
Surgical treatment
Surgery is indicated when the ligament is completely torn and the joint unstable, when the torn end becomes trapped out of position and can no longer heal in place — the Stener lesion in the thumb — or when instability persists despite treatment.
Repair is done with sutures or bone anchors. For an old injury, reconstruction with a tendon graft is needed. In the wrist, arthroscopy allows the injury to be assessed precisely and treated at the same time.
Recovery expectations
A splint or cast protects the repair for several weeks, after which movement and strength are rebuilt gradually.
Return to contact sport comes later than return to daily activity. One point bears emphasis: instability left untreated leads to arthritis over the medium term. That is exactly why a sprain is worth treating properly at the time.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.