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©2013 UpToDate ® Print Email Causes of acute wrist injury in children and adolescents Condition Location Clinical features Radiographic findings Associated activities Simple sprain Dorsal Mild pain or stiffness at full wrist flexion or extension or both, normal range of motion; resolves in two weeks Wrist series is normal Distal radius fracture Radial Common during adolescent growth spurt; point tenderness, swelling, ecchymosis, decreased grip strength Fracture on standard wrist series Impact sports; fall on extended wrist Scapholunate instability Radial Swelling, focal pain and tenderness, decreased range of motion, decreased grip strength, positive scaphoid stability test (but may not be able to tolerate) Increased scapholunate distance on AP view; increased scapholunate angle on lateral view; but may be normal Impact sports; racquet, stick, and club sports; fall on extended wrist Scaphoid (navicular) fracture Radial, dorsal Tenderness in anatomic snuffbox; decreased range of motion in flexion and extension; positive scaphoid compression test Fracture may be seen on AP view with ulnar deviation; may need scaphoid series. Initial radiographs may not demonstrate fracture. When suspected, thumb spica splinting and repeat radiographs in 7 to 10 days should be performed. Bone scan or MRI can demonstrate fracture sooner when earlier diagnosis is necessary (eg, elite athletes). Impact sports, particularly football; fall on extended wrist Midcarpal instability Ulnar Sulcus in the dorsal ulnar wrist border; painful clunk with active ulnar deviation Dislocaton on standard wrist series Distal ulnar fracture Ulnar, dorsal Usually occurs with distal radius fracture; associated with TFCC injury Fracture on standard wrist series Impact sports Triquetral fracture Ulnar, dorsal Point tenderness over the triquetrum or on the ulnar border, distal to the ulnar styloid Fracture on standard wrist series Impact sports Lunotriquetral ligament instability Ulnar, dorsal Tenderness of the lunotriquetral ligament in the ulnar snuff box; positive lunotriquetral shear test Usually normal; may be step-off along proximal carpal row; associated with positive ulnar variance Impact sports Triangular fibrocartilage complex (TFCC) tears Ulnar, dorsal Point tenderness over the lateral wrist just distal to the ulnar styloid; pain with forced ulnar deviation or TFCC compression test

Tenderness of the lunotriquetral ligament in the ulnar snuff box; positive lunotriquetral shear test Usually normal; may be step-off along proximal carpal row; associated with positive ulnar variance Impact sports Triangular fibrocartilage complex (TFCC) tears Ulnar, dorsal Point tenderness over the lateral wrist just distal to the ulnar styloid; pain with forced ulnar deviation or TFCC compression test Associated (but not diagnostic) findings: widening of DRUJ space, positive ulnar variance, fracture of ulnar styloid on AP; dislocation or subluxation on lateral. MRI with intra-articular contrast is most sensitive means of identifying TFCC injury Impact sports; racquet, stick, and club sports; gymnastics Distal radioulnar joint (DRUJ) injury Ulnar, dorsal Pain with supination and pronation; positive DRUJ compression or piano key tests Dislocation can be seen on plain radiographs and these should include AP and lateral views of the forearm to assess for an associated radial fracture (Galeazzi fracture); MRI may be necessary to identify instability Impact sports; racquet, stick, and club sports; gymnastics Hamate hook fracture Ulnar, palmar Pain with sports but not daily activities; point tenderness over the hook of the hamate Fracture best seen on 45° supination oblique or carpal tunnel view or with CT Racquet, stick, and club sports Pisiform fracture Ulnar, palmar Pain with palpation of the pisiform and hypothenar eminence Fracture on standard wrist series CT: computed tomography; MRI: magnetic resonance imaging.