The wrist is mechanically the most complex joint in the body. It comprises of the distal radius and ulna, carpometacarpal joints, and rows of carpal bones. The carpal bones are conventionally assigned into the proximal and distal rows and the scaphoid is reserved the separate status of a bone of bridging the carpal rows on the radial side. The stability of the wrist depends on key ligaments predominately on the volar side and intracapsular ligaments. The ligaments which cross both carpal rows guide the excursion of the proximal row on the distal row, and stabilise the carpus to the distal radius and ulna. The interosseous ligaments of the proximal row provide strong rotation stability. Biomechanically the wrist transmits forces generated or applied through the hand to the forearm. The wrist has the capability to incrementally adjust the movements of the hand and transmit forces between the hand and forearm without any direct motor control. This is achieved through the articulation proximally between the radius and carpal bones and distally through the carpal joint. Forces loaded through the wrist showed the radius and articulation with lateral carpus carry about 80 per cent of the axial load of the forearm. The ulna through the TFCC and medial carpal bones carrying the remaining 20 per cent. Experimental excision of the TFCC alters the load bearing on the radius to 94 per cent and decreases and load bearing on the ulna side to 6 per cent. Wrist injuries comprise approx 25 per cent of general athletic injuries. The wrist is susceptible to repetitive and traumatic injuries, and the complex anatomy of the wrist can make a diagnosis difficult and produce significant disability for the athlete. There are four possible mechanisms of injury to the wrist being weight bearing, throwing, twisting and impact injuries. The throwing injuries are associated with throwing and racquet sports and are generally overuse injuries. Weight bearing injuries are seen in gymnasts and weightlifters who experience high compressive forces through the wrist. The twisting injuries occur when the wrist undergoes a rapid rotation which disrupts the ligaments and the stability of the wrist. The impact injuries are the most common resulting from either the direct impact on the wrist or a fall onto the outstretched hand. The mechanisms of each are reviewed with clinical examples with relevant investigations and case reports. A review of the mechanics of wrist injuries assists the clinician in the diagnosis of wrist injuries in sport and their prevention.
© Copyright 1999 5th IOC World Congress on Sport Sciences with the Annual Conference of Science and Medicine in Sport 1999. Alle Rechte vorbehalten.