Welcome to Hicksville Physical Therapy’s patient resource about Piriformis Syndrome and Sciatica.
Any pain that begins in the area of the buttocks and proceeds down the leg is often referred to as sciatica. Of all the causes of sciatica, the most common is spinal nerve irritation near the lumbar region of the spine. Occasionally, this irritation of nerves can occur away from the immediate region and instead be down the leg. Another possible cause of sciatica is what’s known as piriformis syndrome. While this syndrome can indeed be painful, seldom does it present any danger and/or require surgical intervention. The good news is that afflicted individuals can ease pain and properly manage their condition with a few easy steps and even physical therapy.
The following information will help you learn:
What structures are involved?
What parts of the wrist are involved in ligament injuries?
The front of your wrist, your palm-side, is called the palmar side, while the back that aligns with your knuckles is dubbed the dorsal side.
The wrist consists of eight small bones, or the carpal bones. The carpal bones connect the bones of the hand with the forearm’s radius and ulna. You also have long bones underneath your palm called your metacarpal bones, and these bones attach to your phalanges, or your finger and thumb bones.
The four bones of the proximal row sit next to the forearm’s bones, the radius and ulna, while the distal row connects to your palm’s metacarpal bones. The proximal and distal rows connect together like a chain, allowing for the hand to move up and down. When your hand moves up, the movement is called a dorsiflex, while a downwards motion is a palmarflex. Each carpal bone’s connection allows each bone to shift when your hand makes a sideways motion. When your wrist moves towards your thumb, it is called radial deviation, while moving to your pinky is ulnar deviation.
The wrist is a very complex body part, due to each of its small bones forming a joint with its adjacent bones. The articular cartilage is a smooth and slippery substance that covers each bone’s end, and lets the bones slide against each other without damaging the other bone.
Your ligaments connect your wrist’s small bones to each other, as well as the bones of the wrist with the radius, ulna and metacarpal bones. They play a key part in balancing your wrist’s mobility.
If any of your ligaments are injured, your bones’s movement completely changes, and can lead to lasting problems that cause joint pain. Your wrist may even eventually develop arthritis.
Related Document: Hicksville Physical Therapy’s Guide to Wrist Anatomy
How do ligament injuries of the wrist occur?
The most common way for your wrist to be injured is if you fall on your hand while it’s outstretched, with the palm side down. Accidental force, such as preparing yourself in a car accident by bracing yourself against the dashboard, is also a possible trauma. Athletes who use their wrist repetitively like golfers and tennis players are also at risk. Your wrist or ligament being broken is dependent on a variety of factors, such as the strength of your bones, your wrist’s position during the injury, and the amount of force involved.
However, any type of injury can alter your wrist joint’s functions. If you injure your wrist, damage to the ligament may result in your joint becoming unstable. Injuries change the way your joint moves, even if it’s a mild one; the forces on the articular cartilage may increase, and the cartilage is more prone to wear and tear. Over years, the imbalance joint can damage the articular cartilage. Cartilage is unable to heal itself well, and the joint is unable to compensate for its damage, leading to wrist pain.
How do I know if I have a ligament injury of the wrist?
The main symptoms of a wrist ligament injury are pain and swelling. The wrist may feel painful for several weeks, and also become discolored and bruised, a condition called ecchymosis. However, there are no specific symptoms that allow your doctor to diagnose you with a wrist ligament injury, so an examination is recommended.
Even after the initial pain of the wrist injury has gone away, pain may still persist due to the ligaments being unstable. If the ligaments are injured and do not have the chance to heal properly, the bones do not slide against each other correctly as the wrist moves, resulting in pain and clicking or snapping in your wrist if your wrist grips things.
If the wrist continues to be untreated, it may develop osteoarthritis. Pain with osteoarthritis is a double-edged sword – it usually lessens during activity, but will also increase if activity stops. If left to worsen, pain may be felt even while resting and interfere with nightly sleep and your hand grip ability may deteriorate.
How will my health care provider identify this condition?
If you visit Hicksville Physical Therapy for your wrist ligament injury, we will first ask you about your medical history. We must know about every injury on your wrist, even if it happened years ago and has already healed.
Our physical therapist in Nassau County will then perform a physical examination on your wrist joint, and may probe and move your wrist to see how your wrist moves, its alignment, and where the pain is. Though the examination may hurt, it’s essential to determine the problem.
For more complex diagnoses, a patient may be referred to another doctor. After you are diagnosed, our Physical Therapists at Hicksville Physical Therapy will work with you on a personalized treatment to help speed up your recovery so you can return to your daily routine.
In order to see what’s happening in your bones, your doctor will order X-rays. X-Rays are a great way to determine a problem in your bones and can visualize if a wrist fracture has occurred. They can also help your doctor diagnose ligament injuries by picturing how the bones of your wrist line up.
If X-rays do not visualize all the information needed, other tests may be performed to view the ligaments more clearly. In some cases, an arthrogram may be used. In this test, dye is injected into a small joint of the wrist, and special X-rays are then executed to look for dye leakage out of the joint, and can help confirm that a ligament has been torn.
Doctors may also use magnetic resonance imaging (MRIs) to look at your wrist ligaments. In an MRI, the MRI machine uses magnetic waves to create images that mimic slices of the wrist joint. Unlike an X-ray, an MRI is able to show soft tissues like ligaments quite well and can show the presence of a torn ligament in your wrist.
If all else fails, arthroscopy of the wrist can be used to look into your ligament injury. An arthroscope is a miniature TV camera inserted into your wrist joint that will allow the surgeon to diagnose your torn ligament. It can even be used to repair the ligament in some cases, simultaneous with examination.
If the ligament is completely torn and the joints are unable to line up, you may need to consider surgery to repair your ligaments or pin your bones together so they can align properly and be held in place for your ligaments to heal.
No single operation is universally effective for ligament injuries of the wrist. Depending on the severity of the injury, several different types of surgeries may be the solution to the problem.
Percutaneous Pinning and Repair of the Ligaments
If ligament damage is detected within a few weeks after injury, your surgeon may insert metal pins to hold your bones in place while your ligaments heal. This is called percutaneous pinning; it is a non-invasive procedure, as an incision is not required, the pins only go through your skin. A fluoroscope, which is a continuous X-Ray machine that displays the x-ray on a TV, is used to watch the pins being placed.
In some instances, lining the bones up properly with percutaneous pinning is not possible and cutting an incision is necessary to repair the ligaments. The longer you wait to perform a surgery after injuring your ligaments, the less likely it is for your bones to align properly, and torn ligaments may not be able to heal if scar tissue develops over the bone’s ends. Metal pins are still used to hold the bones in place while the ligaments heal, and are removed in four to six weeks after receiving the surgery.
Ligament Reconstruction
If ligament damage is discovered six or more months after an injury, it may have to be reconstructed. Ligament reconstruction involves an incision being cut over the wrist joint and then locating the torn ligament. After the incision is made, a tendon graft is used to replace the torn ligaments. A tendon graft is a piece of tendon taken from the palmaris longus of the wrist to repair a gap in the body. The palmaris longus is a good tendon to borrow from as it doesn’t borrow much, and is commonly used in surgeries involving grafting for the hand and wrist. This tendon is removed from the underside of the wrist through a few small incisions.
Metal pins are again used to hold the bones in place while the tendon graft heals, and are removed after six to eight weeks post-surgical procedure.
Fusion
If ligament instability is discovered long after the surgery and you’ve developed arthritis in your joints, a wrist fusion may need to be considered. Two or more bones are fused together by removing cartilage between the bones. When the raw bone surfaces are together, they are treated like a fracture, thus the surfaces heal together and the bones fuse into one. This process stabilizes the motion between bones and reduces the pain received from arthritic joints rubbing together.
If your entire wrist has become arthritic from long-term instability, a complete wrist fusion may need to be performed.
