Hand and wrist ligament reconstruction

Discover more about hand and ligament reconstruction surgery

Ligaments are fibrous tissues that help bind together your joints. They connect bone to bone, providing support, stability, and flexibility to your joints, and helping you move properly. If your ligaments become damaged, you can experience stiffness, pain, and swelling in your joints, as well as limited movement. If left untreated, damaged ligaments can lead to a chronic joint condition caused by the breakdown of your cartilage (a tough, flexible tissue found throughout your body that acts as a shock absorber to protect your joints), such as osteoarthritis. Ligament damage often occurs when your ligament becomes torn, stretched, or strained by an extreme motion, such as during a sports injury.

The ligaments in your hands

Your hands are made up of many ligaments that provide stability and function, including:

Ulnocarpal and radioulnar ligaments

These are two sets of ligaments that provide support in your wrist.

Collateral ligaments

These are on either side of your thumb and finger, preventing your joint from moving sideways.

Radial and ulnar collateral ligaments

A pair of ligaments that connect the bones of your wrist and provide stability.

Volar radiocarpal ligaments

This is a more intricate set of ligaments that support the palm side of your wrist.

Dorsal radiocarpal ligaments

Ligaments that support the back of your wrist.

All the ligaments mentioned above comprise a complex network that is incredibly important in your ability to function, allowing you to complete simple everyday actions we often take for granted, such as grasping, holding, feeling, and lifting. These actions play a vital role in how you fulfil daily activities like cooking, cleaning, and driving.

Reasons you may need hand ligament reconstruction

Torn ligaments in your hands and wrists are often caused by the following factors:

Repeated use of your hand

Some people experience damage to their hand and wrist ligaments through general wear and tear that occurs over time. This is also known as osteoarthritis and is common as you get older. Osteoarthritis occurs when the smooth cartilage across the surface of your joint wears down. When the cartilage lining starts to thin out, your tendons (a flexible tissue that connects your muscle to your bone) and ligaments work harder to aid your movement and flexibility, which can result in degenerative wear and tear across ligaments, as well as cartilage, joints, and tendons. This can become very painful and debilitating if left untreated, so it's important to seek help for osteoarthritis as soon as you can.

Falling on your outstretched hand

This mostly happens when you try to protect yourself from a fall. Nicknamed FOOSH (fall on outstretched hand), the direct impact and blow to your hand and wrist can cause the bones in your hand and wrist (of which there are several), to instantly fracture, which can lead to damage to your ligaments and tendons. FOOSH often causes wear and tear in one of the important ligaments around your thumb (usually the ulnar collateral ligament), which is important for gripping and can lead to further joint problems if left untreated.

An injury during sport

You might experience a direct blow to your hand and wrist when playing sport, such as during a rugby tackle, which can lead to an immediate fracture and damage to your ligaments. Hand and wrist injuries (particularly FOOSH) are also common when skiing because people often instinctively break their fall on the ski slope with an outstretched hand.

Key symptoms of damaged ligaments in your hand and wrists

These include:

Pain when bending your wrist backward or forward
Bruising around your hand and wrist
Pain and swelling around your hand and wrist
A popping or grinding sensation
Weakness in your wrist
Pain that keeps you awake at night
Pain that doesn't go away with traditional painkillers, or rest
Pain that gets progressively worse with time

Your Initial Consultation with a specialist

You can usually see an orthopaedic consultant who specialises in the treatment of damaged joints and ligaments for your initial consultation within 48 hours of booking your appointment with us.

During this appointment, your consultant will ask about your general health and your medical history in detail. They will want to know about any existing medical conditions you have, as well as the current symptoms you are experiencing. They'll ask you how long you have had symptoms and when they first occurred (for example, if they began directly after a sport injury or fall).

In order to assess your symptoms and make an accurate diagnosis of your concern, your consultant will next carry out a gentle physical examination of your hand and wrist. In some cases, they might also send for you to get an X-ray, which will be carried out onsite by one of our radiologists. All of this helps your consultant understand whether you have damage to your ligaments and need treatment such as hand reconstruction.

Your initial consultation is where we begin to get to know you as an individual. It is from the information we gather during this session that we will start building your personalised treatment plan. To make the most of the initial consultation, please feel free to talk as openly and honestly as you like about the pain you're experiencing, the way it makes you feel, and what you're hoping to get from surgery.

The time you'll wait between your initial consultation and having reconstructive surgery (or any other treatment you are recommended) will differ from person to person. Your surgeon will provide you with this information during your initial consultation, after which they'll put together a fixed-price treatment package based on everything you have discussed together.

Preparing for hand ligament reconstruction

There isn't a huge amount you can do to prepare for hand and wrist ligament reconstruction surgery, but your orthopaedic surgeon might recommend certain instructions, including:

No alcohol

You should avoid drinking alcohol for at least 48 hours before surgery. Please speak with your consultant about this in more detail.

Changes to your medication

Your consultant will also share information on whether you should avoid taking your usual medication before going into hospital, or the kind of medication you might need to take after you have surgery.

Arrange to be collected from hospital

You will need someone to collect you from hospital because you will still be recovering from local or general anaesthesia and will not be able to drive. We can arrange for a taxi to collect you from the hospital, if you would like.

What happens during hand ligament reconstruction?

There are many types of hand surgery, but ligament reconstruction surgery is usually performed arthroscopically, meaning that the procedure is minimally invasive and performed via a keyhole incision. Your consultant will insert an arthroscope, which is a small, thin telescope with a light and camera attached to the end of it, through a small incision (cut) in your hand. The arthroscope is connected to a monitor, allowing your consultant to look inside your hand and wrist as they perform a procedure to repair damage to your ligament(s). They will make two to four small cuts around your joint and place specialist surgical instruments through some of these incisions to make the repair. This is usually achieved by replacing the damaged ligament with tissue graft from a different part of your body, but your consultant will ensure you understand their technique before you have surgery. The nature of your procedure will differ depending on the extent of damage to your ligament(s).

The operation usually takes between 30 and 60 minutes, depending on how severe the damage is to your hand and wrist. It can be performed under either general or local anaesthesia, depending on your consultant’s decision. You will know the kind of anaesthesia you will have before surgery.

Recovering from hand ligament reconstruction

You should fully recover from the procedure within six weeks. You might have a bandage or splint over your hand to hold it in a neutral position and protect and support your joint as it heals. Your consultant will ensure you know how long to wear your bandaging or splint for, as well as instructions for how best to change your dressing (if needed), and showering with it on.You should be able to go home on the same day as surgery because it is a minimally invasive procedure. Your hand and fingers will be bruised and swollen for a period of up to two weeks after surgery, which you can manage effectively with painkillers. Your pain will ease and the movement in your hand and wrist will begin to improve over the course of six weeks before you return to fully restored function and mobility.

Your physiotherapist might give you tailored exercises and expert advice to help you recover as safely and quickly as possible after surgery. You should follow these instructions diligently, as well as when you can return to more high-impact exercise, such as sport. This is to ensure your recovery goes smoothly and you don't cause any further damage to your hand and wrist.

Your consultant is there to answer any questions you might have about the surgery. They will provide you with a more tailored recovery timeline based on your individual circumstances and needs.

Risk and complications hand ligament reconstruction?

Like with any surgery, complications can sometimes occur during hand and wrist ligament reconstruction surgery, but these are rare. Your consultant will explain all the risks to you beforehand, along with answering any questions you might have, so you'll be able to make an informed decision about how to go forward.

General complications of any operation