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Evaluation of wrist pain and injury in children and adolescents

D Scott Upton, MD
Joseph Chorley, MD
Section Editors
Albert C Hergenroeder, MD
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH


Injuries to the wrist are common in children, adolescents, and young adults. A thorough understanding of the anatomy of the growing wrist, common wrist injuries, and other causes of wrist pain are essential to accurate diagnosis and appropriate treatment.

An overview of the relevant anatomy, epidemiology, and evaluation of wrist injuries in children and adolescents will be presented below. Causes of wrist pain and injury are discussed separately. (See "Overview of acute wrist injuries in children and adolescents" and "Causes of chronic wrist pain in children and adolescents".)


The wrist and hand are described in the anatomic position with the fifth digits medial and the palm facing anterior. "Lateral" and "radial" describe the thumb side; "medial" and "ulnar" describe the little finger side. The anterior aspect is "palmar" or "volar" and the posterior aspect is "dorsal."

Bones – The wrist is formed by articulations between the radius, ulna, and the carpal bones. There are eight carpal bones distributed in proximal and distal rows (figure 1). The scaphoid (ie, navicular) bone provides a stabilizing link between the proximal and distal carpal bones. During development, the carpal ossification centers and the growth plates of the distal radius and ulna appear and fuse in a predictable stepwise fashion that is used to determine skeletal age (table 1) [1].

Joints – The distal radioulnar joint (DRUJ) is a small, J-shaped, fluid-filled joint where the ulnar head articulates with the ulnar notch in the distal radius (figure 2). It serves as the main point for supination and pronation of the forearm.

The articulation between the distal radius and the scaphoid and lunate bones forms the radiocarpal joint (figure 2). The radiocarpal joint and the midcarpal joint, which is between the proximal and distal rows of carpal bones, are responsible for the majority of wrist flexion and extension.

There is no direct bony articulation between the distal ulna and the carpal bones; the ulnar side of the wrist is supported by the triangular fibrocartilage complex (TFCC), interposed between the distal ulna and triquetrum (figure 3). The TFCC is the major stabilizer of the DRUJ; it includes the triangular fibrocartilage, ulnar collateral ligament, dorsal and palmar radioulnar ligaments, ulnolunate and ulnotriquetral ligaments, and the extensor carpi ulnaris tendon sheath [2].

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Literature review current through: Nov 2017. | This topic last updated: Nov 08, 2016.
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