Chronic wrist pain following major injury Discussion
Chronic wrist pain following a wrist fracture, ligament injury or surgery
may be due to a variety of problems, including painful arthritis,
capsulitis, painful nonunion or partial union, partial intercarpal ligament
tear, loose body, neuroma, cartilaginous lesion, as well as others. Bone
scan may be helpful in ruling out occult bone injury if there is no history
of arthritis, prior fracture or surgery. MRI may be helpful in evaluating
suspected occult ganglion or vascular disorder. These studies are rarely
indicated for other working diagnoses, and arthrography is rarely helpful
as a definitive study. Diagnostic wrist arthroscopy may be useful, but
generally only if preoperative evaluation suggests a specific anatomic
diagnosis. There is no universally accepted approach or treatment for this
problem in the absence of a clear anatomic diagnosis. Patients who have
been symptomatic for more than three months are unlikely to be cured by
measures such as immobilization, steroid injection or therapy. If
degenerative joint changes are present, partial or complete wrist fusion
should be considered for pain control. Wrist fusion results in permanent
loss of motion and may not improve function according to objective testing.
If there is no evidence of arthritis, the most practical options are either
living and dealing with the problem or proceed with a multilevel approach
including options of wrist arthroscopy, open exploration, as well as
consideration of partial wrist denervation. Surgery other than complete
wrist fusion is indicated only in selected cases, for it may trigger
worsening of the patient's clinical status.
Discussion Home Page