Chronic wrist pain following a closed injury Discussion
Chronic wrist pain following a closed injury with relatively normal
findings on routine examination may be due to a variety of problems,
including 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
or Kienbock's disease if there is no history of 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 simple local measures such as immobilization,
steroid injection or therapy. In the absence of a clear diagnosis or
evidence of imminent deterioration, 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. The operative approach is
indicated only in selected cases, for it may trigger worsening of the
patient's clinical status.
Discussion Home Page