Cause Of Wrist Pain Research Articles

Non union of scaphoid fracture in a cricketer – possibility of a stress fracture: a case report

Scaphoid stress fractures are rare and can be a cause of wrist pain in sportspersons. All the cases reported in the literature have been sportspersons. Missing a scaphoid stress fracture could lead to non-union of the scaphoid and early degenerative arthritis of the radio-carpal joint. This can cause chronic wrist pain and can reduce the career span of a sportsperson. We report a case of non union of a scaphoid fracture in a cricketer possibly secondary to a stress fracture.

An immunohistochemical study of the triangular fibrocartilage complex of the wrist: regional variations in cartilage phenotype

The triangular fibrocartilage complex (TFCC) transmits load from the wrist to the ulna and stabilizes the distal radioulnar joint. Damage to it is a major cause of wrist pain. Although its basic structure is well established, little is known of its molecular composition. We have analysed the immunohistochemical labelling pattern of the extracellular matrix of the articular disc and the meniscal homologue of the TFCC in nine elderly individuals (age range 69-96 years), using a panel of monoclonal antibodies directed against collagens, glycosaminoglycans, proteoglycans and cartilage oligomeric matrix protein (COMP). Although many of the molecules (types I, III and VI collagen, chondroitin 4 sulphate, dermatan sulphate and keratan sulphate, the oversulphated epitope of chondroitin 6 sulphate, versican and COMP) were found in all parts of the TFCC, aggrecan, link protein and type II collagen were restricted to the articular disc and to entheses. They were thus not a feature of the meniscal homologue. The shift in tissue phenotype within the TFCC, from a fibrocartilaginous articular disc to a more fibrous meniscal homologue, correlates with biomechanical data suggesting that the radial region is stiff and subject to considerable stress concentration. The presence of aggrecan, link protein and type II collagen in the articular disc could explain why the TFCC is destroyed in rheumatoid arthritis, given that it has been suggested that autoimmunity to these antigens results in the destruction of articular cartilage. The differential distribution of aggrecan within the TFCC is likely to be reflected by regional differences in water content and mobility on the radial and ulnar side. This needs to be taken into account in the design of improved MRI protocols for visualizing this ulnocarpal complex of the wrist.

The Scintigraphic Appearance of de Quervain Tenosynovitis

The purpose of this study is to describe the scintigraphic pattern of de Quervain tenosynovitis, a common inflammatory condition of the thumb tendon sheaths related to repetitive use. The author conducted a retrospective audit of consecutive cases with independent clinical validation of the final diagnosis. There were 7 cases of clinically confirmed de Quervain tenosynovitis. The typical scintigraphic finding was a focal area of superficial linear hyperemia and skeletal uptake along the radial aspect of the distal radius corresponding to the anatomic location of the abductor pollicis longus and extensor pollicis brevis. All cases showed an abnormality on at least one phase of the bone scan. Bone scanning appears to be of value in the differential diagnosis of dorsolateral wrist pain when clinical findings are nondiagnostic. The scintigraphic appearance of de Quervain tenosynovitis can help to confirm the diagnosis while excluding other causes of wrist pain. Determining the sensitivity and specificity of this pattern will require further research.

All-Inside TFCC Repair: A Novel Technique and Biomechanical Analysis (SS-64)

Peripheral TFCC tears, a common cause of wrist pain, are amenable to repair. Limitations of current repair techniques include prolonged recovery, button and subcutaneous knot intolerance and septic arthritis. We present a novel technique of an all-inside repair using existing technology to circumvent these complications. Also, there are no biomechanical studies in the literature studying the strength of TFCC repairs. This technique is fast, easily performed, safe, and stronger than current repair techniques. 5 matched pairs of cadaveric wrists were utilized. The experimental group consisted of using the FasT-Fix all-inside meniscal repair system (Smith & Nephew) to repair premade peripheral TFCC tears arthroscopically. The control group consisted of tears repaired using the outside-in technique with 2-0 PDS suture as described by Whipple. The TFCCs were dissected out and the implant’s location compared to neurovascular structures was recorded. All specimens were stressed in an Instron MTS machine to failure, and the mode to failure and lb/F was recorded. Student’s t-test was used to compare the data. Average time of repair for the all-inside technique was 4 minutes, versus 12 minutes for the outside-in technique. Average load to failure for the FasT-Fix repairs was 15.3 lb/F (SD 6.4), versus 12.1 lb/F (SD 9.4) for the PDS repairs (p = 0.29). No neurovascular structures were endangered with either technique. This novel technique for all-inside TFCC repairs is fast, safe and easily performed. In the only biomechanical study of TFCC repairs, we found these repairs are stronger than existing techniques.

Penetrating type intraosseous ganglion cyst of the lunate bone

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Penetrating type intraosseous ganglion cyst of the lunate bone

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Intraosseus synovial cysts of the lunate bone: diagnostic problems

Intraosseous ganglia is one of the most frequent lytic defect at the wrist. Its location in the lunate may be discovered by chance on an X-ray performed for another reason, or because of wrist pain and very rarely for a lunate fracture. A.P., lateral and oblique X-rays are mandatory. Bone scan, CT scan and MRI may be of help. Differential diagnosis may exist with an ulnar abutment syndrome with a lunate defect and with all the lytic bone tumours, a systemic disease or multiple defects as in overuse syndromes. In some cases, there is a condensation around the defect and a Kienböck's disease may be suspected. Thirty-seven patients have been operated on between 1978 and 2001, of which 70% were females. Average age was 34 years (16-58). Clinical presentation was always wrist pain. In seven cases, another carpal localization was present. Surgical treatment consisted in bone curettage and cancellous bone grafting. In four cases, a ganglia emerging from the scapholunate space in soft tissues was combined. Pain disappeared after the procedure. A few patients had a 20-30 degrees wrist flexion decrease but without functional impairment. Several theories have tried to explain the onset of these intraosseous ganglia. In conclusion, these lesions are another cause of wrist pain. One has to be sure that this is this lesion which is the real cause of wrist pain. A systematic X-ray has to be performed for painful soft tissue wrist ganglia.

Arthroscopic repair of radial-sided triangular fibrocartilage complex tears

Injuries to the triangular fibrocartilage complex are a common cause of wrist pain. Debridement of this structure has been the historical treatment of choice. Recent surgical advances have made repair of this structure an option. An arthroscopic technique that uses equipment commonly available in the operating room to repair Palmer 1D tears is presented. A retrospective review of these patients shows 79% good or excellent results after this procedure. Copyright © 2001 by the American Society for Surgery of the Hand

Complications Following Distal Radial Fractures

Union with deformity is the most common complication following a distal radial fracture1-5. The deformity may be extra-articular, characterized by loss of length and metaphyseal angulation; it may be intra-articular, involving either the radiocarpal or the radioulnar joint, or both; or it may be a combination of the two. Surgical treatment of a symptomatic malunion of the distal part of the radius has been recognized for more than 200 years. Resection of the distal aspect of the ulna for the management of pain at the distal radioulnar joint after a distal radial fracture, a procedure attributed to Darrach after his description in 19136, had been suggested by Desault in 17917 and again by Moore in 18808. In 1937, Campbell described a corrective osteotomy of the distal part of the radius with use of an interpositional bone graft obtained from the distal part of the ulna9. In 1945, Merle d’Aubigne and Joussement described a multiple-facet curved osteotomy without the need for an interpositional bone graft10. This concept is currently being revisited and will be described. A deformity following fracture of the distal part of the radius is not necessarily symptomatic. In fact, it is not uncommon for an older patient to have acceptable wrist and forearm function without pain even when there is an apparent deformity. Therefore, impairment of function rather than radiographic deformity is the reason to treat a distal radial malunion, and, consequently, the patient’s wrist and forearm function must be assessed. The most common deformity following a malunited extra-articular Colles type of fracture is the loss of the normal volar tilt of the articular surface in the sagittal plane, loss of ulnar inclination in the frontal plane, loss of length relative to the ulna, and …

COMPARATIVE RESULTS OF RESECTION OF THE DISTAL ULNA IN RHEUMATOID ARTHRITIS AND POST-TRAUMATIC CONDITIONS

The purpose of this study was to determine whether the results of resection of the distal ulna differed depending upon the underlying aetiology of the condition. Patients with rheumatoid arthritis were compared with patients with post-traumatic wrist complaints. Fifty resections in 40 patients (eight male, 32 female) were assessed with respect to pain, range of motion, and grip strength. Of the 23 rheumatoid wrists, 86% were pain-free following surgery; however, only 36% of the patients in the trauma group reported pain relief postoperatively. Pain relief in post-traumatic patients was more predictable when distal radioulnar joint arthrosis was identified as the sole cause of wrist pain.

PHYSICAL EXAMINATION OF THE WRIST

A complete examination of the wrist requires both an accurate history and a thorough understanding of carpal anatomy, biomechanics, and pathology. A thorough examination may necessitate evaluation of the radial and ulnar aspects of the carpus as well as potential extra-articular causes of wrist pain. A carefully obtained history is essential to focus the examination. Our standard approach to the examination of radial wrist pain consists of five maneuvers: (1) ANA, (2) scaphotrapezial trapezoid (STT), (3) DWS, (4) SS, and (5) FET. Additional diagnostic tests, as described, are indicated by ulnar wrist or extra-articular symptomatology. Substitution maneuvers serve to distinguish between actual and fictitious findings on examination.

MR imaging of the painful wrist.

Magnetic resonance (MR) imaging is an effective method for helping determine the cause of wrist pain by demonstrating a broad spectrum of abnormalities, including those of bone, cartilage, ligaments, and tendons. MR imaging is useful in the detection, characterization, and staging of osseous injury and disease, although computed tomography provides superior detail in the depiction of bone. MR imaging may demonstrate irregular cartilage loss in noninflammatory arthropathies such as osteoarthritis, and its superior soft-tissue contrast makes it the method of choice for evaluating the synovial processes. Although arthrography remains the standard of reference in the detection of perforations of the principal intrinsic ligaments of the wrist, three-dimensional MR imaging has shown promise in depicting the small interosseous ligaments. Tendinitis, tenosynovitis, ganglia, and anatomic variants can be diagnosed and accurately assessed with MR imaging. Radiologists need to be aware of the full spectrum of wrist abnormalities and the characteristic MR imaging findings that accompany them.

Evaluation of the Patient Presenting with a Painful Wrist

Wrist pain secondary to injury or disease is a common cause of morbidity and disability. The results of treatment are influenced strongly by promptly determining a correct diagnosis. We have found that a systematic, structured approach consisting of a detailed history and a thorough physical examination supplemented by the proper use of a variety of imaging modalities will establish accurately the diagnosis in almost all patients. Using such an algorithmic approach can greatly minimize medical costs and time lost from work as well as assist the surgeon in diagnosing the cause of wrist pain as quickly as possible. Even when this type of systematic approach is used in the evaluation of patients presenting with wrist pain, it is important for surgeons to remember that several imaging modalities, such as bone scans and arthrography, frequently demonstrate abnormal or atypical findings for which no pathologic correlate exists. If a firm diagnosis cannot be made even after a positive test result, it is unwise to perform surgery based solely on the findings of a test in the hope that wrist pain will thereby be relieved. In such cases, a trial of immobilization for 3 weeks is perhaps the best and most cost-effective way to verify that the pain is caused by an actual bone or joint abnormality that will respond to surgery.

A comparative study of the surgical procedures to treat advanced Kienbock's disease

We have treated a total of 16 cases of advanced Kienböck's disease, stage III and IV by Lichtman's classification, with triscaphe fusion, tendon ball replacement arthroplasty after excision of lunate, proximal row carpectomy as a salvage procedure and limited wrist fusion, since 1985. All cases were followed for minimal 16 months after each operation. Tendon ball replacement arthroplasty after excision of lunate could not prevent further carpal collapse with persistent chronic wrist pain. The triscaphe fusion or radio-lunate fusion induced a marked limited wrist motion later, and the triscaphe fusion alone was not fit for the treatment of advanced one because of progressive proximal migration of capitate and continuous wrist pain due to ligamentous carpal instability in follow-up. So we tried to simultaneously combine tendon ball replacement arthroplasty after excision of lunate with triscaphe fusion in far advanced Kienböck's disease, and their end results was favorable. Proximal row carpectomy could be done in far advanced Kienböck's disease with reasonably painless wrist motions. The overall end results of proximal row carpectomy are much better than any form of carpal arthrodesis. Conclusively the proper way to treat advanced Kienböck's disease seems to depend on the patient's age, their job and sex, and the stage of disease. And the cause of wrist pain in advanced Kienböck's disease seems due to ligamentous carpal instability rather than osteoarthritis on radio-lunate joint.

Carpal Instability: Evaluation and Treatment.

Carpal instability is a common cause of wrist pain, motion loss, and disability. Diagnosis and treatment of carpal instability are dependent on a clear understanding of wrist anatomy and carpal kinematics, both normal and pathologic, as well as their relation to the current concepts regarding management. A brief review of anatomy and normal kinematics is presented, followed by a detailed discussion of specific instability patterns, including pathomechanics. A treatment algorithm is provided, detailing the authors' preferred treatment for the most common instability patterns.

Osteoblastoma of the scaphoid: A case report

Wrist pain is a common complaint that is rarely due to a tumor. We have treated a patient whose wrist pain was caused by a rare tumor, osteoblastoma. The purpose of this report is to emphasize the need to uncover obscure causes of wrist pain.

Intraosseous ganglion cyst of the lunate: Diagnosis and management

Intraosseous ganglion cyst of the lunate is an uncommon lesion and cause of wrist pain. Histopathologically it is identical to the common dorsal wrist ganglion and treatment by arthrotomy, curettage of the ganglion and bone graft resulted in clinical improvement in nine patients, six of whom became symptom-free.

Symptomatic congenital coalition of the pisiform and hamate

Recent reports have shown that carpal coalition, previously regarded as an asymptomatic congenital anomaly, may be an unusual occult cause of wrist pain. Two cases are presented as the first reported examples of congenital piso-hamate fusion creating symptoms due to associated arthritis or occult fracture.

Radial growth plate injury in a female gymnast

Radial growth plate injury is a cause of wrist pain in female gymnasts. The mechanism of injury and its relationship to dowel grips, now standard gymnastic equipment, are considered. An athlete's response to a treatment approach emphasizing moderation and protection is described.

Magnetic resonance imaging of avascular necrosis of the lunate

Avascular necrosis (AVN) of carpal bones, particularly the lunate, is often an elusive cause of wrist pain. Physical examination can be indistinguishable from that of a simple wrist sprain, and standard radiographic evaluations are frequently normal. Early diagnosis is critical, since late treatment is often simple observation of the natural history of the disease, which includes progressive collapse of the lunate and derangement of the carpal architecture. Magnetic resonance imaging (MRI) produces images of high contrast, demarcating necrotic from normal bone. We present a case of lunate AVN (Kienbock's disease) to illustrate the ability of MRI to identify necrotic bone in the wrist. We suggest that MRI is useful in diagnosing AVN in the wrist and that it may allow an earlier diagnosis of lunate AVN than is possible with standard radiographs.