Need help. Very detailed opt report on wrist.

[jimmy p]

Arthroscopic Findings: In the radiocarpatl interval, the radial extrinsics were intact. There was no chondromalacia. There was some dorsal synovitis. The scapholunate ligamente was bulging. There was a little bit of fraying in the ulnocarpal space. Articular surface of the lunate fossa was well preserved. The lunotriquetral ligament was completely disrupted. There was a radial-sided TFCC tear that was about 6mm in lengh, and it was right off of the central part of the sigmoid notch. Peripherally, the TFCC was intact and stable. There was significant dorsal synovitis. A piece of triquetral joint was easily visualized. There was no chondromalacia. In the midcarpal space, there was no chondromalacia. There was a type 2 lunate with a small hemi to the facet. The lunotriquetral joint and the scapholunate joint were grossly unstable. There was a positive drive through sign at the scapholunate joint suggestive of a grade 4 scapholuante rupture.


So thats the opt report. This what happened to me. I injured my left wrist sligihtly when I was about 15. I can't recall how. I gave it rest for 4 weeks, then it felt fine. It would click once in a while when I would work out with dumbells, but I didn't think anytihng about it. It felt perfect.
Now, I am 24. About 7 months ago I was weighlifting, and hyperextended my wrists while having a lot of weight on the bar. I immediatly felt pain on both wrists, and stopped working out. I saw a general orthopedic DR. which sayed I had slightly torn my ligaments, bu nothing too bad. He gave me braces(splint) to put on, and sayed come back in 6 weeks. I did, and they both still hurt. Primarily my left one hurt alot more. I kept on wearing the splint on the left. about 4 onths later, I went and had a MRI on my left wrist, which showed that there was a tear. I dont know whcih one, as my general ortho wasn't very detailed with me.
Well, after 6 months of wearing the splint, the general orthopedic Dr. sent me to see a wrist specialist. He injected it with a cortisone steroid injection, but after a few days the pain came back. He recommended I have a wrist athroscopy performed, which I just posted at the top. The wrist specialist recommends I do a partial fusion and ligament reconstruction. I will loose about 50% mobility on the wrist, but he believes it will be very stable afterwards and I will be able to go back to weighlifting and do heavy lifting if I ever need to.
I went and saw two other wrist surgeons in the area. They both recommended that I dont do the partial fusion yet, that I wait and keep on wearing the brace for atleast 2 more months, then do a couple of months of therapy, and I may be ok to go.Then think about doing the partial fusion. So that would be a delay of 4 months. The first wrist specialist is ready to do the surgery right now, he is just waiting for my OK to do it. What do you guys think I should do? All DR's have told me they are very suprised with the amount of damage done to the wrist with only weightlifting, but thats that truth. One mentioned that because my ligaments are very lax(flexible and stretchie) this may have contributed. Right now I still have 100% movement in both wrists. They just feel somewhat painfull. I would appreciate any help or advice. I know that this may be too much info for alot of people, so if anyone wants to take a stab at it, feel free. Thanks :)

[Mischap123]

Hi there,
Basically what it says is you have joint INSTABILITY. An unstable joint goes beyond it's normal range of movement damaging other tissues and accelerating degenerative arthritis. In other cases a bone may dislocate and cosidering the areas of instability and your sport of weightlifting, I'm surprised that you haven't dislocated your lunate (which often happens in a wrist hyperextended position).
First you need to find out that the pain is coming from the unstable area or something else such as the TFCC(triangular fibrocartilage)
If it's instability, I'd go for lig reco before fusion if possible but leaving it will just make it worse down the track.
Big decisions to make, best of luck.

[Zaynah]

Hey

So, terminology from your report in more lay terms:
If you have no chondromalacia, it means that the bones, its structure and the cartilage is fine and not softening/degrading. The scapholunate ligament and the lunotriquetral ligaments connects all the small bones in your wirst. For your wrist to move, these bones need to move in sync with one another, doing complex gliding movements to allow movement of these tiny bones. The TFCC tear on the radial side, means that at the thumb side of the wrist the cartilage pad between the radius forearm bone and the scaphoid and lunate is torn. If you have damaged ligaments or the TFCC the small joints in the wrist become unstable and they don't move as they should. If you move your wirst back and take weight through the wirst, as you would for a pushup, the bones are all in a compacted posisiton, so if the bones are out of place, this will be painfull.. bending the wirst forwards would be less painfull as bones are then very loosily fitted. Sinovitis is inflammation of the synovium (membrane around joints), because of injury.

The problem with ligament rupture and instability, as that the ligaments rarely grow back and heal as they have poor blood supply. Same goes for cartilage, the TFCC in the wrist joint. So the ligaments only degrade more and the joints become more unstable. Unfortunately the only way to repair this damage is surgicaly. The dr can pin the 2 bones together, where the pin will act as the ligament. But because the pin is not elastic, it does not bend so the motion possible at that joint is less than normal. Because you have 2 small joints that are unstable and a torn TFCC, the range of movement in your wirst will be significantly less. If you choose not to operate and fixate the joints, the joints that are moving out of position, can become arthritic and then the outcome is worse.

i tore my scapholunate ligament and was undiagnosed until 8months later the MRI picked up a huge scaphoid cyst that developed because of the instabiliy. i had surgery 7weeks ago and it's going well.. I think you should have surgery, or really refrain from putting strain on your wrists. no pushups!

[Zaynah]

Options:
1. Cortisone injections: This is for the inflammation and pain. But too much cortisone (a steroid) damages the ligaments, making them brittle. THese injections will not heal the ligaments, it only decreases the inflammtion, making it easier for the body to heal itself without chemical substances causing swelling, pain and stiffness.
2. Ligament reconstruction: the dr will reconstruct the ligament, and then pin the 2 bones together, where the pin will act as the ligament for 4-6weeks while the ligaments heal. then he will remove your plaster cast and the K-wires, and put you in a brace. physical therapy should start asap to regain strenght and movement. After the surgery you will have to, permanentely refrain form putting strain on your wrist. No more putting weight through a fully extended wrist (like in a pushup) and no more carrying heavy objects, as this will pull on the wrist, putting strain on the ligaments. Everytime the ligaments get injured, they heal with scar tissue that is not as elastic as the normal ligament tissue, and so the joints become stiffer.
3. Fusion: If the reconstruction fails the next op will be a fusion where the dr will fuse the two bones with a pin, becoming the new ligament keeping the joint stable. but remember, the pin is not elastic and cannot bend and stretch like a ligament, so the range of movement at the joint will be impaired. If you have many disrupted joints in the wrist, this can lead to significant movement loss.

Discuss this with your doctors. This is your decision. Ask all the questions! you have a right to know all your options, alternatives, and post operative problems.

Good luck