clunk and movement in wrist

[SQ71]

Recently diagnosed with ECU tendon subluxation. MRI showed no TFCC tear, but surgeon isn't convinced of that. Have pain in ulnar side of wrist, loss of strength, & clicking/snapping sound in wrist. Having surgery at the end of the month to stabilise the ECU tendon, and repair TFCC tear if found. All good.

But, I've just recently noticed that I now have a "clunk" sound in my wrist. It's just a little bit off centre (closer to radius side) and when I bend my wrist up and down or rotate clockwise, I can actually see the movement under the skin, when the clunk happens. No associated pain. It just feels a bit uncomfortable. I hadn't noticed it before as 99% of the time my wrist is in a support. I'm not seeing the hand surgeon again until I go in for the op, so was wondering anybody had any ideas what could be causing this?

[Kiwi]

Maybe a Scapho-lunate Ligament problem?? Will your surgeon be using an arthroscope to look around? If he/she is then it would be a good opportunity for them to have a good look around and see what is going on. Good luck with your surgery!
Jess

[SQ71]

Hi Jess. Thanks for your reply. :) The surgery which has been approved by ACC is for an arthroscopy, debridement (TFCC tear), tenolysis & re-stabilisation of ECU tendon, so yeah he'll definitely be having a good look around in there. Surgery day is the 3oth June. Scapho-lunate ligament problem?? Will that require further surgery??

[focus_911]

Recently diagnosed with ECU tendon subluxation. MRI showed no TFCC tear, but surgeon isn't convinced of that. Have pain in ulnar side of wrist, loss of strength, & clicking/snapping sound in wrist. Having surgery at the end of the month to stabilise the ECU tendon, and repair TFCC tear if found. All good.

But, I've just recently noticed that I now have a "clunk" sound in my wrist. It's just a little bit off centre (closer to radius side) and when I bend my wrist up and down or rotate clockwise, I can actually see the movement under the skin, when the clunk happens. No associated pain. It just feels a bit uncomfortable. I hadn't noticed it before as 99% of the time my wrist is in a support. I'm not seeing the hand surgeon again until I go in for the op, so was wondering anybody had any ideas what could be causing this?

it sounds like what I went thru when I was first diagnosed with a TFCC injury to my left wrist. Been a very long series of operations (I am about to get surgery #6 on that wrist). With time it was seen I progressed from a type 1 instability which was corrected with multiple operations (Fusion, soft tissue repair, TFCC repair, ulnar shortening osteotomy) to now a type 3 which as worst as they come.

You might want to ask your surgeon the possibility of Ulnar Impaction which causes in many cases ulnar sided wrist pain. That accompanied with wrist instability whether it be due to a TFCC injury, which is very common or another reason.

What caused this wrist problem in the first place?

[focus_911]

Hi Jess. Thanks for your reply. :) The surgery which has been approved by ACC is for an arthroscopy, debridement (TFCC tear), tenolysis & re-stabilisation of ECU tendon, so yeah he'll definitely be having a good look around in there. Surgery day is the 3oth June. Scapho-lunate ligament problem?? Will that require further surgery??

Just read this last post. Those type of instabilities are a pain. As I just typed in my last post. I initially had my TFCC injury fixed but it was followed months later by an ulnar shortening after we noticed most of the pain was there. Once that was done, it made a huge difference in my recovery and thought I was finally fixed up. It simply took day to day activities around the house and various sports activities to cause the wrist to suffer from more wrist instability that was significant enough I required a partial wrist fusion.Ligament injuries (sprains) are the most nasty because they don't heal due to the lack of blood supply, the other issue being the complexity of the wrist. Even the most experienced surgeons sometimes have issues fixing wrist injuries.

TFCC injuries are nasty to deal with. You really have to nurse that wrist for the following years to come.You would be better off fracturing a bone. As I said despite the fusion that corrected the problem for 2 years I am once again suffering from more instability but now have run out of options. The pain is quite significant and my wrist is easily dislocateable which is why I have to undergo surgery. I only have 2 options, the first one being a complete wrist fusion and the second option being a new currently being tested mid carpal wrist ligament transplant. Who knows if this will work (I'm only 23 so the tested procedure is my only hope)

An x-ray 2 surgeries ago when they fused my part of my wrist due to scapho lunate instability.


Be nice to that wrist. Take your surgeon's advice and follow what he says religiously.

[SQ71]

What caused this wrist problem in the first place?
Stupid accident really - I lost my balance, put my right arm/hand out to catch the fall, onto a table (full stretched arm). Unfortunately only the first 2 fingers (pinky side) and only a small portion of my hand made it onto the table. Basically my full body weight was pushed through those 2 fingers and at the same time the remainder of my my hand (not on the table) which twisted downwards quite sharply.

My Story: I'm 36. The injury occured in May 2007. It wasn't treated initially at A&E as they couldn't find anything broken/abnormal on X-rays. I continued to use it for 2 weeks, until the pain got so bad, I went back to A&E and was advised to take 6 weeks of work and wear a half plaster cast to keep my wrist steady. I still had pain, so was sent to hand surgeon no 1, who suspected TFCC tear (because of the snapping sound and the location of the pain), but when the MRI came back normal, I was given a shot of cortisone. No follow thru. The cortisone worked for a while, but within 3 months, my wrist hurt terribly, and I had developed severe tendonitis in my elbow and shoulder pain from having been using my arm awkwardly to compensate for the pain in my wrist.

My Dr, not happy with surgeon no 1's treatment, then referred me to another hand surgeon in Auckland. By the time I was seen by him (9 months after the accident) I had so much pain, I could hardly use my arm (was dropping things constantly) and on a strength test I could only manage 4kg (30kg in my other -non-dominant- arm.) After a physical examination, he immediately diagnosed subluxation of the ECU tendon & told me it would need surgery to re-stabilise it. He also suspected TFCC tear, inspite of normal MRI findings. He was much better than surgeon number 1 and referred me for hand therapy immediately, whilst I waited for ACC to approve surgery. It took 3 months to get the approval and another months wait before he can do the op.

The physio has been great. She fitted me with a good support for my wrist and one for the elbow, started exercises and manipulating the ulnar bone at the elbow and wrist every week. I have it taped sometimes as well, which seems to help. The tendonitis in the elbow has improved and I have re-gained strength to 10kg (after 2 months.) By the time I have the op, 14 months will have elapsed since the initial injury occured.

I think it is the lunate bone that I can see moving in my wrist that is causing the clunk. It's only recently that I noticed it, so I don't think it is part of the original injury. I am concerned about the time delay between the initial injury and the the diagnosis/repair. I can't wait to have the op now and to find out what the hell is going on. I intend to ask my physio about the clunk when I see her on Wednesday, but came here to see if anybody else might have any ideas.

I appreciate the responses. That X-ray looks spooky. I'm sorry to hear that you've had so much trouble with your wrist at such a young age.

[focus_911]

That is unfortunate so much time has elapsed. Glad to hear tho you now have a good surgeon. With more history posted the diagnosis makes sense. Hopefully your saga doesn't get as complicated and lengthy as mine.

Hope all goes well. Keep us posted.
Cheers

[SQ71]

The physio looked at my wrist today. She doesn't think it is the lunate bone that is clunking, although the new problem is in the lunate area. She thinks it is either a ganglion cyst or a tendon slipping in and out of place. She described the sound more as a pop than a clunk. Feeling slightly more re-assured that it isn't anything too serious, but she's sent of a letter to the hand surgeon to tell him about it and to make sure that he checks it out when I have my op in 12 days time. Will update on my progress after the op. Thanks. :)

[focus_911]

The physio looked at my wrist today. She doesn't think it is the lunate bone that is clunking, although the new problem is in the lunate area. She thinks it is either a ganglion cyst or a tendon slipping in and out of place. She described the sound more as a pop than a clunk. Feeling slightly more re-assured that it isn't anything too serious, but she's sent of a letter to the hand surgeon to tell him about it and to make sure that he checks it out when I have my op in 12 days time. Will update on my progress after the op. Thanks. :)

Make sure you are careful with what you are being told by PT. My experience with PT (I have had 9 orthopedic surgeries, 4 of which were Major, had PT after each and every single one of them) is you need to take what they tell you with a grain of salt. Their level of education vs that of a surgeon varies greatly. Some therapist are well versed and educated with their diagnosis but most (from my own experience) are incorrect.

[SQ71]

UPDATE: Had the op yesterday. It went well. Tenolysis to free up the ECU tendon, then he re-stabilised it. He found a TFCC tear in spite of normal MRI findings, which has been debrided. He also did a ganglionectomy. No other problems were found. This is great news.

[SQ71]

My last post didn't go through, so will try again. Tenolysis & re-stabilisation ECU tendon done. Tear in TFCC found (in spite of normal MRI findings) and debrided. Ganglionectomy done. No other problems found! Yay. Strapped up in thermoplastic splint for 2 weeks, then I can have stitches out. Left-handed activity only for 6 weeks. Today it itches like crazy and is driving me nuts. Otherwise feel good.

[jtk73]

My TFCC tear (peripheral) was non-existent on the MRI and was only found when surgeon did "Christopher Columbus" surgery (exploratory LOL). It was fixed (I had all ROM and strength was getting to 100%) but 1 yr later still a problem. New MRI has now shown CENTRAL TFCC tear so I go in for ulnar shortening in December (The only time I actually have time to have it done)

Good Luck with recovery but do exactly what doc says. I certainly will be in December. :-)

[SQ71]

jtk73 - Good luck with your ulnar shortening procedure in December. From what I've been told by my physio this is "major surgery" and not one to enter into lightly.

UPDATE on my recovery: It has been a complete nightmare for me. The itching under the dressings is driving me insane. Anti-histamine only takes the edge off. My GP removed the plaster splint and dressings earlier this week to take a look and my whole forearm is covered in an allergic rash. He washed and rinsed my arm and put the dressing back on. 3 possible causes for the reaction: betadine/iodine allergy? The so-called cotton padding that to me doesn't feel like 100% cotton, or the plaster of paris? I'm getting my stitches out on Monday and out of this dressing and into a thermoplastic splint; and I can't wait.

Was a little bit shocked to see under the dressings. Somehow I had the impression that all the repairs were being done arthroscopically and was expecting to see only a few portal holes, not a 5-6cm incision up the side of my arm. :eek: