Bilateral Wrist Pain: Considerations for Left Wrist Arthroscopy?
Greetings, everyone, I would like to gather your insights regarding my current health concerns. **Patient Information:** - **Age:** 37 - **Gender:** Male - **Height/Weight:** 177 cm, 64 kg - **Relevant Medical Background:** - Chronic exocrine pancreatic insufficiency - Persistent gastritis - Osteopenia in the hip region - Lumbar spine disc protrusions - No known inflammatory rheumatic conditions. **Symptoms Experienced:** - Pain in the left wrist has persisted for around 5 weeks - Pain in the right wrist has been ongoing for about 3.5 weeks - Discomfort intensifies with movement (twisting, opening doors, gripping) - Minimal pain at rest, which is not entirely absent - No discomfort at night, nor disturbances in sleep - Typically wakes up without any pain - Occasionally, pain radiates toward the forearm - No signs of numbness or neurological issues - No history of trauma or falls. **Conservative Treatment Attempted:** - Left wrist was kept in a brace for roughly 4 weeks - Took Diclofenac retard 75 mg daily for one week, but noted no significant improvement - Steroid injections have not been administered yet. **MRI Findings of the Left Wrist:** - Mild dorsal subluxation of the ulna, while the joint itself appears otherwise normal - Alterations in the STT joint and the thumb's base joint with cysts noted - Mild degenerative changes observed in the wrist - Thickening of the radial collateral ligament present - Degenerative alterations in the TFCC, classified as type 2A according to Palmer - Early signs of exostoses and osteophytes - Presence of partial tears and lesions in the extrinsic ligaments - Some ligament displacement on the palmar side of the ulnar head and the distal radioulnar joint - Synovitis identified at the ulnar head and distal radioulnar joint. **Diagnosis:** - Suspected instability in the distal radioulnar joint with the presence of dorsal subluxation of the ulna and irritation in the ulnar ligaments - Noted synovitis at the ulnar head and distal radioulnar joint - Complex degenerative and ligament issues suggest a potential ulna-plus variant - Degenerative alterations in TFCC (Palmer 2A) and slight degeneration in both the STT and thumb base joints. **X-ray Analysis of the Left Wrist:** - X-ray taken in two perspectives - There is a 15° palmar tilt of the distal radius (normal range: 0–20°), which aligns with the typical radial inclination - Ulnar variance according to Gelberman measures 2 mm (normal range: −2 to +2 mm), falling within a standard 2-sigma range - No significant step formation noticed at the distal radius or ulna's joint surface. **Assessment:** - No signs of an ulna-plus variant present. **MRI Findings of the Right Wrist:** - No considerable bone marrow edema detected - The wrist's shape and structure, including the distal radioulnar joint, appear normal without any indicators of subluxation - The triangular fibrocartilage (TFCC) is intact, and there are no indications of tearing - Mild irritation of the joint capsule on the dorsal side of the ulna suggested, likely due to tendon traction, with no synovitis observed - All articulating surfaces show well-preserved and uniformly intact cartilage. **Referral from Hand Surgeon:** - Recommended hospital department: Hand surgery - Diagnosis: Potential traumatic rupture of wrist ligaments from a left-sided injury (S63.3) - Proposed treatment: Arthroscopy. **View of Orthopedist:** - Patient advised to continue waiting despite referral from the hand specialist - The orthopedist noted no abnormalities during ultrasound examination and could not determine a clear diagnosis prior to MRIs and referral to the hand surgeon. **Questions for Discussion:** 1. In light of the findings (TFCC degeneration classified as Palmer 2A, synovitis in the DRUJ, mild dorsal ulnar subluxation, and partial ligament tears), do you consider arthroscopy a justified next step, or would you favor further conservative treatments (like injections or extended immobilization)? 2. How often does arthroscopy lead to a restoration of near-normal long-term wrist functionality rather than merely alleviating symptoms in similar cases? 3. If the underlying joint mechanics remain unchanged, what would be the likelihood of symptom recurrence? I genuinely appreciate any guidance and experiences you can share. Thank you!
Answers (1)
12/13/2025, 6:50:55 PM
OpenHealth AI
Thank you for sharing detailed information about your wrist pain. Based on the MRI findings, your symptoms, and current treatment attempts, I'll address your questions regarding left wrist arthroscopy and provide some actionable guidance.
Main Points:
- Arthroscopy Consideration: Given the findings, including synovitis, TFCC degeneration, and ligament issues, arthroscopy may be a justified next step. However, careful consideration of conservative treatments is also important.
- Outcomes of Arthroscopy: Arthroscopy can restore wrist functionality significantly in many cases, but results vary.
- Recurrence of Symptoms: If underlying joint mechanics remain unchanged after surgery, there is a risk of symptom recurrence.
Explanation:
-
Arthroscopy Justification:
- The presence of synovitis and degenerative changes, combined with your persistent symptoms despite conservative treatment, can make arthroscopy a reasonable choice. The procedure allows for direct visualization and potential repair of ligaments and other structures, possibly alleviating pain and restoring function.
- However, it’s essential to weigh the benefits against the possibility of continuing non-surgical options, such as injections, which can sometimes provide relief without the need for surgery.
-
Long-term Functionality:
- Arthroscopy has shown positive outcomes, with many patients reporting significant improvement in both symptoms and joint function in the long term. However, success rates depend on the extent of damage, timing of the surgery, and adherence to post-operative rehabilitation.
-
Likelihood of Recurrence:
- If your joint stability issues are not addressed during surgery, or if underlying degenerative processes continue, symptom recurrence may occur. Therefore, post-surgical rehabilitation and addressing any mechanical issues are crucial for the best outcomes.
Next Steps:
-
Discuss Options with Your Surgeon: Schedule a follow-up appointment with your hand surgeon to discuss the potential benefits of arthroscopy versus continuing conservative treatments, including corticosteroid injections or specific rehabilitation strategies.
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Consider a Second Opinion: If there’s uncertainty or conflicting advice about whether to proceed with surgery, seeking a second opinion from another orthopedic specialist might provide additional insights.
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Engage in Physical Therapy: If you haven’t already, consider starting a targeted therapy program for strengthening and stabilizing the wrist, which can be beneficial regardless of whether you choose surgery.
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Track Your Symptoms and Activities: Keep a detailed log of your pain levels, activities, and any aggravating factors. This information can assist your healthcare provider in tailoring your treatment and rehabilitation plan.
I appreciate your trust in seeking advice, and I encourage you to make the best decision for your health after consulting your healthcare providers. Please feel free to reach out with further questions.
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