Resources for Complex Wrist Problem?

Discussion in 'Health & Fitness' started by jon44, Dec 7, 2011.

  1. jon44

    jon44 New User

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    I've got a complex issue with my wrist (luno-triquetral tear and other stuff) that two surgeries (Ulnar Shortening and arthroscopic debridement) haven't helped much.

    The USTA used to have some articles on Ulnar-sided wrist pain problems, but they seemed to have gone off the site.

    Can anyone suggest anywhere else to turn?

    (I've seen surgeons considered to be excellent in Boston and New York, but have sort of gotten to the "stop playing tennis" advice point.)
     
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  2. charliefedererer

    charliefedererer Legend

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    I see no one has answered your post over the several days since you posted it.

    Probably that is because it sounds like too complex a problem for someone to really help in a Health and Fitness post.


    So, I don't know if you'll find the following helpful, but here are some USTA articles that potentially could be helpful:

    Wrist Injuries http://www.usta.com/Improve-Your-Ga...uries-Prevention-and-Recovery/Wrist_Injuries/

    Wrist Management: Prevention of Wrist Injuries in Tennis Players
    http://www.usta.com/Active/News/Hea...evention_of_Wrist_Injuries_in_Tennis_Players/

    Prevention of wrist injuries http://www.usta.com/Improve-Your-Game/Sport-Science/340460_Prevention_of_wrist_injuries/

    Although the initial part of these last two articles is on prevention, included are the type of exercises that could help build up forearm muscle strength to take the stress off of the mobile wrist joints.


    Have you ever been cleared to do exercies?
    Have you worked with a physical therapist to increase the strength in the arm muscles enough to help take much of the stress off of the wrist by "locking" it firmly for most activities of daily living and even for tennis strokes?
    Has anyone analyzed your tennnis technique for potential problems that made an overuse wrist injury or recurrence likely?
    Have doctors already concluded that return to tennis is too likely to result in a permanent disability limiting daily living activities?
    Have you gotten opinions from anyone at
    The Hospital for Special Surgery in NY: http://www.hss.edu/conditions_minimally-invasive-hand-and-wrist-surgery.asp
    The New England Baptist Hospital in Boston: http://orthoinfo.aaos.org/topic.cfm?topic=A00001&return_link=0
     
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  3. jon44

    jon44 New User

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    Well, thanks for replying.

    I've seen the USTA articles, but it's always good to be reminded. They have another, longer, sort of White Paper that I found that talks about how limited range of motion in lower body could also lead to wrist problems, which I found interesting.

    Interesting that you link to Scott Wolfe (HSS) webpage--I'm curious about how you came across him? He did the first surgery on my wrist. Recommended the second (which I had done in Boston), but now seems ready to give up on me / my wrist ("you need to think about how important tennis is to you.")

    He thought I should keep playing and just see what developed. All this is frustrating, as in the literature there clearly is a syndrome--"Lunotriquetral instability"--which matches my history and symptoms exactly. Unfortunately, most of the work on surgical solutions seems to be done at Mayo clinic.

    Thanks again,

    Jon
     
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  4. charliefedererer

    charliefedererer Legend

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    You mentioned that you had surgery in New York. The Hospital for Special Surgery is well know for dealing with more difficult and less common problems.
    I simply went to the HSS web site and looked for information on wrist problems and turned up the informative page from Dr. Wolfe.

    I wish I had more specific advice for you, but clearly your problem is in the realm for real experts to treat you. In part my reply was because a fair amount of time had gone by without a response to your initial post, and I thought maybe touching on the basics would be worth reexamining.



    Just a thought:

    A google search of "Lunotriquetral instability" turned up this article:

    "Scapholunate and Lunotriquetral Instability in the Athlete: Diagnosis and Management
    Steven H. Goldberg, MD, Robert E. Strauch, MD, Melvin P. Rosenwasser, MD
    Hand and wrist injuries are common and, if inadequately diagnosed or treated, significant morbidity can occur. Scapholunate ligament tears and lunotriquetral ligament tears are serious disruptions of the proximal carpal row and may lead to carpal instability, degenerative changes, and often pain. An accurate, timely diagnosis will minimize the loss of playing time for the athlete and result in better outcomes. Recognition of the physical findings and use of appropriate imaging examinations will minimize time away from play for the athlete. Advanced imaging studies are expensive, may be misleading, and may not change the initial treatment plan but often are ordered in high-level athletes. After diagnosis, the injury must be assessed regarding age, degree of dynamic or static radiographic instability, the presence of arthritis, and any associated injuries. These multiple variables can provide the rationale for effective treatment. Options include immobilization, arthroscopic debridement with or without intercarpal Kirschner wire pinning, thermal collagen shrinkage with electrothermal probes, ligament repair, ligament substitution or reconstruction, and limited intercarpal arthrodesis. Acute tears that are dynamic are often amenable to arthroscopic debridement with or without percutaneous stabilization, whereas chronic injuries with static diastasis may require extensive reconstruction to restore carpal stability and prevent or limit degenerative changes such as scapholunate advanced collapse syndrome. The rehabilitation time frame for major reconstruction is 4 to 6 months to allow for healing and sufficient tissue remodeling permitting unrestricted activity."
    - http://www.optechsportsmed.com/article/S1060-1872(06)00040-2/abstract

    The last two authors of this 2006 article are senior hand surgeons at NewYork-Presbyterian/Columbia just in case you are still considering another opinion.
     
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  5. jon44

    jon44 New User

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    Thanks, I didn't realize that.

    I personally don't have a problem with getting a number of opinions (though people immediately want to label you as a neurotic doctor-shopper these days). Jimmy Conners interviewed 25 surgeons before deciding on where to get hip replacement... I think that's smart as orthopedic procedures have enormous consequences...

    Best,

    Jon
     
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  6. Baloo

    Baloo Rookie

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    Jon, any update on your condition? How long since you procedure?
    I had the same procedure (ulnar shortening and TFCC debridement) last July. It's been a long road with some other complications but there is finally light at the end of the tunnel.
    Best
    B
     
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  7. ollinger

    ollinger Legend

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    I was thinking "stop playing tennis" after reading your first sentence -- the "two surgeries" and "other stuff" are red flags. Both suggest problems that could lead to significant arthritis in the wrist (which may already be the case, as that's what "other stuff" often refers to). If you still have the problem after two surgeries, it may be time to take up billiards.
     
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  8. jon44

    jon44 New User

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    Glad you have some light. I saw another wrist guy who disagreed that luno-triequetral is issue. So, now I'm waiting and seeing.

    Could you say more about your experiences? I found it took a terribly long time to recover from the ulnar shortening. In retrospect, I think there's an issue with that surgery in that you have to use your wrist to create a new joint surface on the ulnar, but in doing so, there's a lot of stress on the other connective tissue in the wrist that still needs to adapt to the new geometries. (Anyway, that's my theory...)
     
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  9. Baloo

    Baloo Rookie

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    Sorry for the delay, we had our first baby a few days after my last post. Been busy to say the least!

    I had TFC debridement and ulnar shortening (arthroscopic) in June last year. It did take a long time (6 months) for that area to settle. Unfortunately now I would say I have developed a similar problem to you.

    The TFC is fine it's like the pain has moved from the ulnar head/triquetrum are to the triquetrum/hamate/5th metacarpal area. My surgeon is stumped and doesn't know why I'm experiencing pain there.

    So stopping tennis (again) and starting more strengthening exercises.

    Have you had any success with your problem?

    B
     
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  10. jon44

    jon44 New User

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    Wow--exact same situation. I stopped playing tennis, but strengthening has only done so much for me... (E.g., even without tennis, wrist still gets aggravated by rotational movements such as scooping stuff out of a bowl)
     
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  11. Baloo

    Baloo Rookie

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    Getting keys out of my pocket and using a mouse all day (have switched both to left hand) can get mine going, not to mention tennis!

    Oh forgot to mention I also had a cortisone shot which worked wonders (and confirmed to the surgeon the exact location of the problem) but the pain has come back.

    One thing I've done with some success is to change to a more western grip (probably a strong semi from a strong eastern) I find it gives the wrist more stability especially on the ulnar side. I don't have any problem with pronation or supination.

    Have you talked to any more specialists?
     
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  12. jon44

    jon44 New User

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    Interesting.

    No more specialists for me (just letting it sit quiet for a while). The same sort of activities bother mine as well, especially getting keys out of my pocket.

    Can I just ask where exactly you had the cortisone shot?

    Thanks,

    Jon
     
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