Chronic wrist pain following major injury Discussion

Chronic wrist pain following a wrist fracture, ligament injury or surgery may be due to a variety of problems, including painful arthritis, capsulitis, painful nonunion or partial union, partial intercarpal ligament tear, loose body, neuroma, cartilaginous lesion, as well as others. Bone scan may be helpful in ruling out occult bone injury if there is no history of arthritis, prior fracture or surgery. MRI may be helpful in evaluating suspected occult ganglion or vascular disorder. These studies are rarely indicated for other working diagnoses, and arthrography is rarely helpful as a definitive study. Diagnostic wrist arthroscopy may be useful, but generally only if preoperative evaluation suggests a specific anatomic diagnosis. There is no universally accepted approach or treatment for this problem in the absence of a clear anatomic diagnosis. Patients who have been symptomatic for more than three months are unlikely to be cured by measures such as immobilization, steroid injection or therapy. If degenerative joint changes are present, partial or complete wrist fusion should be considered for pain control. Wrist fusion results in permanent loss of motion and may not improve function according to objective testing. If there is no evidence of arthritis, the most practical options are either living and dealing with the problem or proceed with a multilevel approach including options of wrist arthroscopy, open exploration, as well as consideration of partial wrist denervation. Surgery other than complete wrist fusion is indicated only in selected cases, for it may trigger worsening of the patient's clinical status.

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