Chronic wrist pain following a closed injury Discussion

Chronic wrist pain following a closed injury with relatively normal findings on routine examination may be due to a variety of problems, including 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 or Kienbock's disease if there is no history of 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 simple local measures such as immobilization, steroid injection or therapy. In the absence of a clear diagnosis or evidence of imminent deterioration, 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. The operative approach is indicated only in selected cases, for it may trigger worsening of the patient's clinical status.

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