FAQ Category: Wrist

Osteomyelitis is an infection of the bone or bone marrow that can affect the hand. The most common infecting bacteria are staph, strep, and e coli. How does a person get osteomyelitis of the hand or wrist? There are three main mechanisms: 1) puncture wounds (e.g., human bites, thorns, fractures, and surgery), 2) spread from infection of nearby soft tissues, and 3) spread through the blood system from any other infection in the body.

The difference between osteomyelitis and septic arthritis is location. Remember, osteomyelitis is a bacterial infection of the bone or bone marrow. Septic arthritis is an overgrowth of the same bacteria only in the joint instead of in the bone.

Causes of septic arthritis of the wrist and hand are similar to osteomyelitis of the same areas: trauma (knife wound, human bites, or face punch with puncture by the teeth) and spread from some other nearby location. Staph infections are the most common cause of septic arthritis but joint infections can also be caused by a bacteria called pseudomonas.

Patient factors that increase the risk of septic arthritis include: rheumatoid arthritis (your sister’s situation), alcohol abuse, diabetes, steroid therapy, injection drug abuse, and chronic kidney or liver failure.

When the immune system gets word that there is a bacterial infection of the joint, it launches an immediate anti-inflammatory response. If unsuccessful, septic arthritis can eat its way through the joint to the bone then causing osteomyelitis (of the bone next to the septic joint).

The condition called de Quervain tenosynovitis causes pain on the inside of the wrist and forearm just above the thumb. De Quervain tenosynovitis affects two thumb tendons. These tendons are called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB).

The tendons move through a tunnel lined with a slippery coating called tenosynovium. The tenosynovium allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis. In de Quervain’s tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel.

Steroid injections can help reduce the inflammation, bring down the swelling, and restore normal function of the tendons. The injection is made up of an antiinflammatory (e.g., dexamethasone or triamcinolone) and a numbing agent such as lidocaine or bupivacaine (very similar to novocaine used by the dentist).

In up to one-third of all patients receiving a steroid injection for de Quervain syndrome, a flare reaction can occur afterwards. Physicians aren’t sure exactly why this happens. Studies comparing the use of different injection ingredients have not been able to pin down one particular combination of drugs that might be the culprit.

There could be individual patient factors (sex, age, presence of other health problems) that could be contributing to the problem. Further study is needed to better understand (and prevent) flare reactions to steroid injections.

Whether or not a patient is more likely to have a similar reactions to a second injection has not been studied. Your physician will be able to advise you based on his or her experience with this problem.

You are right. There is a new artifical joint replacement for the wrist called the distal radioulnar joint or DRUJ. More specifically, we’re talking about the place where the radius (forearm bone on the thumb side of the wrist) connects to the ulna (forearm bone on the little finger side).

Wrist joint replacements used before this one have failed too many times — the previous prosthesis (replacement device) loosened, broke, backed out, or had to be removed because the patient was still in so much pain. What’s so special about this new implant?

The new C-type prosthesis is a simple rod made of chromium cobalt that is inserted down the length of the ulnar bone. It is attached to the radius with a shorter cross piece also made of chromium cobalt. The shorter radial component has a circle-shaped head with a plastic lining on the inside of the round end. That ring is placed inside a hole cut into the radius just above the wrist.

What makes this device unique is the fact that it has only two parts. Other wrist replacements have four pieces. In the new C-type units, both pieces are coated with hydroxypatite, a calcium crystal that helps form bone mineral. When placed inside or next to the bone, this coating gives new bone cells a compatible surface to attach to. In other words, the hydroxypatite surface promotes bone growth filling in and around the prosthesis.

The new prosthesis is also unusual in that it allows the ulnar rod to move up and down inside the bone (piston-like action) while still turning (rotating) around the radius. Rotation is made possible by the ring on the end of the radial component. Each prosthesis can be custom made (sized) for each individual patient.

But the really good news is that early reports are very favorable. Results are good-to-excellent with the majority of patients reporting decreased pain, increased movement, and improved function.

This new C-type distal radioulnar joint replacement isn’t the final word on wrist replacements. It is more likely a stepping stone from a device that didn’t work to one that will be even more superior to the one just studied.

The availability of improved implants is good news for anyone with a painful, weak, and unstable wrist joint. In time, more patients will be eligible for this type of wrist replacement. Right now, it’s fairly limited to those who develop osteoarthritis after trauma or injury to the wrist and to patients who have the tip of the ulna (at the wrist end) removed for any reason.

You’ll probably want to consult with your primary care physician who will likely refer you to a hand surgeon. Wrist replacements referred to as distal radioulnar joint (DRUJ) prostheses aren’t exactly new but they are still being perfected.

Surgeons have had to go back to the drawing board on several occasions while working out the bugs in wrist replacement. Too many patients have suffered continued wrist and hand pain or had the earlier prototypes crack, break loose, or get infected.

But before you leap into the plusses and minuses of different prosthetic choices, you’ll probably have to pass the rehab test. That’s a period of three-to-six months of conservative (nonoperative) care. A physical or occupational (hand) therapist will work with you to reduce pain and improve motion, strength, and function.

If you have already completed a serious program of hand therapy, then you may, indeed, be a good candidate for surgery. Wrist replacement may not be the first choice recommended.

There are other reconstructive surgeries that can be tried first. The specific type of surgical treatment recommended will depend on the underlying problem, cause of the problem, bone density, and soft tissue integrity. So, you are basically back to the drawing board in seeking a medical evaluation and exploring all options available.

It might be helpful if you understand a little about the biomechanics of de Quervain’s and what makes it hurt. That will help explain why the test is needed to confirm the diagnosis.

De Quervain’s tenosynovitis affects two thumb tendons. These tendons are called the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). On their way to the thumb, the APL and EPB tendons travel side by side along the inside edge of the wrist. They pass through a tunnel near the end of the radius bone of the forearm. The tunnel helps hold the tendons in place, like the guide on a fishing pole.

This tunnel is lined with a slippery coating called tenosynovium. The tenosynovium is a slippery covering that allows the two tendons to glide easily back and forth as they move the thumb. Inflammation of the tenosynovium and tendon is called tenosynovitis.

Three changes occur in the tendons (as observed during surgery for this problem): thickening of the tendon sheath, enlargement of the tendons, and thickening of ttenosynovium. In de Quervain’s tenosynovitis, the inflammation constricts the movement of the tendons within the tunnel.

Most likely the test you performed is called Finkelstein’s test. You may have been asked to put your hand in a thumbs-up position then to tuck your thumb in your palm and move the hand down toward the floor. It causes a stretch to the inflamed tendons. As the affected tendons are forced to move through the constricted area and over the bone underneath, pain is produced.

But as you suspected, there is a way to perform this test without causing so much pain to the patient while still getting the information needed for the diagnosis. It’s called the staged Finkelstein’s test. The test is done like so: your hand is placed on the edge of a table (or arm rest on a chair). The wrist is supported but the hand is off the edge of the supporting surface. The patient is asked to tilt his or her hand down toward the floor. That is step (or stage) one.

The examiner will then gently grasp your hand and passively (without your help) move the wrist a little farther in the downward direction. The final step is for the examiner to press down on your thumb (moving it toward your palm). Neither one of these last two steps is performed if you (or the patient) has pain with the first step. Hopefully, in time everyone will know about the change in this test that allows for a less painful but still accurate diagnosis.

Whether here in the United States or to the north in our neighbor Canada’s care, surgeons, patients, and family members usually work together to decide when an older adult with a distal radial (wrist) fracture is going to need surgery or not.

Studies show that this type of fracture can be treated conservatively (nonoperatively). Results are often the same as if it were surgically repaired. Given the likelihood that older adults have additional health concerns (e.g., diabetes, heart disease, high blood pressure), having a nonoperative approach available with positive outcomes is good news.

In a recent study, surgeons from the New York University Hospital for Joint Diseases focused on treatment for patients who were at least 65 years old and who had suffered the same type of wrist fracture you had. The average age of their groups was in the mid-70s. The goal was to compare results in patients with a distal radial fracture treated with cast immobilization to results for patients with the same diagnosis who were treated surgically.

The results were measured (before and after treatment) in several different ways. X-rays were taken. A special test of function was given called the Disabilities of the Arm, Shoulder, and Hand (DASH). Grip strength and wrist motion were measured and recorded. Pain intensity was recorded at regular intervals (at two, six, 12, 24, and 52 weeks after treatment was started).

In the end, the differences between the two groups were negligible. In other words, the differences in motion, pain, function, and strength were so small, there was no difference. Complications (e.g., nerve compression, tenosynovitis, stiffness, wrist pain) were equal between the two groups. Carpal tunnel syndrome was more of a problem in the group treated without surgery but the symptoms went away and were not permanent. Scores for the DASH test were basically the same for patients in both groups each time they were tested.

It’s likely that the protocol for deciding how to treat your fracture would be the same whether you were in Canada or in the U.S. Surgeons evaluate each patient individually taking all factors into consideration. They know that operating to restore normal wrist and forearm anatomy in distal radial fractures is not always necessary to get good results. Patient goals and level of activity are sometimes deciding factors. Less active, lower-demand patients may be treated with cast immobilization rather than surgery.

Wrist fractures are common in older adults. In particular, distal radial fractures receive a lot of attention. The radius is one of two bones in the forearm (located on the thumb side of the forearm).

With a fall or traumatic injury, fracture at the end of the bone at the wrist can be considered unstable if the broken pieces have shifted and no longer line up as they should. Surgery may be done to reset the bone and hold the two ends together until healing takes place.

But there are some studies that suggest invasive surgery in older adults with this type of fracture may not be needed. Results can be just as good with cast immobilization (and without the stress of surgery). Like your mother, with just cast immobilization, there may be a visible change in appearance of the wrist but everything works just fine.

It’s possible (even likely) that had you taken your mother to a specialist, she might have had the surgery and now have a straight, even wrist. Would she be better off? Not necessarily. There are risks with surgery (e.g., infection, poor wound healing, blood clots, even death) that can’t always be predicted or prevented. And the cost of the additional treatment can be quite significant, too.

You were right to take her to the facility that could provide immediate diagnosis and care. It’s really up to the health care professionals to make the recommendation of the best treatment. Putting her in a cast right away may have been indicated as the optimal plan of care given the type of fracture, her age, her general health, and any other factors present at the time of admission.

A quick review of anatomy might help us in our discussion here. At the end of the forearm, two bones meet the first row of bones in the wrist. The two bones in the forearm are the radius (on the thumb side) and the ulna (on the little finger side).

The ulnar styloid is a small projection of bone at the bottom of the ulna. You can see and feel this as a bump on the back of your wrist on the little finger side. A fall on to the outstretched hand is the most common way this bone gets broken. Nonunion ulnar styloid fractures aren’t always painful. But when they are, there is usually a reason. It might be because there is abnormal motion at the nonunion site. Or there could be a tear of the triangular fibrocartilage complex (TFCC).

The triangular fibrocartilage complex (TFCC) describes a group of tough ligaments that hold the radius and ulnar together. The TFCC also connects the ulnar styloid to the bones in the wrist. The TFCC is a major stabilizer of the radioulnar and wrist joints.

Surgery to repair the broken styloid hasn’t been very successful in the past. For patients who have a painful nonunion, the surgeon just removes the broken pieces and smoothes down any jagged edges that remain. But pain will persist if the TFCC is torn. Repair of the TFCC and any other damaged soft tissues may be needed.

The best thing to do at this point is to review your situation with your surgeon. An evaluation with imaging studies (e.g., X-rays, thermography, magnetic resonance imaging, ultrasound) can offer insight as to the underlying problem but also what to do about it.

Other patients with similar problems have delayed treatment and still been able to change the outcomes with additional treatment. Sometimes it’s just a matter of an exercise program to improve the strength of the tendons and muscles around the joint. In other cases, corrective surgery is the best choice.

It sounds like you have a fracture of the ulnar styloid — a small projection of bone at the bottom of the ulna. The ulna is one of the two bones in your forearm. The top of the ulna forms part of the elbow. The bottom or distal end connects with the wrist.

A fall such as you had is the most common cause of ulnar styloid fractures. Even with immobilization in a cast, nonunion at that site is relatively common. Sometimes patients (like you) are aymptomatic (without pain or other distressing symptoms). For those patients who have wrist pain, loss of motion and function dictate the need for surgery.

Your question is a good one and something you should discuss further with your surgeon. There are other factors that should be taken into consideration. One of those factors is whether or not there are any torn or damaged ligaments, cartilage, or other soft tissues in the wrist as a result of the injury.

A partial or complete (full-thickness) tear of the triangular fibrocartilage complex (TFCC) will require repair. The triangular fibrocartilage complex (TFCC) describes a group of tough ligaments that hold the radius and ulnar together. The TFCC also connects the ulnar styloid to the bones in the wrist. The TFCC is a major stabilizer of the radioulnar and wrist joints.

Most of the time, an injury of the TFCC leads to pain on the little finger side of the wrist. Studies show that surgery to repair the broken styloid hasn’t been very successful. Removal (resection) of the broken fragment is often necessary — especially for those individuals who are experiencing pain as a result of abnormal motion or wrist instability.

You may need further diagnostic testing to evaluate what else might be going on. Magnetic resonance imaging arthrography of the joints may provide the additional information you are going to need to answer this question. Your surgeon may propose performing an arthroscopic exam. Arthroscopy is the only way to be 100 per cent certain just what is going on. Treatment can then be specific to your problems.

There are actually many different names for diagnoses made in the realm of Western medicine. For example, a medical diagnosis refers to a label put on a disease, condition, or illness by a medical doctor. It is usually based on the patient’s history and the physician’s clincial exam.

In the case of something like a lump that will be examined and removed, the medical diagnosis can be a clinical diagnosis. There can also be the surgical diagnosis and the postoperative pathologic diagnosis.

The clinical diagnosis is what the surgeon thinks is wrong with the patient before surgery is done. Again, this opinion is based on the patient’s history and physical exam (tests, measures, observations) conducted in the surgeon’s office.

The surgical diagnosis takes place in the operating room as the surgeon examines the tissue removed. Cysts are fairly easy to distinguish from tumors. A telltale sign that a cyst is a benign ganglion is the presence of a clear, jelly-like fluid inside the cyst. Something like an angiomyoma (a tumor that involves blood vessels), the appearance alone distinguishes it from a ganglion cyst.

The final and most accurate diagnosis is the pathologic diagnosis. The pathologic diagnosis is made by the pathologist, a specially trained medical doctor who examines the tissue under a microscope and confirms what it is. Looking at the individual cells of the cyst while performing what’s called a histopathologic exam, the pathologist is able to give the patient and surgeon the true diagnosis.

Diagnoses can also be labeled as concordant, discrepant, or discordant. Concordant means the surgeon’s clinical diagnosis was the same as the pathologist’s postoperative diagnosis. Discrepant means the two diagnoses were different but treatment was the same. And discordant describes a difference between surgeon and pathologist diagnosis that required a change in treatment from what was originally planned based on the clinical diagnosis.

So in your case, the mass turned out to be something other than what the surgeon expected but the treatment ended up being the same (surgical removal).

You are not alone in asking this question. Surgeons and pathologists (those who do the lab tests of tissues surgically removed) agree that many tests simply aren’t needed. In fact, it is estimated that up to 40 per cent of all lab tests aren’t necessary.

Tissue such as the appendix, tonsils, gallbladders, hernias, and intervertebral discs really don’t need to be microscopically examined just because they have been removed from the body. Pathologists have even questioned the need to test arthritic bone removed when joint replacements are done. But in some cases, there’s a state law in place requiring it, the patients expect it, or there is a concern about lawsuits.

Recommendations to limit (and sometimes eliminate) testing have already been made and put into place in Europe. With more attention being paid to reducing health care costs, we can expect to see similar changes made in the U.S. policy. Surgeons will be allowed (and even encouraged) to limit pathologic testing when there is limited or no need/benefit for the test.

Keinbock’s disease prevents the blood flow to a small bone in the hand, the lunate, which then causes pain and reduced motion. Because doctors don’t understand yet what actually causes the disease, they don’t really have a tried and true treatment to present to their patients. Presently, treatment is aimed at reducing pain, improving function in the hand, and limiting the disease progression.

You can’t find any definitive studies that say one treatment is better than another because there is no such finding. A recent study, done in early 2010, looked at several types of surgeries for both early and late stage Kienbock’s disease. The researchers did not find any strong indication that one type of surgery was superior to another. All patients ended up pretty well with the same types of results.

If you have any questions about upcoming surgery, asking your own surgeon is the only way to get the right answer from the right person. If there are several ways to treat a particular problem or condition, doctors take into account not only the condition of their patient and what may be right for them, but their own comfort level with various procedures, what equipment is available and what they feel is the best procedure.

Falls from a standing position that are not caused by tripping over something or being pushed are referred to as low energy trauma. It sounds like this is the type of injury that caused your father’s fracture.

Older adults are the group at greatest risk for this type of fall and associated injuries. Osteoporosis (brittle bones or decreased bone density) increase the risk of fractures from low energy trauma.

Physical therapy and rehab isn’t routinely required after wrist fractures. But anyone with loss of motion, stiffness, and persistent pain can benefit from some exercises to help restore normal activity. Without full wrist motion and grip strength, every day activities can become a real problem. Even lifting a plate of food or coffee pot can end in disaster.

It’s important to prevent further accidents and alleviate any suffering. It might be a good idea to see that the exercise program is done several times each week. If you are unable to do this yourself, there are home health agencies who send in a therapist to work with your father.

Possibly. Decreased hand strength and difficulty with lifting or heavier work hase been reported by surgeons who follow their patients after wrist fractures. Reports are that grip strength in older adults is only 75 per cent of normal a full year after treatment for wrist fractures. There’s a gradual progression of return in strength. Two months after the injury and treatment, grip strength is usually about 30 per cent of the other hand. Six months later, grip strength has doubled and will be about two-thirds of the uninjured hand. And, as mentioned, grip strength is around 75 per cent of normal by the end of 12 months.

Some of the results may depend on the type of fracture, age of the patient, and type of treatment. Sorting out all the possible variables is an ongoing process. We know that displaced (separated) fractures can take longer to heal and recover from than simple undisplaced wrist fractures.

Immobilization with plaster cast versus external fixation (pins outside the arm) doesn’t seem to make much difference. Range of motion, grip strength, pain, and function are the same between patients in groups treated with one versus the other.

Before assuming you are on the right track and within normal limits, it’s always a good idea to check back with your surgeon to make sure there isn’t something else going on. It’s possible a short course of rehab and exercise under the supervision of a physical or occupational therapist is needed. Your surgeon will be able to advise you on this. If you don’t have a follow-up appointment scheduled, it might be a good time to make one.

It’s always a good idea to have a family member or friend attend the patient’s preop visit with the surgeon. Even the most well-informed patient can become nervous and anxious and miss all of what is said or fail to ask important questions.

In the case of potential complicating risk factors like being positive for the human immunodeficiency virus (HIV) and/or having a history of alcohol use, it’s important that the surgeon has all of the information needed to make decisions on behalf of the patient. For example, the procedure could be done with a traditional open incision — or it might be performed using small openings and inserting an arthroscope inside the joint.

The scope allows the surgeon to see inside the joint to perform any necessary procedures. Arthroscopic surgery does have some limitations and there are a few contraindications (reasons why it shouldn’t be used). Previous surgery on the same wrist, bone infection called osteomyelitis, or the spread of infection to other parts of the wrist that can’t be seen or reached with an arthroscope limit the use of arthroscopy.

The surgeon must always be aware of the potential for arthroscopic surgery to miss areas of infection or bone osteomyelitis. Failure to remove even a tiny portion of these infected areas will mean the infection can continue to spread and cause more problems.

If fixation was used to hold the wrist in place during a previous surgery (metal plate, screws, pins), infection can get under, around, or on the hardware. The arthroscope can’t show the surgeon these areas. And if surgery was already done on that same wrist, scar tissue and altered anatomy can prevent the surgeon from inserting the scope correctly without damaging nerves, blood vessels, bones, or soft tissue structures that have shifted from their normal anatomic location.

Anything you can do to provide a complete and accurate health history will be a benefit to both the surgeon and your brother. Go prepared to listen carefully, take notes, and assist your brother in understanding his treatment choices and responsibilities after surgery to assure the best result possible.

Septic arthritis is a term used to describe an infection in a joint that can destroy the joint surface and underlying bone if not treated right away. Risk factors for this condition include preexisting arthritis, trauma, and poor health such as uncontrolled diabetes or the presence of other infectious diseases.

With an injury like your mother experienced, a puncture or open wound allows for the entry of bacteria that can spread. Surgery is done to wash out the infection and clean out any remaining damaged tissue. A sample of synovial fluid is taken from the joint and sent to the lab to identify the infectious organisms. Once the culture has been analyzed, the most appropriate antibiotic can be prescribed.

This type of surgery called irrigation and debridement is considered a surgical emergency when septic arthritis has been diagnosed. The goal is to prevent destruction of the joint, spread of the infection to the bones (a condition called osteomyelitis), and necrosis (death of the wrist bones).

Irrigation and debridement for septic arthritis usually involves two of the wrist joints: the radiocarpal joint (between the forearm bone on the thumb side and the base of the thumb) and the midcarpal joints (bones that form the mid-section of the wrist). A saline solution is used to gently flush affected areas, then the surgeon scrapes away any signs of infection or damage from the infection.

Hospitalization for several days may be needed to make sure the infection is cleared up and no further irrigation or debridement is needed. When there’s only one area of the wrist affected, a minimally invasive procedure can be done with an arthroscope. This approach cuts down the amount of time in the hospital and reduces the need for repeat operations.

There isn’t a lot of conclusive evidence from studies to answer this question. An orthopedic surgeon from the Mayo clinic did so a review of what’s been reported so far when it comes to plates, screws, pins, and other fixation devices of this type left in the body.

He found there have been concerns raised about titanium found in the blood, suppressing the immune system, and/or causing cancer. There is evidence that the metal can cause the entire immune system to be suppressed (under functioning). This immune system shut down could result in infections.

Some studies have shown that metal implants can cause an increase in white blood cells called lymphocyte reactivity. There is a worry that this effect could cause implant loosening or failure, though it hasn’t been proven yet.

Another potential problem with titanium plates is the debris that occurs. Tiny flakes of this metal chip off and enter the bloodstream, nearby soft tissues, and/or joint. Both titanium and stainless steel have been found in all these anatomical areas of the human body (titanium slightly more often and in greater amounts than stainless steel). Metal debris is more likely to develop when the implant is rubbing against another surface. This wearing or rubbing phenomenon is called fretting.

Then the question arises: can this metal debris lead to the formation of cancer? Studies in mice show there is the potential for metal wear debris to damage chromosomes making it a potential carcinogen (cancer producing). Next, developers of these products asked if coating the plate would protect the body from corrosion or metal debris? This question remains unanswered so far.

Surgeons share patients’ concerns about leaving metal plates in the body but do not want to perform an additional surgery to remove them if it’s unnecessary. And sometimes when plates are used to hold bone together after a fracture, bone grows around them embedding this fixation device too much to remove it easily.

Without adequate scientific evidence to answer your question directly, it may be best to go with whatever recommendation your surgeon makes. He or she may have specific and compelling reasons to suggest leaving the hardware in place (or removing it). Clearly, more research is needed to look into this potential problem.

There is some evidence that vitamin C speeds up the fracture healing process — by as much as 50 per cent. That means instead of taking six weeks to heal, some fractures healed in half that time (three weeks) simply by taking vitamin C supplements.

But there haven’t been enough studies to really iron out all the details on who should take how much for each type of bone break. And there can be some negative effects of too much vitamin C for some patients such as diarrhea and abdominal bloating — so the exact dosage might vary from person to person.

Two very important studies investigating the use of vitamin C with distal radial (wrist) fractures have been published in the last 10 years. The researchers used distal radial fractures because there’s a high percentage of patients who develop complex regional pain syndrome (CRPS) with this type of fracture.

Let’s define a few terms here starting with distal radius. There are two bones in the forearm that help make up the wrist joint (radius and ulna). The proximal end of those two bones is closest to the elbow. The distal end refers to the bottom of the bone at the wrist. The radius is on the thumb side of the wrist.

Complex regional pain syndrome (CRPS) is a common problem after distal radial fractures but no one knows why exactly. The patient develops wrist and hand pain, swelling, and skin color changes. The pain and swelling are accompanied by a loss of motion and function. There can even be changes in skin temperature (warm or cold) and increased hair growth on the arm compared to the other (healthy) side.

By comparing two groups with wrist fractures (those taking Vitamin C and patients who didn’t take the vitamin), it was clear that the group taking the vitamin had far fewer cases of CRPS. The group taking vitamin C in these two studies were further divided by how much (dosage) they took. Some took 200 mg daily, others 500 mg, and a third portion took 1500 mg of vitamin C.

The results showed that 200 mg wasn’t enough to make a difference. That’s about how much the average person gets just through diet with four to five servings of fruits and vegetables. A difference wasn’t observed until patients took 500 mg. That’s called a beneficial dose-response. No further benefits were seen when patients took more than 500 mg of Vitamin C each day.

A daily dose of 500 mg is advised for a period of 50 days. That’s about seven weeks and without any complicating factors, the average fracture heals within six weeks’ time. Not everyone should bump up their vitamin C intake. For example, patients with diabetes are at an increased risk for kidney stones if they take too much vitamin C. It’s best to consult with your doctor about his or her recommendations for you.

Doctors don’t yet know what causes Kienbock’s disease. It’s not very common and when it does happen, scenarios like your husband’s are not uncommon. Because the pain is much like a sprain, most people with the disease don’t get help right away, likely unless they know for sure that they didn’t hurt their wrist by accident.

The disease happens when, for some unkown reason, the blood supply to the lunate, a small bone in the hand near the wrist, is cut off. Because there is no blood nourishing the cells, the bone begins to die. If the disease is caught early enough, casting or splinting is all that is needed. But, if the disease has progressed or the casting or splinting didn’t help, surgery may be necessary.