FAQ Category: Wrist

The pain from Kienbock disease is very easily mistaken for a sprained or injured wrist at first. The difference is, usually the injured wrist stops hurting after a while, while Kienbock disease won’t and it does start to make the wrist less bendable. It can also affect the strength in the hand.

While, technically, part of the bone in your wrist is dying, it’s not that cut and dry. What happens in Kienbock disease is that the blood supply is cut off from some small bones in the wrist, for an unknown reason, and without the blood supplying the necessary oxygen and nutrients, the cells in the bone do begin to die. However, this doesn’t spread, so there’s no worry for that.

Treatment for Kienbock disease is often a surgery called an osteotomy. In the surgery, the surgeon removes a very small part of the bone that has been affected. The surgery is usually quite successful and allows the patient to return to his or her previous level activity after it is completely healed.

If you go to the doctor complaining of wrist pain, your doctor will examine your wrist and ask you questions about your medical history and any recent injuries or trauma to your arm. Following that, it’s very likely you will go for an x-ray. If your doctor isn’t sure, you may be referred for a more specialized test called a magnetic resonance imaging scan (MRI), which allows the doctor to see the joint and the tissues more clearly. Some doctors also use computed tomography scanning (CT scans).

You’ve hit upon a problem that faces many Workers’ Compensation claimants. Functional status, limitations, and abilities/disabilities can be very different between home and work. And tests to measure function don’t always address these types of limitations.

There is one tool that seems to take into consideration both sides of the worker’s life: home and work. This is the Patient-Specific Functional Scale (PSFS). Besides providing useful clinical information, the test helps predict functional limitations.

Each WC claimant completing the PSFS is asked to list the top three activities they are having the most trouble with. This gives them a chance to personalize an otherwise standard test. The test is more meaningful to the patients because they can discuss their own unique problems and challenges.

Call and write a letter to the Workers’ Compensation Board. Express your concerns. Ask about test procedures such as the PSFS to help identify areas of disability that need to be addressed through rehab before returning to work. This can help prevent future recurrences of problems from injuries or accidents.

Sometimes, when a child breaks a bone, it’s hard to tell and if they’re not acting very differently from usual, it can be impossible to tell.

That being said, scaphoid fractures usually cause pain and swelling at the base of the thumb, with the pain getting worse when the thumb is moved.

Treating children for arm breaks is one of the most common tasks for doctors who work in emergency rooms that deal with fractures. The forearm is vulnerable because of the way the arm reaches out to break a fall.

Why the treating doctor didn’t believe you isn’t something that can be addressed, but emergency personnel take many things into consideration when making their decisions. Of course, they do make mistakes from time to time and that is why it’s important for parents to go with their gut instinct.

Gymnastics places a heavy burden on growing wrists. When tumbling, for example, your daughter’s weight is forced onto her wrists for very brief intense periods. Vaulting does the same thing. With the uneven bars, there is the strength the wrist needs to support her and help her swing. And, with the other events, such as the balance beam, there is, of course, the risk of a fall.

The best way to prevent injury is to be sure that the wrist is healthy to begin with. Don’t allow your daughter to practice on injured joints; this can only make things worse. check with your doctor and be sure that your doctor is aware of the signs and symptoms of wrist problems that are unique to gymnasts so that they are not missed by accident.

You can depend on your orthopedic surgeon to advise you. Having regular check-ups will help show any changes that have occurred over time and how rapidly they are progressing. Some people rely on their symptoms. If pain and loss of motion, strength, and function are great enough, then surgery may be the best choice.

For some people with this condition, pain occurs with everyday activities. Severe, disabling pain may prevent them from completing daily activities at home or at work. X-rays can show if there is breakdown of the affected bone and/or joint. Though symptoms don’t always match what’s going on in the X-ray, changes in the bones or joints must be considered.

There are procedures available to restore blood flow to the area. Removing a bone or a row of carpal (wrist) bones takes the pressure off the wrist. Reducing compression can help revascularize the area.

Kienböck’s disease is a fairly rare condition of deterioration in the wrist caused by a loss of blood supply to the area. The lunate bone along the little finger side of the wrist (next to the forearm) is affected.

Removing the lunate and/or the entire row of carpal (wrist) bones is one way to manage the problem. This latter procedure is called a proximal row carpectomy (PRC).

There aren’t very many studies to go on to answer your question. When studies are presented on PRC, patients included don’t always have Kienbock’s. Sometimes the studies are reporting on the use of PRC with a variety of wrist pain problems.

One long-term study from the University of Wisconsin offers some insight with a small number of patients. All had PRC for advanced Kienböck’s disease. Follow-up was carried out for a minimum of 10 years. Data for some patients is available for up to 20 years.

Overall the results were good to excellent. The patients all reported decreased pain and improved grip strength and function. X-rays showed some joint degeneration but the patients were not having symptoms to suggest a problem.

Based on the small number of studies published, unless some other injury occurs, there’s no reason to suspect your situation will change.

There’s no doubt that a wrist fusion limits wrist motion. But a painful wrist is often nonfunctional. So even with a fusion, the patient is able to do more despite the loss of motion.

A recent study from the Harvard Medical School offered some additional insight to this problem. They used splinting to test the idea that wrist motion is directly linked with functional ability.

Subjects were 45 years or older and right-handed. The choice of age was intentional to mimic the same ages as patients who need wrist surgery for arthritis. All participants had normal motion and function with no history of arthritis.

While wearing a partially restrictive splint, wrist and hand function were assessed and compared to when wearing a fully restrictive splint. Although the subjects with less motion also had less function, their function was not as limited as might be expected.

Fusion does have functional effects on modern day activities. But most patients find ways to perform tasks despite highly restricted conditions. Having full range of motion is always preferred. But sometimes fusion does provide relief of pain with acceptable function.

You may want to try a simulation of sorts. Wearing a wrist and hand splint that restricts motion while painting may help you see how much you can adapt. Resting the joints with a splint may help reduce your pain levels as well. A trial of this type can be very informative before having a fusion procedure that can’t be undone.

Restricting wrist motion with a splint can provide helpful information prior to making a decision to have surgery. When properly fitted, a splint can prevent motion and protect the joint. Some splints only partially restrict motion, while others are meant to prevent all motion.

But an uncomfortable splint can reduce compliance (patients stop wearing it). Comfort is always a concern and should be addressed by the person who made or provided the splint. This could be a hand therapist, orthotist, or physician.

Modifications can be made to decrease skin irritation and improve comfort. Sometimes the splint size isn’t quite right for the patient and must be modified or changed. Custom-made openings for the thumb and palm may be needed. Moleskin and foam can be used to pad areas that chafe or rub.

When properly fitted, a functional splint provides little hindrance to hand function. Sore spots and areas of irritation do not occur. A layer of cotton stockinette placed over the skin before applying the splint may also help reduce skin irritation.

Ganglion cysts are very common in the wrist or on the fingers. No one knows for sure what causes them. They may be linked with overuse of a joint. Ganglia seem most common in music performers and athletes who use the wrist repetitively or strenuously.

If the cyst isn’t bothering you, one treatment option is to leave it alone. In half the cases, it will go away by itself. If it creates problems (pain or loss of wrist/hand function), then it can be aspirated or excised. Aspiration means a long, thin needle is inserted into the cyst and fluid is drawn out. Excision is the surgical removal of the cyst.

You should be aware that recurrence is high with aspiration. Even with removal, ganglion cysts often come back but the recurrence rate is much lower. Hand surgeons are now investigating the use of an open incision versus arthroscopic surgery to remove ganglion cysts. They are particularly interested in whether the recurrence rate is different between the two surgical techniques.

A study was recently published comparing recurrence rates for these two surgical approaches. No difference was found in rates of post-operative residual pain or recurrence. More studies are needed to provide surgeons with the information they need about outcomes with various approaches to this problem.

Most experts agree with the wait-and-see approach suggested by your physician. If the cyst grows or causes further problems, aspiration or excision is always available.

Wrist ganglions are known to return no matter how the operation is performed. A recent study comparing open surgery to arthroscopic (minimally invasive) surgery showed no difference in return rates of the ganglion.

In fact, the study may have brought to light new information about recurrence. It was always thought that the ganglion comes back when the stalk of the cyst isn’t fully removed. But when open surgery was compared with an arthroscopic approach, there was no difference in recurrence rates.

In the study, the cyst was removed down to the base of the stalk during open surgery. The cyst and stalk were removed during the arthroscopic procedure. These results lead surgeons to think perhaps the real cause of ganglion recurrence is multifactorial.

More study is needed to understand why there is such a wide range (2 to 40 per cent) of ganglion recurrence after surgical removal. At this point, it doesn’t look likely that the surgical approach (open versus closed) is a factor.

Carpal boss was first reported in the literature back in the early 1930s. It refers to a condition of wrist pain caused by a bony protuberance or bump. It’s located at the base of the index and middle fingers near the back of the wrist.

It’s not a very common problem, so there isn’t a lot of information about the best way to treat this condition. Some studies report that just surgically removing the extra bone isn’t the answer. The problem can come right back.

Further studies found that cutting the dorsal ligament between the base of the finger and the wrist during the procedure caused joint instability. Now, surgeons are careful to remove the bone without disrupting the soft tissues whenever possible.

But before surgery is ever attempted, a long trial of conservative care is advised. Nonsteroidal antiinflammatory drugs (NSAIDs) may be prescribed. Hand therapy with a physical or occupational therapist may be helpful. Splinting at night can stabilize and protect the wrist, thereby reducing symptoms.

When surgery is necessary, more than one operation may be needed. If removing the bone results in wrist joint instability, then a fusion is the next step. Bone scans can be used to predict the need for this type of surgery. Relief from painful symptoms occurs in six out of seven patients who have a fusion.

Carpal boss is an extra amount of bone growth in the wrist. Sometimes the extra bone is called an exostosis. It can develop in utero (before birth in the womb). Or it can occur as a result of micro-trauma in the wrist from repetitive motions.

Joint injection is usually done with a numbing agent combined with a steroid drug. Painful symptoms from inflammation can be helped with this technique. But in the case of carpal boss, steroid injections have not been shown to help provide symptomatic relief. This may be because the pain comes from joint instability, not an acute inflammatory process.

Most experts agree that painful symptoms from carpal boss require surgery. Conservative care is always tried first in order to avoid complications from surgery. But with a protective cyst forming over the bony bump, you may not get pain relief without surgery.

You may be referring to the dorsal radiocarpal ligament (DRCL) across the back of the wrist. The natural history of injuries to this area remains unknown. There aren’t enough studies on this topic to follow patients over time to see what happens.

From the few studies published, it appears that conservative care should be tried first. A hand therapist can apply heat, mobilization, splinting, or other modalities to help the tissue heal or to stabilize the wrist. Once the pain has been taken care of, then range of motion and strengthening exercises are usually added. A trial of six months of nonoperative care is usually advised.

If this treatment is not successful, then surgery may be needed. Your surgeon was probably able to find the areas and extent of damage with the arthroscopic exam. Surgery can be done using an arthroscope, but sometimes an open incision is needed when extensive reconstruction is required.

The cause of Kienbock’s disease isn’t yet known; it isn’t a very common disease. The disease causes a lack of blood circulation to the lunate bone, a small bone that goes from your wrist to your hand. Because the blood can’t feed the bone the nutrients it needs, the bone tissue begins to die.

The symptoms of Kienbock’s disease are very similar to spraining your wrist, so it is easy to believe that you’ve merely hurt your hand. Symptoms can be:

Surgery may be tried to re-establish blood flow to the bone or to fuse bones together.

Kienbock’s disease has four distinct stages; it’s important for doctors to distinguish between the different stages because of the differences in treatment.

Stage 1 – this stage may be when you think you have sprained your wrist. It’s painful, maybe a bit swollen

Stage 2 – if the bones were examined by x-ray, you would be able to see where the bone tissue is dying. The wrist may be more painful, swollen, and tender

Stage 3 – the bone may begin to break apart, causing more pain and making it difficult to move the wrist

Stage 4 – the adjoining bones are affected

You may be experiencing tendinitis or another similar condition called de Quervain’s. Pain while making a fist or grasping and holding objects are common with de Quervain’s tendonitis.

Lifting babies and young children puts you at risk for this problem. You are grasping, holding, and putting pressure on the wrist while it’s in a downward angle.

These hand and wrist positions and motions cause irritation of the tendons at the base of the thumb. Since you perform these movements many times each day, they become repetitive. The constant tension on the tendons causes inflammation, thickening of the tendons, and swelling around them.

New mothers are especially at risk because it’s a new movement and it’s often done while the child is moving. Hormone fluctuations (up and down) linked with pregnancy and nursing may also add to the risk of developing this problem.

Don’t let the unusual name confuse you. The name de Quervain came from the first physician who described this condition back in 1895. De Quervain’s is a painful condition of the wrist caused by repeated motions of the thumb and wrist.

Grasping items and ulnar deviation are the usual mechanisms of injury. Ulnar deviation refers to moving the wrist toward the little finger side of the hand. Sometimes just holding objects for long periods of time can bring this problem on.

Tension from repeated grasping causes thickening and swelling in the area. The area affected is referred to as the first dorsal compartment. Dorsal refers to the back of the hand. The compartment is a tunnel that helps keep the tendons straight and gliding smoothly. There is a sheath or lining inside the compartment that helps protect the tendons. The first compartment is located at the base of the thumb.

The compartment around the tendon swells and enlarges, making thumb and wrist movement painful. Inflammation isn’t the main cause of this condition. A degenerative process is really the problem. There’s physical wear and tear of the tendons called attrition.

Women are affected six times more often than men, especially in middle age. Pregnancy and nursing babies seems to put younger women at increased risk of de Quervain’s. Certain occupations or job tasks are also risk factors. These include factory jobs with repetitive duties, typing, and lifting.

It sounds like your daughter may have an impingement of the extensor retinaculum. The retinaculum is a broad band of fibrous connective tissue. There is a retinaculum across the tendons on both sides of the wrist.

Athletes who participate in activities that require hyperextension are at increased risk of extensor retinaculum impingement. Gymnasts, platform divers, and shot put throwers are the most likely to develop this problem.

A recent study of seven athletes with this condition showed that steroid injection or surgery to release the retinaculum work equally well. Patients in both groups were able to return to full participation in their sport.

The steroid injection is less invasive than surgery and recovery time is faster. Patients were followed for several years without a return of their symptoms while still continuing with their practice and competitions.

An orthopedic surgeon may be the best one to advise you. Reviewing her history and the results of the exam will guide the doctor in suggesting the best course of treatment for your daughter.