Joe A Shaw PA-C - 6/20/2008

Question
Hi Mr Shaw, Thank you for your time! I fell on my right wrist in 9/2007. It was initially treated as a sprain and I was put in a splint for two weeks. After this time I saw a hand surgeon who believed I had a TFCC tear. I was casted for four weeks. The pain was somewhat alleviated after casting, but over the next 2 months the pain returned. I had an MRI in 2/2008 that showed no TFCC tear but I did have a ganglion cyst and joint effusion in that area. It also showed a scapholunate ligament tear, which my doctor decided not to focus on since I was not very symptomatic of that at the time. As on last resort before surgery I was give a cortisone injection into the ganglion cyst in the TFCC area. One month later I returned still in a significant amount of pain and my doctor decided that surgery was the only answer we had left. I had wrist arthroscopy at the end of 3/2008. She removed the cyst and performed TFCC debridement. Also it was found that there was a definite tear of the scapholunate ligament beginning at the base. I also showed gross laxity in the scapholunate ligament, the midcarpal ligament and the lunotriqutral ligament. Now, after surgery the pain in the TFCC area has greatly improved but I have begun having a lot of pain in my anatomical snuff box and all around the scapholunate ligament. I have been in OT since the end of April but still am in pain and have had trouble in regaining my range of motion. My surgeon says my only option is now to have open surgery to correct the scapholunate ligament by inserting pins in the bones to promote growth of the ligament. I tried to receive a second opinion from another hand surgeon but was just sent back to my original doctor after my x-rays showed no evidence of any instability or a gap in between the bones. I am at a loss as to whether I should have the surgery because I've been told that it requires extensive rehab and recovery time and that it has a pretty high rate of not being effective. If you could please provide me with any advice or possible surgery alternatives I would really appreciate it! I'm sorry this is so long. Thanks Again!!

Answer
Elizabeth,
We have referred a couple over the yrs for this type of surgery. You probably do need the surgery to repair this scaphoid lig. tear, which hopefully will reduce your pain. I don't think you will ever have a "normal" wrist either way, but you should be able to get some relief. I don't really understand about the second opinion?..so was his opinion you don't need surgery just from an xray?..you need to get your records, actual MRI films etc and take to the second opinion of an ortho hand surgeon. Maybe you need to go the next city over? The other question to ask, is there harm in a wait and see approach?

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