Joe A Shaw PA-C - 3/21/2008

Question
am 35 yr old male, and have had chronic left wrist pain for over 15 years.  
have had other injuires that superseded this one so i have done nothing up til
now about it,

It has never healed even tho i rarely use left wrist.  makes aclicking sound
when i rotate it in one direction.  it is very weak and hurts when i do anything
that relies on it- e.g. cant play a round of golf or do certain yoga positions.

My question is:  Is this a soft tossue problem?  and what are my treatment
options?  and if there are viable options what kind of repair level can i expect
after 15 years of doing nothing about it.  I assume if i had broken the wrist it
would have healed back and been perhaps stronger, but something is clicking
and wrong and even typing aggravates it.  again, no amount of rest seems to
help.  also, it only clicks if i rotate in one direction.

Any possible ideas and treatment options?  I guess i need to start by going to
an orthopedist.

Answer
Ryan,
You need to research a TFCC tear..sounds like what it could be or at least needs to be ruled out. The best diagnostic test is a arthrogram..MRI type xray after they inject the wrist with dye and ck for "leaks" (tears) Although some studies show that as many as 50% of 50 yr olds will show or may show some leakage, but along with exam and history it can be pretty accurate. The ortho may not want to to do it right away..may want you to try cortisone injs etc,,,It is expensive about $2000 or so. If you have a tear then it can usually be repaired by endoscopic surgery.

http://www.wheelessonline.com/ortho/triangular_fibrocartilage_complex