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

Question
Hello Dr,

I am desperately seeking advice for my next move on what seems to be a
damaged Scapholunate  ligament. I have had dorsal ganglion cysts appear
and disappear on my right wrist twice in the past. About a year ago, I woke
up with pain on extension of the same wrist and last week I finally had an MRI
taken.

The conclusion of the MRI reported "the appearance suggest chronic tear of
the Scapholunate ligament with a small dorsal ganglion cyst lying deep to the
extensor tendon. Minor change is noted in the TFC in the peripheral
attachment in the dorsal aspect"

I've done a small amount of reading on the net, and have become thoroughly
confused with what to do. The surgeon, suggests that he go in with an
arthroscope first to remove the cyst and clean up some tissue but also to
assess the damage. The results of this procedure will determine if a
reconstruction is necessary. I've been told reconstruction involves a painful,
and slow recovery and I'm petrified.

My main questions are, should I just get the reconstruction done at the same
time to avoid 2 procedures and even longer recovery? Is the procedure usually
successful or do I stand a chance of not being any better off after surgery,
and what happens if i choose to do nothing and learn to live with the current
pain? Is it true It will become arthritic in the future?

Any advice would be a blessing as these are confusing times for me.
Many thanks
James

Answer
James,
Unfortunately you have one of those conditions in where you if you talk to 3 diff orthos you might get 3 diff answers. But I would get a second opinion from a ortho hand specialist...(go to AAOS.org I believe "find a ortho"..if you can't get any good recommendations)
It sounds reasonable to me what your ortho is telling you..the cyst operation shouldnt be that big of a deal. So while he is in there he can explore this SL tear better. They are classified as to the degree or severity Geissler TYPE I and II etc..and depending on that..it will dictate what procedure might be best. SO in other words thats why its hard to give just 1 answer cause one pt may have one type and another pt may have another type and the procedures can differ depending on the variables. i wouldn't want him doing a cyst surgery and then say ..well while your in there do this too..I think you need to talk w him and discuss the options after he knows better the severity of the SL injury.
Yes you can stand a chance of not being any better after surgery..but frankly that can be the case with almost any surgery.
Yes if you do nothing, but the SL will remain unstable and this will increase your chance of pain and arthritis, but again without getting a good look..it would be hard for an ortho to say for certain.

found summary of article that backs up what your ortho is doing I think
http://www.jaaos.org/cgi/content/abstract/10/1/32