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Wrist pain, x-ray and CAT scan clear, massage therapist diagnosed ligament tear. Would HBOT help?

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Orthopaedic Surgeon
Practicing since : 2000
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Hello
My son was playing tennis a few months ago and felt a noise in his wrist when he went for a shot. He basically had to drop the racquet because of the pain. He has been putting up with it as it only hurt depending on the angle he bent his wrist. He decided recently to go to the doctor for it and had an xray and catscan which came up clear. He went to a massage therapist and his prognosis was that he had torn some ligaments in his wrist and the only thing that can be done would be to rest it. He is booked in to see a specialist in a few weeks and also to have an mri. If the therapist is correct, is there some way to repair the ligaments quickly. Would HBOT help perhaps? Would a quarterzone injection help?
Posted Tue, 24 Apr 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Atul Wankhede 1 hour later
Dear user,

Thanks for asking your query.

A snapping sound with clear X XXXXXXX and CT scan can only mean a ligament tear. A specialist as you said needs to see your son soon to confirm the diagnosis and start the treatment. It can be confirmed by a simple sonography or more accurately by an MRI.

Even so, now it’s been a few months and whatever healing is naturally expected must be done. So technically it’s a little late for any intervention. And if he has no stiffness, swelling or deformity, he would benefit by physical therapy and gradual range of motion exercises.

I won’t say HBOT is helpful in this scenario and steroid injection given locally can be XXXXXXX to
the already compromised ligaments. Hence in my opinion:

Abstaining from sports temporarily is important.
Avoid the position of hand that is painful.
Immobility could help only in initial phase so keep the other activities on.

Hope this answers your query. If you need more help I am available for follow up.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Wrist pain, x-ray and CAT scan clear, massage therapist diagnosed ligament tear. Would HBOT help? 3 days later
I have received the report from my sons wrist MRI. It states as follows:
TECHNIQUE:
Standard non contrast MRI right wrist protocol.
FINDINGS:
No effusion of the distal radioulnar joints. Central aspect of the triangular fibrocartilaginous complex (TFCC) intact with a 3mm
ganglion arising from the dorsal aspect of the peripheral aspect of the TFCC, likely due to degeneration and a small focal tear. No
diastasis of the scapholunate or lunotriquetral intervals. Focal full thickness perforation of the dorsal of the scapholunate ligament
results in a 22 x 6 x 4mm (ML x SI x AP) ganglion. Dorsal radiocarpal and intercarpal ligaments intact. Small ganglia arises from
the palmar aspect of the radio-scapho-capitate ligament, measuring 6 and 7mm in maximal dimension. Remaining palmar extrinsic
ligaments within normal limits. No abnormality of the flexor and extensor tendons. Median nerve and contents of Guyon's canal
within normal limits. No focal osseous lesion. No joint effusion. Intrinsic muscles of the hand demonstrate normal signal intensity and
morphology.
CONCLUSION:
1. Focal full thickness perforation of the dorsal band of the scapholunate ligament results in a 22mm maximal dimension dorsal
ganglion cyst.
2. Two ganglia arise from the volar radio-scapho-capitate ligament, the largest of these measuring 7mm in maximal dimension.
3. Peripheral tear of the TFCC results in a 3mm dorsal ganglion

What do you suggest is the best way forward from here Doctor?
 
 
Answered by Dr. Atul Wankhede 2 hours later
Hi,

Thanks for replying.

The diagnosis is more than clear now. Your son has multiple traumatic ganglia. The cause for his discomfort is this condition that usually is not seen at this age.

Though unfortunate he requires the ganglion removed; especially the ones that are large.

There are other options like aspiration of the fluid but the chance of recurrence is high. So in my opinion consult your orthopaedic surgeon for ganglion cystectomy.

Hope this answers the query. Do accept the answer if you do not have any further queries.

Wish your son an early recovery.

Good luck.

Above answer was peer-reviewed by
 
Follow-up: Wrist pain, x-ray and CAT scan clear, massage therapist diagnosed ligament tear. Would HBOT help? 38 minutes later
Are you saying the chance of reoccurence if the aspiration option is taken is high or the chances of re-occurence is high even if they are removed?
If the specialist suggests to remove them as you have stated, is it a major operation or just a go in the hospital in the morning and go home at night procedure?
Also if they are removed, will my son make a full recovery ie. have full strength in his wrist/hand?
And how long after the operation will it take for it to be healed.

If they do operate, how are the tears that are mentioned in the report going to be fixed? Do they stitch them up?
And you mentioned these ganglia are unusual for a person of my son's age. What do you think caused it?
 
 
Answered by Dr. Atul Wankhede 3 hours later
Hi,
Thanks for writing back.
The chances of recurrence are high after aspiration and minimal after removal. The procedure involves a small incision over the wrist, identifying the cyst, removing it in its entirety and finally sealing the point of origin by either tying or cauterisation. This prevents it from recurring. After that, we stitch the part of tendons and ligaments that gave way to the cyst.
It is a day care procedure. Healing usually takes a span of 3 to 6 weeks followed by gradual physical therapy. The rate of recovery is high and complete recovery of strength and function usually takes place.
A ganglion is unusual for his age and I feel it can be related to the wrist trauma he sustained few months back. I definitely think that his recovery would be quick and complete.
I hope this answer was informative. Thank you for choosing us and I hope I can be of assistance to you in the future.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Wrist pain, x-ray and CAT scan clear, massage therapist diagnosed ligament tear. Would HBOT help? 2 hours later
If my son was to get the ganglias cut out say on the 1st March, how ong do you think it would be before he can start playing competitiontennis or football again?
 
 
Answered by Dr. Atul Wankhede 2 hours later
Hi,
Thanks for getting back.
His return to playing sports will depend on his recovery which varies from person to person. It should be left on the discretion of his treating surgeon. For contact sports such as football and tennis, he has to completely recover before attempting them. My experience suggests, as I mentioned earlier, that it takes about 3 to 6 weeks for full recovery. So if he gets operated on the 1st March, he would recover by second week of April. Then, if the physical therapists say he's ok that should be the completion of treatment.

Regards
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Follow-up: Wrist pain, x-ray and CAT scan clear, massage therapist diagnosed ligament tear. Would HBOT help? 36 hours later
Thankyou Doctor.
Interestingly I went to my GP to obtain another referral to another specialist. one who had operated on my other son's knee 12 months ago. Anyway, the GP mentioned he would not get them cut out and would rather leave them be so they can disppear themselves I suppose. I mentioned that to my son and he stated he would prefer to get them cut out anyway. I think if the Doctor had the pain my son had he would ge them cut out also
 
 
Answered by Dr. Atul Wankhede 2 hours later
Hello,

It’s good to get a second opinion and I suppose it helped you take a decision.
So go right ahead and get this over with.

Good luck to your son.

Thanks again for the query. Do not forget to accept the answer if you are satisfied with my answers.

Regards
Above answer was peer-reviewed by
 
Follow-up: Wrist pain, x-ray and CAT scan clear, massage therapist diagnosed ligament tear. Would HBOT help? 7 hours later
Thanks for your help
 
 
Answered by Dr. Atul Wankhede 28 hours later
Hi,

You are most welcome.

If you do not have any further queries, do close this discussion.

Best wishes.
Above answer was peer-reviewed by
 
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