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Dr. Andrew Rynne

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Suggest treatment for wrist pain after a fall

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Dr. Karl Logan

Orthopaedic Surgeon

Practicing since :1999

Answered : 705 Questions

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Posted on Mon, 18 Aug 2014 in Bones, Muscles and Joints
Question: I fell on my wrist 5 months ago. Had three xrays over 3 month period. Just had MRI arthogram.. Shows a 5 mm ulna minus variance and a TFCC tear. I have decreased strenght in grip and use of wrist. Also pain whenever I use my wrist. Have had two steroid injections with minimal affect. One dr suggests "modified joint replacement. any suggestions ?
doctor
Answered by Dr. Karl Logan 1 hour later
Brief Answer:
DRUJ arthritis

Detailed Answer:
Hi, thanks for your question and your X-rays.

The joint between the end of your ulna bone and your radius bone, the distal radio ulna joint (DRUJ), is arthritic and there are therefore no reconstructive options for the tear in the TFCC or repair of the joint.

You could manage your wrist pain with anti-inflammatory medication and a wrist splint if you want to avoid surgery.

The surgical options available to you range from removal of the end of the ulna bone to fusion of the DRUJ and removal of a portion of the ulna bone. The newer replacement surgeries of this joint have not been conclusively validated in the scientific literature and so I would be a little cautious regarding this surgery particularly as you are young. I would ask your surgeon for supporting evidence for DRUJ replacement and how many he has performed. How long his follow up has been? Why he would prefer this surgery to one of the tried and tested operations?

I hope this helps answer your question.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Karl Logan 12 minutes later
I have been taking 2400 mg of Ibuprofen a day, using 2grams of Voltaren gel 4 times daily as well as the wrist splint everyday since Feb 16th . I can feel the difference between "bone " pain and soft tissue .... I feel the arthritis is well managed especially since it was asymptomatic until Feb 16th ( date of injury ).
The first report and tx was "possible scaphoid and lunate fx. " after 5 weeks of OT and splinting, it was changed to sever DRUJ arthritis and the TFCC tear.
I am a nurse and was able to do 100% of my job before the fall but now can not push /pull more than 20 lbs and that is with shooting pain during any weighted rotation of the wrist. Also during extension or flexion.
What would you recommend as next tx ?
P.S. - I am open to any and all treatments that will allow me to return to post- injury work status with reduction in pain and improvement of strength in joint function
doctor
Answered by Dr. Karl Logan 12 minutes later
Brief Answer:
Further treatment options discussed.

Detailed Answer:
Hi, Thanks for the further information.

I'm sorry to hear about your pain and discomfort.

Firstly I would change your anti-inflammatory to naprosyn/naproxen/alleve as it has a longer action and you only need to take it twice per day. Anti-inflammatory gel is not know to have any significant added benefit to oral medication.

I would consider a local and steroid injection into DRUJ as a diagnostic test to see if this is the source of your pain and this may also prove therapeutic.

A simple mouldable wrist splint may also help your symptoms although they can be a little cumbersome to wear.

I hope this information is helpful to you.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Karl Logan 44 minutes later
I am allergic to naprosyn. Have tried other NSAIDS. The bone pain is gone but still have pain on use . Have the molded splint. Had two steroid injections . First one in the DRU joint and the other on the outer aspect of the wrist. Relief in swelling but not the sharp pain when being used . Have given all the conservative options a go. What should be next ?
doctor
Answered by Dr. Karl Logan 3 minutes later
Brief Answer:
treatment options discussed.

Detailed Answer:
Hi,

thanks for your follow up question.

you could discuss your concerns with your surgeon. if you really feel that the pain is not bony and may be related to the tear in your TFCC then a wrist arthroscopy and debridement / repair of the TFCC may be worth a try although I would be surprised based on your X-rays alone if this would help you significantly.

I would therefore look at options for DRUJ resection / arthroplasty / replacement.

Best wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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