OBJECTIVETo explore the therapeutic effects of arthroscopy for post-traumatic chronic wrist pain.

METHODSFrom February 2007 to June 2010, 12 patients with post-traumatic chronic wrist pain treated with arthroscopy were reviewed. Among the patients, 9 patients were male and 3 patients were female, ranging in age from 19 to 47 years, with a mean of 35.6 years. After physical examinations or MR abnormal findings, all the patients underwent wrist arthroscopic examination and treatment. Eight patients with tear in the central area of the triangular fibrocartilage complex (TFCC) underwent endoscopic partial resection. Two patients with relaxation of inter-carpal ligament after injury underwent radiofrequency shrinkage. One patient with distal radioulnar joint instability was treated with Kirschner fixation through distal radius and ulna in the neutral forearm rotation after clean-up of wrist joint, and also fixed with long arm cast immobilization for 6 weeks. One patient with ulnar impaction syndrome was treated with wrist clean, border modeling of triangular cartilage plate, partial resection of distal ulna.

RESULTSAll the patients were followed up with an average duration of 10 months. Modified Mayo wrist score were evaluated from preoperative mean of (51.67 +/- 15.27) ( 25 to 75 scores) to postoperative mean of (77.92 +/- 10.54) (65 to 95 scores). Eleven patients recovered to normal work.

CONCLUSIONArthroscopy is an effective method for patients with post-traumatic chronic wrist pain which can diagnosis and cure the injuries under arthroscopy.

Adult ; Arthroscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Pain ; surgery ; Wrist Injuries ; pathology ; surgery ; Wrist Joint ; pathology ; surgery ; Young Adult

INTRODUCTIONArthroscopic excision of the hypertrophic dorsal synovium is performed on patients with dorsal wrist pain in hyperextension. Although dorsal wrist impingement has been described in cadaveric studies, to our knowledge, there is no published clinical data on its treatment with arthroscopic synovial excision. Herein, we present the results of arthroscopic management of this condition in our hospital.

METHODA total of 13 patients underwent arthroscopic excision of the hypertrophic dorsal impinging synovium. All patients presented with the cardinal symptom of dorsal-radial wrist pain in extreme extension. The diagnoses were made after excluding other causes and confirmed on wrist arthroscopy. Arthroscopy was offered after nonoperative measures failed. The mean postoperative follow-up period was 14 (range 6-31) months.

RESULTSMean pre- and postoperative quick Disabilities of the Arm, Shoulder and Hand scores were 49 (range 34-82) and 17 (range 0-48), respectively; paired t-test revealed a significant difference between the two (p < 0.001). Mean postoperative flexion-extension arc and radial-ulnar deviation arc were 120º and 46º, respectively. Postoperatively, one patient developed complex regional pain syndrome, with tethering of the dorsal branch of the ulnar nerve, which required surgical release, while another patient required revision arthroscopic excision of the impinging tissue. Both patients had good postoperative outcomes.

CONCLUSIONWhen treating patients with dorsal wrist pain, dorsal wrist impingement caused by synovial hypertrophy should be included in the differential diagnosis. Arthroscopic excision of the impinging synovium can achieve reliable pain relief with significant functional improvement in the short term, although further research on its long-term benefits is required.

Adult ; Arthralgia ; diagnosis ; etiology ; surgery ; Arthroscopy ; methods ; Female ; Humans ; Hypertrophy ; Male ; Middle Aged ; Pain Management ; Synovectomy ; Synovial Membrane ; pathology ; Wrist Injuries ; diagnosis ; etiology ; surgery ; Wrist Joint ; surgery

Intraosseous ganglion cyst of the carpal bones represents a rare cause of wrist pain. We report a case of a 42 year-old, right-handed female, who presented with pain of the right wrist following a fall on the palm of the hand. Clinical study revealed a moderate swelling over the mid-section of the palmar face and pain through extreme ranges of motion of the wrist. Plain radiographs and CT-scan of the wrist have revealed an intraosseous ganglion cyst of the lunate bone. Curetting-filling by Kuhlman's vascularized radial bone graft allowed a good functional recovery. The clinical, radiological and therapeutic aspects are discussed.
Adult ; Female ; Ganglion Cysts ; diagnostic imaging ; pathology ; surgery ; Humans ; Lunate Bone ; diagnostic imaging ; pathology ; surgery ; Wrist ; diagnostic imaging

BACKGROUND: Some surgeons consider the abscission of a part of the articular bursa around the point of the input of ganglion's nape (average 1-2 cm diameter) to be very important with excellent results. However, a literature search revealed disagreement as to whether it is essential to repair a bursa defect. This study examined the effectiveness of this method without repairing the articular defect. An attempt was made to identify the anatomical origin of wrist ganglia during the surgical procedure. METHODS: This study evaluated 124 wrist ganglia that had been treated surgically during 2004-2009 using this technique and without repairing the bursa defect (1-2 cm in diameter). The variables studied were age, gender, time from the occurrence till abscission of the ganglia, former surgical interventions, preoperative and postoperative pain, insertion of the ganglion's nape and complications. Sixty-six patients with a mean follow-up of 42 months and minimum 12 months were examined. RESULTS: At the time of the follow-up, 80.3% had no pain whereas 92.2% showed a remarkable improvement. Seven cases of recurrence (10.6%) were found 2 to 85 months after surgery, of which most appeared during the first year (71.4%). It is important to mention that the majority of the dorsal ganglia (42.8%) originated from the capitate-lunate joint. None of the patients presented with scapholunate or other instability. CONCLUSIONS: This surgical method is a simple and safe with excellent long-term results and a lower recurrence rate compared to other surgical approaches. Overall, repair of the articular bursa is unnecessary.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bursa, Synovial/*surgery ; Female ; Humans ; Ligaments, Articular/pathology ; Male ; Middle Aged ; Recurrence ; Synovial Cyst/pathology/*surgery ; Wrist/*surgery ; Young Adult

PURPOSE: To evaluate the diagnosis and treatment of the carpal tunnel syndrome (CTS) due to space occupying lesions (SOL). MATERIALS AND METHODS: Eleven patients and 12 cases that underwent surgery for CTS due to SOL were studied retrospectively. We excluded SOL caused by bony lesions, such as malunion of distal radius fracture, volar lunate dislocation, etc. The average age was 51 years. There were 3 men and 8 women. Follow-up period was 12 to 40 months with an average of 18 months. The diagnosis of CTS was made clinically and electrophysiologically. In patients with swelling or tenderness on the area of wrist flexion creases, magnetic resonance imaging (MRI) and/or computed tomogram (CT) were additionally taken as well as the carpal tunnel view. We performed conventional open transverse carpal ligament release and removal of SOL. RESULTS: The types of lesion confirmed by pathologic examination were; tuberculosis tenosynovitis in 3 cases, nonspecific tenosynovitis in 2 cases, and gout in one case. Other SOLs were tumorous condition in five cases, and abnormal palmaris longus hypertrophy in 1 case. Tumorous conditions were due to calcifying mass in 4 cases and ganglion in 1 case. Following surgery, all cases showed alleviation of symptom without recurrence or complications. CONCLUSION: In cases with swelling or tenderness on the area of wrist flexion creases, it is important to obtain a carpal tunnel view, and MRI and/or CT should be supplemented in order to rule out SOLs around the carpal tunnel, if necessary.
Adult ; Aged ; Carpal Tunnel Syndrome/*diagnosis/*etiology/pathology ; Female ; Gout ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Retrospective Studies ; Tenosynovitis ; Tomography, X-Ray Computed ; Wrist/pathology/surgery

OBJECTIVETo investigate the imaging features of synovial tuberculosis of sheath of wrist.

METHODSThree patients of synovial tuberculosis of sheath of wrist underwent surgical operation from Oct. 2002 to Oct. 2009 included 2 males and 1 female, the age of 48, 67, 76 years respectivly. X-rays of 3 patients, CTs of 2 patients and MRI of 1 patient were retrospectively analyzed and the relevant literature were reviewed.

RESULTSThere were 3 cases with the soft tissue mass in the palm side of wrist, the section was unclear. There were no osteoporosis and no changes of bone destruction. There was 1 case with the punctate calcification in the soft tissue. MRI showed the embedded cystic mass of flexor tendon and "8" shape in carpal tunnel pressure, and showed abnormal signal (T1 low-signal, T2 slightly higher signal), a small part of the internal point showed high signal. CT showed the synovial membrane were obvious thickening and enhanced, corpus liberum in tendon sheath were no obvious strengthening.

CONCLUSIONSynovial tuberculosis of sheath of wrist has certain characteristics on radiographic image. The MRI has more clinical value than X-ray and CT.

Aged ; Female ; Humans ; Male ; Middle Aged ; Synovial Membrane ; diagnostic imaging ; Tomography, X-Ray Computed ; Tuberculosis ; diagnostic imaging ; pathology ; physiopathology ; surgery ; Wrist