Need some advice regarding a Wrist disorder diagnosis, please....

[Baz]

Ha - OK I know I'm opening myself up for some quality peanut gallery commentary but you should know it's my LEFT wrist and I am RIGHT handed so it's not what you're thinking!

I fell backwards about 2 years ago while working on the back patio - I think my foot got caught up in a water hose. Broke my fall with my left arm and the wrist took a jolt.

I didn't see a doctor for quite a while, hoping things would heal themself. I wasn't in agony - just an annoying discomfort.

I finally went in March of 2021 and they ordered an x-ray. After one visit they gave a diagnosis - and I ended up not doing anything.

Well two years later I still have some discomfort but now it's causing some numbness and tingling in my left hand.

So I decided to refresh my memory on that initial diagnosis and figure out my next step.

This is what was posted in my patient portal.

Looks like next step would be an MRI?

Appreciate any thoughts for anyone who has some insight....thanks!

[Tobra]

Apparently, you have injured the ligament connecting the lunate and Scappoose bones. MRI gives far more info than radiographs

[Baz]

Originally Posted by Tobra

Apparently, you have injured the ligament connecting the lunate and Scappoose bones. MRI gives far more info than radiographs

OK thanks, Tob.

So you're saying I should go ahead and get the MRI?

I wonder if this kind of injury is even repairable/treatable?

[Zeke]

I live across the street from a hand surgeon. He would have probably put you in a brace. You are active and never let it heal, so now it may be more difficult. Better follow Tobra's advice and find out.

[Steve Carlton]

Doctor's advise > Our advise

[Baz]

Originally Posted by Steve Carlton

Doctor's advise > Our advise

Sure - I get it Steve.

But there are doctors on this forum - such as Tobra.

Aside from the many here (like Tob) with medical backgrounds, I also find it helpful to get takes from non-medical, such as folks who have experienced similar incidents themselves.

[carambola]

Depends how you fell, I once delivered a blow with the heel of my hand, ended up crushing an artery.
Associated nerve damage.
Surgeon wants to cut open my leg to grab a vascular piece and place it ?backwards? in my palm. Good thing the hand has a circle too, just like Willis.
I'm waiting for a stent.
have you thought about waiting?
#OurAdvice

[gchappel]

You can look up slac wrist- scaphoid lunate advanced collapse.
The sl ligament is one of the buttresses of wrist stability- and if that is injured or torn the wrist can become unstable- which can lead to early significant arthritic changes. Early it can be treated with splint, nsad's, etc. Later other interventions including surgery can be warranted.
I am not a hand guy- I stayed at a holiday inn express.
I am a radiologist that looks at these type images everyday.
1. Get to a good hand guy
2. Get an MRI so you really know what the heck is going on.
Good luck
gary

[Steve Carlton]

Originally Posted by Baz

Sure - I get it Steve.

But there are doctors on this forum - such as Tobra.

Aside from the many here (like Tob) with medical backgrounds, I also find it helpful to get takes from non-medical, such as folks who have experienced similar incidents themselves.

Hand specialist > Physician > Podiatrist > Forum member

I'd suggest seeing an expert. YMMV.

[Baz]

Originally Posted by carambola

-snip-
have you thought about waiting?
#OurAdvice

Well it's been a couple years already so I think that's what I have done. Thanks for your comments and input!

Originally Posted by gchappel

You can look up slac wrist- scaphoid lunate advanced collapse.
-snip-
1. Get to a good hand guy
2. Get an MRI so you really know what the heck is going on.
Good luck
gary

Thanks, Gary.....really appreciate the info! I did a Google search and found some helpful info:
https://www.webmd.com/arthritis/what-is-scapholunate-advanced-collapse-slac-wrist

Originally Posted by Steve Carlton

Hand specialist > Physician > Podiatrist > Forum member

I'd suggest seeing an expert. YMMV.

OK thanks, Steve. Great advice!

[Tobra]

There are some really groovy tools for doing orthopedic repairs. There is a tool you can use to drill a curved hole in a bone, did you know that? Same curvature as a suture needle. I see something like that in your future B. There are these little soft tissue anchor devices that might be just the ticket for you. MRI will tell you what all you did. You want to ask your primary care doctor who the hand guy is. You don't want a regular ortho guy. Might be a plastic surgeon, sometimes they do hands too.

Originally Posted by Steve Carlton

Hand specialist > Physician > Podiatrist > Forum member

I'd suggest seeing an expert. YMMV.

Actually Steve, I guarantee you I know far more about this than any Internist or General Practitioner.

If I were in Alaska or Michigan, I could do hand surgery right now, or that is how it was when I graduated school.

[Baz]

Originally Posted by Tobra

-snip-You want to ask your primary care doctor who the hand guy is. You don't want a regular ortho guy. Might be a plastic surgeon, sometimes they do hands too.

Actually Steve, I guarantee you I know far more about this than any Internist or General Practitioner.

If I were in Alaska or Michigan, I could do hand surgery right now, or that is how it was when I graduated school.

Tob - I would trust you with anything medically related.

And as you know truly appreciate all you do for us non-medical people on here.

This is the place I went to - was a referral from my GP:

https://www.volusiahandsurgery.com/

I will keep the thread updated on new developments as they happen.

Sounds like this is treatable so I'm very pleased if that's the case.

[Steve Carlton]

My dad's a TV repairman and he has an awesome set of tools. Good luck, Baz!

I would think even amongst hand specialists, some are better than others. I would recommend getting the guy with the best credentials you can. Jay Leno probably knows somebody really good.

[Noah930]

Baz, you're talking about 2 different things.

If you fell and injured your wrist, such as a scapholunate ligament tear a couple years back, that could lead to pain and arthritis in the wrist, but not numbness and tingling. If you now have numbness and tingling, that's more likely going to be a nerve problem, like carpal tunnel syndrome--not scapholunate ligament tear. So, I'm not sure these two things are necessarily related.

The natural progression of a scapholunate ligament tear will result in SLAC (scapholunate advanced collapse) wrist arthritis over several years. You don't want this. If you have a scapholunate ligament tear, you should consider getting that reconstructed (it's too late to have a simple repair now).

The scaphoid, lunate, and triquetrum are three bones in the wrist (carpus). They sit together in a row. They are held together by ligaments (scapholunate and lunotriquetral). If one of them tears (like the scapholunate), then stability is lost. I think of the 3 bones like 3 friends (the bones) walking down the street, holding hands (the ligaments). The scaphoid always wants to fall forward. The triquetrum always wants to fall backwards. Because the 3 friends are all holding hands, the forces balance out and no one falls anywhere. But if you injure yourself and tear the SL ligament (much less common to tear the LT ligament), then the scaphoid and lunate will drift apart from each other (scapholunate widening--you'll see extra space between these 2 bones on the x-ray). What's more difficult to appreciate is the fact that now unconstrained, the scaphoid will fall "forward" (flex), and the lunate (inspired by the still-connected triquetrum) will fall "backwards" (extend). Because there are rotational forces acting on these bones as well. The problem is then that the scaphoid does not sit properly in the little concavity at the distal radius with which it articulates. Think of it as 2 spoons nestled together in your kitchen drawer. When the spoons lie on top of each other, no big deal. But if the spoons are slightly off-kilter from one another, then there are high spots and low spots of contact, which leads to uneven wear and arthritis in a characteristic pattern. First the cartilage wears away between the scaphoid and the radial styloid, so you get radioscaphoid joint space narrowing. Then the arthritic pattern extends distally to the scaphotrapezial joint and ulnarly to the lunate facet. If becomes a disaster. If you already had some radioscaphoid arthritis back then, you should have considered having had something done back then. Because as time goes on and the arthritic pattern worsens, you lose options on what to do to salvage the situation. Eventually, only total wrist fusion/arthrodesis remains available. You don't want to be stuck with that as your only option.

To work this up, get a set of x-rays of the wrist first. The MRI is somewhat optional after that. A hand surgeon can make the diagnosis and formulate a treatment plan based upon x-rays alone, at this point. You want to know how bad the arthritis is at this point, as it will dictate what options remain on the table to try to salvage the wrist.

This is likely all separate from the numbness of which you're complaining. That makes me think carpal tunnel (or some other compressive peripheral neuropathy). A SLAC wrist is not going to cause numbness and tingling in the fingers. But nerve compression will. To work up the numbness and tingling, see a hand surgeon and/or obtain a nerve study (EMG/NCV) from a neurologist or physiatrist. In the meantime, you can try wearing a wrist splint (like you might see a supermarket cashier wearing) at night when you sleep; see if that helps you sleep through the night and have fewer symptoms during the day.

Good luck.

[PorscheGAL]

Nothing to add but I hope you are feeling back to normal soon.

Noah: This is one of the best descriptions I think I have read. Thank you for the hand holding analogy.

Originally Posted by Noah930

The scaphoid, lunate, and triquetrum are three bones in the wrist (carpus). They sit together in a row. They are held together by ligaments (scapholunate and lunotriquetral). If one of them tears (like the scapholunate), then stability is lost. I think of the 3 bones like 3 friends (the bones) walking down the street, holding hands (the ligaments). The scaphoid always wants to fall forward. The triquetrum always wants to fall backwards. Because the 3 friends are all holding hands, the forces balance out and no one falls anywhere. But if you injure yourself and tear the SL ligament (much less common to tear the LT ligament), then the scaphoid and lunate will drift apart from each other (scapholunate widening--you'll see extra space between these 2 bones on the x-ray). What's more difficult to appreciate is the fact that now unconstrained, the scaphoid will fall "forward" (flex), and the lunate (inspired by the still-connected triquetrum) will fall "backwards" (extend). Because there are rotational forces acting on these bones as well. The problem is then that the scaphoid does not sit properly in the little concavity at the distal radius with which it articulates. Think of it as 2 spoons nestled together in your kitchen drawer. When the spoons lie on top of each other, no big deal. But if the spoons are slightly off-kilter from one another, then there are high spots and low spots of contact, which leads to uneven wear and arthritis in a characteristic pattern. First the cartilage wears away between the scaphoid and the radial styloid, so you get radioscaphoid joint space narrowing. Then the arthritic pattern extends distally to the scaphotrapezial joint and ulnarly to the lunate facet. If becomes a disaster. If you already had some radioscaphoid arthritis back then, you should have considered having had something done back then. Because as time goes on and the arthritic pattern worsens, you lose options on what to do to salvage the situation. Eventually, only total wrist fusion/arthrodesis remains available. You don't want to be stuck with that as your only option.



Good luck.

[KFC911]

My eyes just glazed over a bit, but I would let him build me an ark any time he wants too !

Good luck Baz!

[Shaun @ Tru6]

Originally Posted by Noah930

Baz, you're talking about 2 different things.

If you fell and injured your wrist, such as a scapholunate ligament tear a couple years back, that could lead to pain and arthritis in the wrist, but not numbness and tingling. If you now have numbness and tingling, that's more likely going to be a nerve problem, like carpal tunnel syndrome--not scapholunate ligament tear. So, I'm not sure these two things are necessarily related.

The natural progression of a scapholunate ligament tear will result in SLAC (scapholunate advanced collapse) wrist arthritis over several years. You don't want this. If you have a scapholunate ligament tear, you should consider getting that reconstructed (it's too late to have a simple repair now).

The scaphoid, lunate, and triquetrum are three bones in the wrist (carpus). They sit together in a row. They are held together by ligaments (scapholunate and lunotriquetral). If one of them tears (like the scapholunate), then stability is lost. I think of the 3 bones like 3 friends (the bones) walking down the street, holding hands (the ligaments). The scaphoid always wants to fall forward. The triquetrum always wants to fall backwards. Because the 3 friends are all holding hands, the forces balance out and no one falls anywhere. But if you injure yourself and tear the SL ligament (much less common to tear the LT ligament), then the scaphoid and lunate will drift apart from each other (scapholunate widening--you'll see extra space between these 2 bones on the x-ray). What's more difficult to appreciate is the fact that now unconstrained, the scaphoid will fall "forward" (flex), and the lunate (inspired by the still-connected triquetrum) will fall "backwards" (extend). Because there are rotational forces acting on these bones as well. The problem is then that the scaphoid does not sit properly in the little concavity at the distal radius with which it articulates. Think of it as 2 spoons nestled together in your kitchen drawer. When the spoons lie on top of each other, no big deal. But if the spoons are slightly off-kilter from one another, then there are high spots and low spots of contact, which leads to uneven wear and arthritis in a characteristic pattern. First the cartilage wears away between the scaphoid and the radial styloid, so you get radioscaphoid joint space narrowing. Then the arthritic pattern extends distally to the scaphotrapezial joint and ulnarly to the lunate facet. If becomes a disaster. If you already had some radioscaphoid arthritis back then, you should have considered having had something done back then. Because as time goes on and the arthritic pattern worsens, you lose options on what to do to salvage the situation. Eventually, only total wrist fusion/arthrodesis remains available. You don't want to be stuck with that as your only option.

To work this up, get a set of x-rays of the wrist first. The MRI is somewhat optional after that. A hand surgeon can make the diagnosis and formulate a treatment plan based upon x-rays alone, at this point. You want to know how bad the arthritis is at this point, as it will dictate what options remain on the table to try to salvage the wrist.

This is likely all separate from the numbness of which you're complaining. That makes me think carpal tunnel (or some other compressive peripheral neuropathy). A SLAC wrist is not going to cause numbness and tingling in the fingers. But nerve compression will. To work up the numbness and tingling, see a hand surgeon and/or obtain a nerve study (EMG/NCV) from a neurologist or physiatrist. In the meantime, you can try wearing a wrist splint (like you might see a supermarket cashier wearing) at night when you sleep; see if that helps you sleep through the night and have fewer symptoms during the day.

Good luck.

as soon as I read your post Baz I thought about contacting Noah. He's the only one you should be listening to. Good luck and I hope you heal up soon.

[herr_oberst]

Originally Posted by Noah930

Baz, you're talking about 2 different things.

......snip.....

Good luck.

This explanation is fantastic. It changes the entire scope of this thread.

And also, this is a great reminder to talk with trained experts when seeking medical advice.

Good luck Baz!

[Steve Carlton]

Noah930 > Hand specialist > Podiatrist > Physician > TV Repairman

[Baz]

Thanks Alarick and everyone else.

Agree, Alarick's (Noah930) post was amazingly informative! VERY helpful!

You know, I'm not really in pain. It's more of an annoyance than anything else at this point. I just don't want it to get worse and the tingling numbness is really worrying me - so I definitely plan to get going on a collaboration with my specialist.