[i.munro]

Apparently i need the surgery in the title anyone had any experience of this?

Thanks

[Ali]

My partner had this in July.

The problem was caused by using a pick-axe. For about a year he'd had intermittent problems of the wrist 'locking up' painfully. This would then get better over anything from a few minutes to a couple of weeks. Between these episodes he could climb normally.

He had the arthroscopic surgery under a general anaesthetic, which I think is normal due to the degree of manipulation. They debrided a tear in the TFCC and plica (a fold in joint lining). Not too painful afterwards, except for soreness around the incisions. There wasn't much guidance on how soon to return to activity but the GP said to just do whatever wasn't painful. He started climbing again after 2 weeks and gradually built up the difficulty. Unfortunately after 9 weeks he had a recurrence of the 'locking up'. Before surgery it wasn't going anywhere near that long between occurences. He's been back to the consultant who thinks it's probably residual inflamation of the plica and has injected it with cortisone and told him to rest it for 2 weeks. That was a week ago so too soon to know the outcome.

I think the surgery has been generally positive, it's not seemed to cause any loss of strength or movement and hopefully the inflamation will prove to be the current problem.

Let me know if there's any specifics you want to know.

[i.munro]

Thanks for taking so much time to reply. That sounded quite reassuring until the end bit 

Can I ask you to let me know what happens?

[Ali]

Well, he had been climbing on it at near normal intensity for around a year. Hopefully you've had a quicker diagnosis and maybe sustained less damage. Also, in retrospect, resting it for longer after the surgery would probably have helped.

Forgot to mention before, but he was ok to drive after about a week.

When's your surgery planned for? We're off to France for a fortnight in a couple of weeks time so I'm going to have my work cut out curbing his enthusiasm to do too much! But I could let you know how it's going after that.

[i.munro]

I haven't got a date yet and I'm told it'll be at least four months so plenty of time. I've been building the intensity of climbing back for the last few months since the original incident as well. Perhaps a bad idea. Currently I can't even hold a pen though. Thanks again for the help.

[Snoops]

I haven't got a date yet and I'm told it'll be at least four months so plenty of time. I've been building the intensity of climbing back for the last few months since the original incident as well. Perhaps a bad idea. Currently I can't even hold a pen though. Thanks again for the help.

\

I had a TFCC 4 years ago. Quite bad couldn't turn door handles, change gear without pain etc.

Had an MRI, called in an NHS perk and saw a top hand/wrist guy. Had the option of surgery, but he was very honest and said outcome was highly variable, and can make it worse.

I opted for conservative treatment and although it aches occasionally and I also prophalactically tape it up I'm cranking fairly decently these days with no problems, although I do avoid left hand dyno's! It took a long time for mother nature to sort it out though.

Be careful although joint surgery can be very beneficial sometimes, its not a 'cure all' and you do run the risk of making things worse.

P.S If you haven't been told this already - get a wrist splint ASAP for wearing in bed now as it heals. Its very common for us to sleep on our wrists etc (I know, I know!) and stress the TFCC big time. Mine got better a lot faster once I started that.

P.P.S Whichever route you go down, once pain settles, gentle wrist strengthening exercises.

Good luck

[i.munro]

Thanks. Not sure I have an option. I've been taping and gradually building up strength for 3 months  now then suddenly, for no real reason, I'm back to not being able to pick up a pen.

If that pattern continues I'm going to be crippled for a good deal of the time. I don't mean unable to climb but unable to open doors or carry things.

Did you not get this recurrence pattern?
How did you get a diagnosis? The surgeon described the arthroscopy as mainly diagnostic they're going to try a repair if
it looks promising but mainly it's to have a look to see what's going wrong.

[Ali]

Can I ask what the 'conservative treatment' involved? Was it just rest or were there any exercises etc involved. Also when you tape it is this a simple loop around the wrist or something more complex. Would be good to know as Phil has had little general advice on how to look after it.

 

[i.munro]

My physio showed me a method of taping that seemed to allow me to climb without a problem (certain moves apart)
Unfortunately it didn't  prevent the re-occurrence as I wasn't climbing or wearing the tape.

We videoed the procedure on my phone & I could send you that if you want (just let me know) but I'd suggest seeing a physio yourself as the injury might not be the same so it could do more harm than good.

[Snoops]

How did you get a diagnosis? The surgeon described the arthroscopy as mainly diagnostic they're going to try a repair if
it looks promising but mainly it's to have a look to see what's going wrong.

Have you had an MRI?
How do they know its a tear/pull off? A lot of them are perforations due to 'ulnar variance' (when your ulnar bone is a tiny bit longer than your radial. Arthroscopy could help a pull off but not a perforation.

[i.munro]

Have you had an MRI?
How do they know its a tear/pull off? A lot of them are perforations due to 'ulnar variance' (when your ulnar bone is a tiny bit longer than your radial. Arthroscopy could help a pull off but not a perforation.

I have had an MRI followed by a series of x-rays apparently "to conform the MRI". All that the surgeon said was that it was
clear there was contact between the ulnar & lunate (I took it that that's  not a good thing) & a shadow on the x-ray (oedema)???

The surgeon talked about going straight to "ulnar shortening" before deciding on an arthroscopy first "to have a look".
The summary that came with the MRI data said :

"There is  cystic change /oedema seen within the proximal lunate.
There is no marrow oedema seen in the distal ulna.
There is a tear of the TFCC which surfaces on the ulnar aspect of the TFCC.
There is a slither of fluid seen at the distal radioulnar joint.

Conclusion evidence of ulnar lunate impingement with a tear of the TFCC."

I have no idea what a slither is ??

[Snoops]

Tiny thin bit along the surface. Sounds like they have worked you up well and that u are in safe hands. Something like this is always a grey area. If it has been  6 months and its not getting better, it may be best to let them have a look as mother nature is obviously not helping.

Interesting though that you do seem to have a bit of ulnar variance. The treatment for that is shortening (a different op), here you have an incision in your forearm and a slither of bone taken out with a recon plate put on. That said as there is a demonstratable tear  maybe  a keyhole looksee is not a bad thing.
I don't envy your situation.  Please feel free to PM in me although there is not a lot else I can add.

Do get a SPLINT for night time

[i.munro]

SPLINT sorted thanks.

What worries me is it did seem to be slowly improving until the recent relapse.
If this pattern is going to continue then yes it's clearly worth the risk of surgery.

On the other hand if this is just a one-off set back then risking surgery seems nuts ???

[jmews]

Do you have any updates on this?


I saw a hand surgeon today following an MRI. I was recommended debridement for a central tear. My injury is 5 months old, and although I have had physio, I have not been given any other conservative treatments (immobilisation or steroids)[size=78%]. [/size]
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[/size]
[/size][size=78%]As far as I understand it, there is no healing from this - it is purely symptom relief. I also have a ganglion cyst on the thumb side of my wrist that is from the same trauma. Again, wrist is functional, but it causes pain. I am really torn (no pun intended) between symptom relief and playing it safe. It is quite annoying, but never truly outright painful[/size]