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Doctors have new insight into wrist pain

September 30, 2010 12:00:00 AM PDT
Millions of people are diagnosed with carpal tunnel syndrome and arthritis every year. But now, one doctor says some of them may have the wrong diagnosis. He discovered a new source of wrist pain, and for some professional and everyday athletes, the solution saved their joints and their games.Barbara Metcalf has something in common with a professional baseball player. She has a mysterious wrist injury that threatened to take her away from some of her favorite games.

"It was just a persistent, aching, occasional, sharp pain," said Metcalf.

Metcalf found a solution when she found Mayo Clinic orthopedic surgeon Dr. Richard Berger. "Up until a few years ago, I didn't know this condition existed," he said.

Dr. Berger discovered what is now known as a U-T tear. The ligament that runs from the lower arm to the pinky side of the hand twists and splits down the middle.

"Many of them have gone from physician to physician," said Dr. Berger.

He developed a minimally-invasive surgery to cure the wrist pain. He makes three small holes and inserts an arthroscope and razor to shave down the inflamed tissue. He then puts stitches across the ligament.

"We simply pull them tight, and as we do so, it folds the ligament back up into its normal position," said Dr. Berger.

It's a discovery Philadelphia Phillie Jayson Werth credits with saving his career.

"To go from where I came from, and a short few years later, be a world champion," said Werth.

Metcalf said the surgery saved her retirement plans, and wait until you hear about her first swing after surgery.

"It just made a beautiful arch, and then it came down and made one bounce and went into the cup," said Metcalf.

Patients must wear a cast on their forearm for six weeks after surgery. The surgery is an outpatient procedure. Dr. Berger is now teaching the technique to other doctors.

Web Extra Information: Discovering A New Source Of Wrist Pain

BACKGROUND:

Mayo Clinic orthopedic surgeons are the first to identify a new type of tear in a wrist ligament called the ulnotriquetral or UT ligament. It's a ligament that connects a person's two forearm bones. Injury to the UT can split the ligament length-wise where it still connects the two bones, but remains ripped. It causes pain and can prevent someone from playing sports, opening a jar, or turning a key.

In the past, many patients were misdiagnosed with other conditions such as carpal tunnel syndrome or arthritis. However, a UT wrist tear has specific indications when it comes to pain. "It can be a very sharp pain. It can be a pain that makes you stop in your tracks. Whatever you're doing, it creates a sense of weakness," Richard Berger, M.D., of the Mayo Clinic, told Ivanhoe. Carpal tunnel syndrome is more of a nerve pain that creates numbness or tingling. Arthritis is mostly an aching pain on the thumb-side of the wrist.

These UT split tear injuries cannot be detected by normal imaging techniques. "This doesn't show up on a plain X-ray at all. It doesn't show up on a CT scan, and it doesn't even show up with special tests that we order sometimes called arthrograms," said Dr. Berger. Dr. Berger says he finally discovered the tear after talking with many patients who indicated exactly where their pain was located. He performs a simple exam where he presses down on a patient's ulnar fovea to determine if the pressure causes pain similar to that experienced by the patient when he or she uses the wrist. Symptoms of a UT split tear are typically noticed soon after the injury. Low-impact movements like shoveling snow and playing golf or tennis can cause this tear.

TREATMENT:

A treatment option for this injury is minimally-invasive surgery. Doctors suture the torn ligament arthroscopically and immobilize the patient's forearm to allow it to heal in a cast. Most patients return to activities without pain six weeks after surgery and are able to use their wrists at full strength within a few months. "I'm never going to claim that this is saving lives. This isn't a breakthrough in cancer. This isn't as dramatic as bringing someone back from cardiac arrest, but I like to think of it as saving a lifestyle," said Dr. Berger.

BASEBALL CONNECTION:

Dr. Berger performed this surgery on Pro baseball player Jayson Werth who plays for the Philadelphia Phillies. Werth now credits Dr. Berger with saving his career.


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