2023-05-27 08:35:46
[APOA 수부상지학회 스토리]
Mr. A (59), a farmer, suffered a fracture of his left wrist following falling twice three years ago and received conservative treatment. He recently said that it hurts even when he sleeps and even when he doesn’t use his hands. As a result of wrist arthroscopy, the ligaments between the wrist bones were completely ruptured, and the arthritis of the joint of the ulnar head was severely progressed.
Retired civil servant B (66) visited the hospital with pain and swelling in his left wrist that started 4 to 5 years ago. He said that he received injections and drug treatment at other hospitals, but that only then did not improve. On MRI, severe inflammation in the joint was confirmed, suggesting tuberculous arthritis or inflammatory arthritis. He has been doing well without recurrence for 2 years following the removal of inflammatory tissue through wrist arthroscopy.
The wrist of our body is an important part that anatomically connects the hand and the upper limb (arm), and is connected to a large part of the cerebral cortex together with the hand. Therefore, if it fails to function due to causes such as pain, it may cause a disability that disables the function of the entire arm, and it is very likely that psychological problems such as depression can be affected because the warm heart conveyed through the hands cannot be conveyed. . Therefore, restoring the function of the wrist can be said to restore the entire arm, psychological and mental problems, not simply the problem of the wrist itself.
Chronic pain in the wrist is generally a case that persists for more than 3 months even following steady treatment. However, as in the case of Mr. A, if there was severe trauma such as a wrist fracture or ligament rupture, chronic pain is judged to be present if the damaged tissue continues even following sufficient time, usually one year, following recovery.
The most common cause of chronic pain is synovitis of the wrist joint due to lack of proper treatment following trauma. Other injuries include ligament damage, articular cartilage damage, wrist bone fracture and nonunion, and triangular fibrocartilage complex damage. The wrist joint is a complex structure composed of three large joints, eight carpal bones, and joints between them, triangular fibrocartilage complex, and 27 ligaments, so it is difficult to pinpoint that any one part is injured when injured. Causes caused by diseases include synovitis caused by non-specific chronic inflammation, such as in Mr. B’s case, synovitis caused by rheumatoid or gouty arthritis, tenosynovitis occurring in flexor or extensor tendons passing through the wrist, ganglion, arthritis due to continuous bone collision , and avascular necrosis of the carpal bones.
Most chronic wrist pain can be roughly diagnosed to some extent mainly through physical examination and radiographs. However, it is not possible to accurately identify the disease that causes chronic pain only with radiographs, and in most cases, it is confirmed and differentiated through special tests such as MRI. However, severe trauma, joint cartilage damage, ligament damage, etc. are difficult to diagnose and differentiate, so most cases are confirmed through wrist arthroscopy. Just as we receive gastroscopy when we feel sore, wrist arthroscopy is the most accurate test for diagnosing chronic wrist pain. . In addition, therapies have been developed and used for treatment in a wide range beyond the realm of diagnosis.
Chronic pain is relatively rarely resolved through conservative treatment. In the case of synovial inflammation due to inflammatory disease, synovial resection was performed through an incision in the past, but synovial resection is currently being performed through an arthroscope. This has the advantage of rapid recovery with fewer complications such as ligament damage, pain, and joint stiffness due to the incision. In addition, since the wrist joint is not a joint that supports the body weight like the knee or ankle joint, even if the joint destruction has progressed to some extent on radiographs, synovectomy using an arthroscopy is performed to prevent further joint destruction and reduce pain. And it is effective in restoring the function of the wrist joint.
In the case of chronic pain following trauma, damage to complex structures is more likely to be the cause than any one problem. Therefore, arthroscopy, which can more accurately diagnose the inside of the joint as a whole, is performed and customized treatment according to the results, that is, suturing or reconstruction for ligament damage, deinflammation for synovial inflammation, debridement for cartilage damage, bone graft for nonunion, etc. You can be freed from chronic pain by receiving the
-RICE therapy for minor damage…
If the wrist joint is injured, do not overlook it and be sure to visit a medical institution and receive a simple examination and treatment, such as taking a radiograph. At this time, if it is not a big damage, RICE (Rice) therapy is recommended as a general treatment. In other words, R (Rest) means to rest without using the painful part. I (Ice) means cold compress. Cold compresses reduce blood circulation to the injured area in the early stages of an injury, reducing swelling and pain. However, it is usually limited to 2-3 days, following which warm compresses are applied. C (Compression) would mean fixing it with a pressure bandage or cast. And the last E (Elevation) means that the injured area should be elevated above the heart to remove edema. In addition, anti-inflammatory pain relievers can be taken. If you do the above, the damaged tissue will usually recover in 1 to 2 weeks, pain will be relieved, swelling will go down, and joint motion will be restored. However, if the pain persists even following using the above method, it is good to get tested once more. As it is a part with complex structures, experts may sometimes miss the diagnosis.
If a wrist fracture or ligament injury is diagnosed, the use of the wrist joint should be avoided for a sufficient period of time for bone and ligament tissue to recover. This is because too fast joint movement hinders the recovery of ligament tissue, which can lead to chronic pain and arthritis.
Those who have a lot of repetitive wrist use should take appropriate breaks. For example, it is important to take a break from using your wrist for regarding 10 minutes following working for an hour. After work, before going to bed, massage with warm water and an anti-inflammatory agent can reduce pain and relax muscles.
Anyone who enjoys sports should be careful not to fall down during exercise, and in particular, when exercising that requires protective gear, he must wear protective gear. Even if you exercise for health, you will have to avoid the same posture continuously, and stretching to release muscles before exercise is essential. And if you feel that you have some abnormal symptoms, avoid the same posture any more and do the RICE therapy mentioned above at home.
In order to do the work and exercise you want happily with a healthy wrist for a long period of time, receive treatment even for simple wrist pain, and if chronic pain persists, consult a hand surgeon for accurate diagnosis and treatment so that you can enjoy a happier life.
Professor Lee Young-geun (Academician of the APOA Floating Upper Body Society)
1685179370
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