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D18H CLINICAL CASE SLIDE PRESENTATION UPPER EXTREMITY

BILATERAL WRIST PAIN-WEIGHTLIFTER

Weiss, A K.1; Tsai, H H.1; Puffer, J C.1

Author Information
Medicine & Science in Sports & Exercise: May 2002 - Volume 34 - Issue 5 - p S138
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HISTORY:

- A 48-year-old weightlifter presents with bilateral wrist pain. He reports that the pain began 2.5 years ago when he was carrying a 200 pound pumpkin. As he was carrying the pumpkin, it slipped and he caught it as it was dropping, hyperextending both wrists. He felt and heard a painful pop in both wrists. Since this time he has had bilateral wrist pain, especially with weight-lifting, in particular bench and military press. The pain has progressed and now bothers him with most daily activities that require wrist movement. He denies any swelling, redness, paresthesias or change in the skin color of his hands or wrists.

PHYSICAL EXAMINATION:

- Examination of the wrists revealed pain with palpation of the snuff box, radial carpal joint and of the scapholunate interval bilaterally. There was pain with full wrist extension bilaterally. No effusion was present. Watson's, TFCC Provacative, Phalen's and Tinel's tests were negative bilaterally. Active range of motion and neurologic testing were normal.

DIFFERENTIAL DIAGNOSIS:

  1. Congenital bilateral dorsal intercalated segmental instability
  2. Traumatic bilateral dorsal intercalated segmental instability
  3. Bilateral osteoarthritis of the wrists
  4. Bilateral scapholunate dissociation
  5. Bilateral non-union scaphoid fracture
  6. Bilateral TFCC tear
  7. Bilateral scapholunate advanced collapse

TESTS AND RESULTS:

  • AP left wrist radiograph:
  • -severe osteoarthritis of radiocarpal compartment
  • -bony ossicles along radial and ulnar aspects of the distal radius AP right wrist radiograph:
  • -mild osteoarthritis of radiocarpal compartment Lateral radiographs bilaterally:
  • -scapholunate angle about 75 degrees bilaterally Clenched fist view bilaterally:
  • -widened scapholunate gap compared to AP view bilaterally

FINAL WORKING DIAGNOSIS:

Bilateral traumatic scapholunate dissociation with resultant bilateral DISI deformity and evidence of early SLAC wrist on the left

TREATMENT AND OUTCOMES:

The patient was referred to hand surgery, but has refused surgical intervention at this time.

©2002The American College of Sports Medicine