The clinical presentation of patients with hourglass-like constrictions in their nerves is similar to that of patients with neuralgic amyotrophy. Histochemical analysis suggests that the pathogenesis may be immunological in origin. The role of surgery in this condition is uncertain.
Healed distal radial fractures are frequently complicated by chronic wrist pain which is multifactorial and can be debilitating. An accurate delineation of the pathoanatomy is the key for successful treatment. This study reviewed 22 patients who had surgical treatment between 1997 and 2001 for chronic wrist pain after distal radial fracture. Four patterns of pathoanatomy were identified: (1) ulnar impaction caused by radial malunion and shortening; (2) ulnar styloid non-union; (3) triangular fibrocartilage complex (TFCC) tears with or without distal radioulnar joint (DRUJ) instability; and (4) intercarpal ligament injuries and chondral lesions. Surgical treatment directed towards identified abnormalities gave satisfactory outcome. At six months after surgery the mean functional score improved 36%, mean pain score decreased 50%, mean grip strength improved 25%, and 64% of patients returned to work.
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