Mayo Clinic Orthopedic Surgeon Richard Berger describes the process that led him to discover a common cause of mysterious wrist pain, called a split tear of the ulnotriquetal (UT) ligament. The UT is a ligament housed within the ulnar side of the wrist, connecting two forearm bones, and located at the axis of the wrist’s rotation.
Dr. Richard Berger describes the ulnar fovea sign, a simple test he developed that has 93 percent specificity in diagnosing a type of mysterious wrist pain that can be surgically repaired with a 95 percent success rate.
I have a patient who may be a good candidate for this surgery. Anyone in the Olympia, WA or Seattle, WA area performing this?
Thanks in advance.
Dr. Berger says: “Jeff Freidrich is on the faculty at the University of Washington Department of Plastic Surgery in Seattle. He’s a recent graduate of our hand fellowship and know how to treat split tears.”
I have several patients that have a UT tear. They have a very interesting differentiating symptom from that of the TFCC. The patients with a tfcc tear have limited weight bearing tolerance of the wrist using a non digital scale and comparing it to the unaffected wrist. You can see this test at http://www.youtube.com/watch?v=SVqgnleuSII
The patients with UT tears have painful wrist flexion and extension with load- i.e.: hitting a back hand, and they do not see a change in their weight bearing with Distal radius and ulna squeeze. These cases have a hard time recovering with splinting, acupuncture, cortisone, therapy etc. I am most curious what your post op protocol is for your patients with split tears of the UT. Could you kindly forward me a post op protocol (splinting, casting, therapy, activity) to forward onto the patients that inquire.
Warmest Aloha,
Wendy Medeiros, OTR, CHT
I have been suffering from wrist pain for over a year, off and on.I think a tear in the UT ligament could be possible. It is painful to do things like open something that is difficult to open or wring a towel out. I recently picked up something heavy and the pain has gotten worse and is constant. Does anyone know if this is a condition that someone can function with? I’m thinking of going to the doctor to get this checked out, but am not sure if I’m overreacting because I can still do most normal things. Also, what type of doctor would be able to diagnose this? I live in Port Angeles, WA, near Seattle.
Thank you for your time,
Danielle
Dr. Berger says: “Jeff Freidrich is on the faculty at the University of Washington Department of Plastic Surgery in Seattle. He’s a recent graduate of our hand fellowship and know how to treat split tears.”
I have had an ulmar osteotemy and still have pain and selling. I performed this test and it was very painfull. Is there anyone in Ontario Canada with knowledge of this?
I have been suffering from wrist pain for over a year, off and on.I think a tear in the UT ligament could be possible. The pain has gotten worse and is constant, I performed this test and it was very painful. What type of doctor would be able to diagnose this? I live in Toronto Canada.
Every time I go to a hospital with crazy pain, the doctors here give me a pep talk regarding wrist anatomy and tell me to take pain killers every 4 hrs, it is not helping I can’t take the pain and also the limitations can’t work or anything, this is my left wrist, and I’m left hand as well, so my stuck big time.
You should see an orthopedist. Dr. Richard Berger is our specialist on UT tears. To make an appointment contact Mayo Clinic, 1-507-284-2511.
I live in Canada and think I have an injury to the UT ligament as described above. That’s exactly where it hurts when I press on it. It’s not debilitating but more of a nuasance pain. Does anyone know if its possible to have a minor injury to this ligament but not a full blown tear? If its just inflamed, would ice and a wrist brace help it heal?
Any assistance is greatly appreciated.
I need to know if you have your office in washington state.
We do not have an office in Washington state. We are located in Scottsdale, Arizona; Jacksonville, Florida and Rochester, Minnesota.
I have been suffering from wrist pain over three years. I had a surgery on my wrist twice but I still have pain and it getting worst. It very painful to do thing like typing, writing and lifting something. When I I try to pick up something heavy and the pain had gotten worse and is constant. Is there any candidate in washinton that I could go see?
I have had two surgeries on R (11-5-09)(07-13-10) and 1 on left (12-3-09) and the gruesome pain in the right continues – not as bad in the left. Exactly as described – throbbing ache with intermittent sharp pains in right hand. I’ve had to quit tennis and gardening. Can’t open bottles, cans, turn doorknobs. The MRI came out normal and now people think I’m faking. I need to see someone in Tucson, Phoenix or Scottsdale area.
Debby, we have referred your question to Dr. Berger for possible suggestions. We hope to have an answer for you soon.
I have been suffering from wrist pain for 5 years and have told numerous Doctors that the pain is in the same place that Dr. Berger described. When I press in this area the pain gets worse. Do you know if there are any doctors in Oklahoma who are familiar with UT split tears?
I’m checking on this and will get back to you soon.
Dr. Berger says: Although there may be someone familiar with this, I don’t have any specific names. Unfortunately, there is no national registry of surgeons doing this surgery. Of course, I am always happy to see patients like this – it’s just the travel hardship can be significant.
I’ve suffering in wrist pain from bowling for the past 2 years. Are there any doctors in the New York area familiar with this procedure? I had TFCC debridement in May and cannot complete physical therapy due to the constant pain in the wrist even before the surgery.
Thank you for your comment. I will get back to you with an answer soon.
Is split tear wrist surgery being done at Mayo Phoenix?
We have your question and will let you know soon.
I think I may have a split tear as I press on that area, the pain is intense. Is there another wrist diagnosis that may not be a split tear, but have similar symptoms? And also, is surgery the only method that a split tear can be healed?
Thank you for your message.
Unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. However, I have attached a couple of links to pages on our website that you may find helpful: http://www.mayoclinic.com/health/wrist-pain/DS01003, http://www.mayoclinic.org/orthopedic-surgery/. If you would like to seek help from Mayo Clinic, please call one of our appointment offices in Arizona at 480-301-1735; Florida, 904-953-0323; or Minnesota, 507-284-2511.
Thank you for your response Polly. I am from Ontario, Canada and I’m wondering if this knowledge of split tear repair has passed on to here?
I am in a desperate situation to get my wrist fixed as I plan to turn professional in my sport in 2012. Is there a way I can contact Dr. Berger directly through e-mail? Please send me an email Polly at tcfcamp@gmail.com as we can communicate there more easily. thank you!
My wrist has been like this for a few years now, It’s on and off. One day it’ll be fine, the next day, the pain is unbearable. The pain feels like someones stabbing my wrist. Right on top of it. But it doesn’t hurt when I push on it. Also, I can’t do the simplest things like: Pick up semi-heavy/light objects, sometimes hurts to write, and it hurts to bend/twist my wrist. I’ve had numerous x-rays done, but my doctor’s really don’t want me to get an MRI done, would this likely be a split tear? or something else?
Jill, we have received your question and are looking into the reply.
Thank you for your question. If the pain is on the back side of your wrist, and not in the “soft spot” on the ulnar (little finger) side of your wrist, it is not a split teat of the UT ligament. But there are a number of other things it could be. It sounds like this really bothers you. I would suggest having a hand surgeon look at your wrist. I would be happy to do this as well, but travel may be an issue for you, depending on where you live. Dr. Berger
I’m going through my second attack of severe wrist pain in 6 months. The first time lasted about 5 days including a couple of emergency room trips, my general doctor and an Orthopedist Surgeon. The MRI showed nothing wrong then as well as e room x-rays or blood tests.The surgeon recogmended I see a doctor that specializes in gout, etc…
Pressing on the area under the base of my little finger will hurt like nothing else ever has. Yesterday was the worse day of the pain during this attack as I couldn’t move any of my fingers due to the pain as well the pain was a constant and stabbing pain on top as well as under my wrist. The base of my thumb also hurts to the touch but not nearly as bad. My whole wrist is swollen but wasn’t yesterday. My doctor’s office did more blood work yesterday and ruled out gout. They want me to see the same Orthopedic Surgeon as last time. They gave me a Cortisone injection as well as non-steroidal anti-inflammatory’s yesterday as they did before. The nsai’s never helped last time but the Cortisone injection did. Does this sound like a Split Tear?
Thanks,
Gene
We have sent your question for reply.
I injured my hand two months ago just hitting range golf balls. The pain is on the ulnar side and about where the UT is located. Kaiser doctors have examined this and prepared 2 setso x-rays. The latest diagnosis is a sprained ligament and I have been in a splint for 3 weeks with not much relief. My fingers have become stiff, I have no strength in the hand, pain persists and the hand swells daily.Should I suggest to tke hand surgeon I see the possibility of UT Split? Or is there a doctor in the DC-Baltimore area I can see for consultation?
We have referred your question for an answer.
My son is a college baseball player experiencing the wrist pain that you are describing in your video. He has been to a local orthopedist and he thinks he has a tear. Are there any surgeons in the Atlanta, Ga area that you know that are doing the minimally invasive repair ?
Thank you
I first posted my concerns on July 6, 2011. Since then I have had no relief. I saw Dr. Warren Breidenbach who is the chief of Hand Reconstructive Surgery at the U of A in August 2011 and after tests he recommended re-surgery on R hand using alloderm to create a bridge over the median nerve in addition to possible removing the knobby wrist bone (with my palm facing up) on the outside base of my R hand. I did not feel comfortable using alloderm due to its history and I did not want any bones removed until I could rule out a UT Split Tear. When I mention possible UT Split tear the Dr.’s don’t seem to know what I’m talking about and just ignore me. My PCP and the Tucson Center for Neurosciences is treating my hands as if I have RSD altho the only swelling I have is a swollen area between my R wrist bone and the hand. They have me on Amitriptyline, Gabapentin & Narcotics all to no avail. I have never had a Dr. perform the UT Split tear test on me ( Ulnar Fovea test). I need some relief and some help!
Hi, I noticed pain aqbout a year ago immediately after digging holes for trees. The pain is in my left wrist, pinky side. Rite above my ulna is swollen. It is extremely painful. Bending my hand towards my ulna and down hurts. Bending my hand back is also painful. Any kind of weight bearing is painful. If I keep it straight all night it is painful. If I use it excessively, it is painful. When it is inflamed, it throbs in severe pain. I just had surgery to remove a cyst in my right hand, so I am seeing an orthopedic surgeon currently, I want to ask him what could be wrong. I am a nursing student and am scared I wont be able to work to my ability due to this. I ask, might I have a split tear?
Any surgeons in Texas
Yes –
Wendy L. Parker, MD PhD FRCSC
Assistant Professor Department of Surgery
Scott and White Clinic
Texas A&M University
Plastic, Reconstructive, Hand and Wrist Surgery
Douglas Sammer, MD
Plastic Surgery
Outpatient Building
University of Texas Southwestern Medical Center
1801 Inwood Rd
Dallas, Tx 75390-9163
Any surgeons in the San Francisco Bay Area? Particularly the East Bay?
Unfortunately, I don’t know of any specically in that area managing these problems. That doesn’t mean there aren’t, it’s just that we don’t have a registry of participating surgeons. As always, we would welcome you in Rochester. Appointment numbers can be found at mayoclinic.org. Dr. Berger
I have written a couple of times abut my hands. I’m scheduled for a median nerve block tomorrow in both hands. I already had cortisone (3) injections in my median nerve last August by Dr. B mentioned in my prior note. Can I get an appointment with Dr. Berger if I fly to Seattle?
I didn’t mean Seattle – Where ever Dr. Berger is located.
I’ve had surgery on triangular tear fibrocartilage on right wrist in 2009, also have a same tear in left wrist, no surgery just therapy. But after reading this I may have been miss diagnosed. It happen once already, the pain started in 2004, was treated for two years for neck problems, they said my wrist pain had to be coming from there, until a ortho specialist found the tear in 2008. Does any one know of someone in the Chicago area that practices these procedures.
Thanks
Rick
Chicago, Ill
We’ll check and let you know.
I have a wrist condition that is currently being treated with PT. MRI indicating possible TFCC tear according to my doctor. But after seeing this about a UT ligament split tear, I think that this may indeed be my issue.
Can you possibly recommend any doctors in Chicago who are experienced in this type of surgery?
Many thanks!
The following list identifies graduates of the Mayo Clinic Hand Surgery Fellowship that have experience with the evaluation and treatment of these disorders:
Jason M. Anane-Sefah, M.D. Peoria
Brian J. Bear, M.D. Rockford
Mark D. Greatting, M.D. Springfield
Kelly A. Holtkamp, M.D. Crystal Lake
Mary Ling, M.D. Warrenville
There are other hand surgeons in the Chicago area, many of which I feel are good. I just don’t know what their approach is to these types of clinical problems, as we do not maintain any type of registry. I hope this helps.
This sounds exactly like my problem is there anyone doing this procedure in Colorado?
Unfortunately, there is no “registry” of surgeons that are familiar with the diagnosis and treatment of this condition. All one can do is make an inquiry to practicing hand surgeons in the area and see if anyone sounds promising. Although the distance is sizable, I would be happy to see you here in Rochester as well – it’s just an option. I wish you the best. Dr. Berger
i have had ulnar pain on rotation of right wrist for a couple of years now. had physical therapy, worn wrist braces and doesn’t help. Only really hurts on rotation. Find it painful to hold a fork or spoon, when bringing utensil up to my mouth my wrist tends to lock on rotation and becomes very painful. trying to wash face with both palms upwards, and my wrist locks with pain. the pincer grip between thumb and litlle finger is extremely painful and weak. The pain is off and on and when on is extremely dibilitating.
my x-rays and MRI- came out normal . Does this sound like UT split tear?
If so is there anyoe in my Columbus, Ga that does this surgery?
thanks.
We’ve forwarded your question to Dr. Berger.
I have written a couple of times before and I did not have the sympathetic nerve block that was scheduled in March since the Anesthesiologist at the Center for Neurosciences in Tucson ( Dr. Chase) said I do NOT have RSD- he said I have a definite orthopedic problem that obviously was not corrected by the CTS surgeries (3). Back in 2010 I faxed Dr. Berger’s article to the surgeon that did my 3 CTS surgeries asking if this could be the problem and he said no altho he did not ever do the “soft spot” test which if I do on myself is positive. Because he said No I was turned down my Mayo. I have now been raised to a Schedule 2 pain killer (Nucyntra). I just want to get back to normal things and playing tennis. I can go to Scottsdale or Rochester – travel does not matter altho Scottsdale would be better financially. I’m quite sure the Split UT tear is my problem and I just want to get it fixed. I found out about the split UT tear when it was aired on a Denver new channel back in 2010 and a friend saw it and called me right away. Can you help me get an appointment??
I’ve lived with wrist pain for 15 years now believing it was just normal due to breaking my wrist from a fall at the age of 12. Just over the last couple of years the pain has become much worse and even causing me to lose strength in my pinky and ring finger of my right hand. When asked to put a finger on where the pain originates, I point to the exact spot that Dr. Berger touches in the video above. I was wondering if there are any known doctors in the New Orleans area that might be familiar with this? If not, I’m set to see a local Orthopedic Surgeon soon and wondering if there is anything I could tell him so he could research this more?
Your question has been sent to Dr. Berger.
Dear Amy,
Thank you for your inquiry. I am sorry you have been suffering so long with your wrist pain. I do not have a registry of who is doing the “split tear” surgery. Starting with your orthopedic surgeon sounds like a good idea to me. He or she can take a good look at your wrist, including x-rays, to determine the most likely cause of pain. If it is something that requires specialized attention, your surgeon can determine where the best care can be rendered. And of course, I would be happy to see you at Mayo Clinic, but I realize that travel can be an issue. Please let us know if there is anything we can do for you in the future.
Sincerely,
R. Berger, MD. PhD
My son had a FOOSH in late April and we thought it was a sprain so we treated it that way,Three dyas after the injury he started his baseball season unable to swing we went to the local ortho and he suggested rest. My son would only have really bad pain when batting and after making contact would not really swing well after that at bat.I found your article and went back to the ortho with it and he put my son in a cast for 3 weeks which did not help. We have since had an MRI with Dye and was told bone bruising of the Lunate and Tricletro also possible ligament tears No TFCC tears.In talking with my son I beleve he may have the UT tear. Is there any doctors in Iowa that could do this type of surgery? We are not that far from the Mayo clinic But I am worried on how long it would take to be seen By Dr.Berger.
Thank you for writing. Unfortunately, I don’t have a registry of who is doing this surgery. However, I would be happy to see your son – and I don’t think it will take that long to get in. One thing that might help would be to see the MRI before making the trip. If you could send a CD with the MRI and x-rays, I could take a look at it, and we could go from there. If you want to do that, my mailing address is:
Richard A. Berger, MD, PhD
Gonda 14 Orthopedic Surgery
Mayo Clinic
200 1st Street
Rochester, MN 55905 USA
I hope this helps.
R. Berger
Thank you again It is on the way should be there tomorrow UPS. My son’s name is Noah.
Are there any doctors in the Phoenix area that currently perform surgery on a UT split tear? I’ve been experiencing symptoms for several years. Thanks.
We’re checking on the answer.
Thank you for your inquiry. Dr. Kevin Renfree is an Orthopedic Surgeon specializing in upper extremity disorders at the Mayo Clinic Arizona in Phoenix. He has experience with this diagnosis and procedure and is willing to see you. You can arrange for an appointment by calling 480-342-1384. I wish you the best. R. Berger, MD, PhD
Thank you very much!
Hello Dr. Berger, Thank you for taking time to read this. I do hope you can help me.
I suspect the injury that put a decided end to my ability to earn a living as a manual laborer in late 2009 may well be the one you describe above. One evening I set an empty dessert sized plate down on a counter using my left hand. As I did so, a bolt of pain shot through that wrist on the ulnar side. This occurred simultaneously with an audible cracking sound. I did seek medical attention the following day, following the usual protocol; my primary care physician on thru referrals to orthopedics. Mean while I continued to attempt returning to work as a grocery store cashier. Neither pursuit was successful. After several different tests with negative results, the specialist’s response was equivalent to a shrug, and a suggestion for some cortisone shots and hope for the best. I’ve been an unemployed college student since.
My resources are practically non existent, and I’ve only encountered roadblocks when seeking additional medical opinions because of my lack of insurance.
Doctor, I’m sure much of this is a result of years on manual labor that contributed to a repetitive stress injury. I’m only 50 years of age and want to return as a productive member of the American work force. I’m not seeking to collect disability benefits. That’s why I’m back at university. This injury is even effecting my ability to do course work, (I’ve been studying Library and Information Services; lots of computer work and heavy books) and I’m afraid that unless it is repaired, my employment opportunities will be quite limited. (GPA is still up though…)
My question to you is this: how can I present this injury as a possibility to any physician I can get the attention of? I’m on the verge of desperate and don’t know where else to turn.
Again, thank you so much for your time. Peace to you,
Carol
Thank you for your note, we have forwarded onto Dr. Berger.
I sustained an injury six years ago on my right wrist. I went back to work hauling 5 gallon paint buckets around with my left hand, and one month later, pain appeared on that one. Ended up in phys therapy/rehab on LW and RW had an arthroscopy. Debridement of inflamed tissue around ulna and TFCC. Dr. described post-operatively as an “angry wrist”. Two months ago after some strenuous activity, the pain returned. I’d like to know if there are any hand specialists in Nashville or Dallas who are able to diagnose and operate on these UT ligament tears? Thanks!
From Dr. Berger: Don Lee, MD, an Orthopedic Surgeon at Vanderbilt University in Nashville, TN may do this surgery, but I don’t know for certain. Wendy Parker, MD, PhD in Plastic Surgery at Scott and White Clinic in Temple, TX (130 miles from Dallas) most definitely does the surgery.
thank you so much! Two more questions- Are there any surgeons in the New York area who do the surgery? What is the rehab time post-op? thanks much.
i wrote earlier in May 2012 and really need your help. i never got a response. i have had wrist pain on rotation for a couple of years please see earlier posting.
i am not getting any joy from my ortho surgeon. he says my MRI is normal and has wrote me off leaving me in pain and with limited use of wrist on rotation and strength. Could Dr Berger please get back to me with any suggestions of maybe anyone in Atlanta that could help. do my symptons sound as though this split tear could be my problem?
Desparetly needing a response!
thank you.
I am going through this exactly. Pain in my ulna side of my wrists. Both my wrists are weak, tender, cracks and clicks and feel like they are going to give out. I have a high profile job were i use both wrist in the dental field. Can you refer me to a good surgeon that knows about this procedure in south Florida. All of the doctors here are stumped. please help. I had to quit my job because of the pain.
We’re checking on an answer.
I think I have this issue. Until I can figure out how to get to the Mayo Clinic from NYC, can I make this worse? I stopped wearing the hand brace and I started to try to strengthen my grip strength. However, after watching the video, I am not sure what to do before I see you. Thanks. NYC Bryan.
Thank you for writing, Bryan. If what you have is indeed a UT split tear, it will not propagate into a worse condition. Overusing it may result in increased pain, but that is not a sign that more damage has occurred. I hope this helps.
R. Berger
I guess i do have all the symptoms stated here , i am suffering from this weird kind of pain from one year, As Dr. Richard Berger explains no sings can be found either in my MRI or X-ray. Even my right hand is bent at an angle, which is hard to figure out. Is there any one around California ?
Thanks
Thanks for this informative site. My son a high school junior baseball player( catcher) has been dealing with a tfcc condition since last July. An MRI indicated a small tear and a bruised hamate hook. Despite 2 periods of rest in casts and even an injection of PRP he has once again aggravated the left wrist at a holiday baseball tourney- pain severe enough after a swing he was unable to close his mitt the next inning. He’s very frustrated since he was looking forward to attending college showcases in the next few months as well as playing for his HS team this spring. We’re in the Los Angeles area and are willing to travel if Dr. Berger or another specialist could see my son for a diagnosis soon. Thanks
Steve
Hi Steven, We are sorry to hear about your son’s injury. If you would like to seek help from Mayo Clinic please contact one of our locations: Arizona: 480-301-1735 Florida: 904-953-0853 Minnesota: 507-284-2511.
I’m a Physical Therapist Assistant in WV. I’m experiencing similar pain which started last month. I did however have an actual injury and have re-injured 2 additional times. I’m being scheduled for MRI and referral to orthopedist. Is there any orthopedist/hand specialist in WV performing this procedure?
Hi Dr. Berger,
I am a family physician who is suffering from probable left wrist Lunotriquetral ligament injury as diagnosed on physical exam by a hand orthopedist and excellent Hand therapist Wendy Medeiros (dorsoulnar pain between the lunate and triquetral bone) which began insidiously hitting 2 handed backhands in tennis.
Despite rest, splinting, acupuncture, manipulation, it has not improved much since it began about 3 months ago. Would you recommend MRI or MR arthrogram? I understand MR arthrogram is better but is it better enough to be worth the risk of any damage to my wrist from the dye and the procedure?
Thank you for your opinion.
Hi David, I will forward your questions to Dr. Berger for possible response. Thank you.
Thank you for writing. Lunotriquetral injuries cover a whole spectrum of conditions, from age-related degeneration of the fibrocartilagenous midportion of the LT ligament to full blown mechanical dissociations. They can all look the same on imaging, even MRI. LT problems can be dynamic (requiring provocation to see them on imaging), to static (where the displacement is fixed). I personally have found no difference between MR arthrograms and regular MR imaging in the specificity and sensitivity of the diagnosis..
What I would suggest is to also be certain that you have plain x-rays, preferably of both sides for comparison, with standard PA and lateral views as well as radial/ulnar PA and flexion/extension laterals, as well as grip views. This helps sort out issues like laxity and can draw out a dynamic instability. On the MRI, I would not pay much attention to the proximal region of the LT ligament – this is what can degenerate over time and has no bearing on stability.
These injuries can be tough to sort out, and it requires experience with the physical examination (and not just tenderness but also trying to provoke displacement resulting from instability) as well as appropriate interpretation of imaging. Even with these steps well executed, it may still require arthroscopy to make the definitive diagnosis. But it’s important to make sure of the diagnosis, because a misguided procedure can make you worse (and I don’t mean to scare you away from pursuing this – not at all – just be careful).
Dr. Berger
Dr. Berger. The results of my MRI are as follows
“EXAMINATION: L MRI WRIST W/O – (UMR/0102)
HISTORY: Pain, distant fall, failing conservative care. Evaluate for
lunotriquetral ligament and TFCC injury.
TECHNIQUE: On a 3 Tesla MRI scanner, axial T1, axial T2 fat-sat, coronal T1,
coronal T2 fat-sat, coronal 3D gradient-echo, sagittal T2 fat-sat images of
the left wrist were obtained.
FINDINGS: There is oblique linear intermediate signal intensity along the
triangular fibrocartilage articular disc (series 5, images 7-9; series 4,
images 12-17), which appears to extend to the proximal articular surface, as
well as the volar radioulnar ligament. There is mild intermediate signal
intensity and thickening at the peripheral TFCC ulnar slip onto the ulnar
styloid (series 5, image 8), compatible with prior injury (e.g. prior sprain
or mild partial tear). The lunotriquetral and scapholunate ligaments appear
intact. The remainder of the carpal ligaments appear intact. There is faint T2
hyperintense signal within the dorsal lunate. There is no evidence of
associated fracture. No significant joint effusion is noted.
No muscle or tendon tear is identified. The visualized tendons are normal in
size and signal intensity. The visualized nerve courses are unremarkable
IMPRESSION:
Oblique intrasubstance tear of the triangular fibrocartilage articular disc
and volar radioulnar ligament, which may extend to the proximal surface.
Evidence of prior mild injury to the peripheral TFCC.
Bone marrow edema-like signal in the dorsal lunate. This may be due to
contusion or reactive change.”
My tolerable pain is purely in the Lunate/Lunotriquetral region, only occurring with striking the the tennis ball. Would a steroid injection here increase likelihood of healing or just provide pain relief?
Thank you again for your expertise,
David Lin, MD
Hi Dr Berger
I have had pain in my wrist in the exact position you mention. I am very keen golfer and have played for 30 years. In September out of the blue i just could swing the club due to severe pain in my wrist (and have not played since); the pain seems to originate from the pressure/weight the club creates in my little finger and the one next to it. I have had an MRi scan and was referred to hospital to have a steroid injection. On arriving i was given a scan and the doctor (having looked at the scan) said this would not help, so did not do it. Do you know of anyone in England who specialises in this procedure you describe as this seems to me like a very possible cause of my pain.
Kind regards
Mark Smith
Hello, Mr. Smith.
I am sorry you have been suffering with your wrist – I know it can be miserable. I have a good friend who is an excellent surgeon just outside of Manchester at the Wrightington Hospital that is your best shot at finding a solution in England. I do not know for sure if he does split-tear repairs, but if anyone in England would be doing them, he would be the one. His name is Mr. Mike Hayton and he can be reached by telephone at 0161-495-7766 or electronically at enquiries@mikehayton.com. Of course, I would be happy to see you anytime, but I know that the travel is likely prohibitive. I hope this helps and I wish you the best.
R. Berger
Hi Dr Berger,
Sorry for the delay in replying to your response but i couldn’t seem to log back too this page the last few times i tried but thank you very much for your response, i am very grateful. As i mentioned i haven’t played or been able to swing a club since last September (and had tried on numerous occasions to in the back garden and there seemed to be no improvement at all) but last week i tried again and the pain (whilst swinging) had completely gone. I feel the underlying problem is still there however as even when i move my wrist a certain way or lean on my hand there is pain in that area (very bearable though in these instances). I don not want to seek out surgery for the sake of it and wondered if this was normal in your patients for the pain to come and go (albeit it has taken 7 months and then seems to have gone overnight). I know its difficult for you to diagnose without seeing me but would you suggest i still seek help or wait to see if it reoccurs?
Hello Dr. Berger,
I recently had right wrist arthroscopic surgery at the recommendation of an orthopedic surgeon based on a diagnosis of a tfcc tear. The tfcc was found to be intact but based on the movement of dye from an mri-a done during the surgery. Additionally, another tendon was found to be torn but not repaired at the tear was in the middle of the tendon and the outer edges were still connected to the bone. I am currently at the tail end of a post op rehab program and i am still getting the same ulnar side sharp and sometimes locking or catching type pain. The pain is very evident on twisting movements and seems to catch when doing simple things such as washing my hair and drying off with a towel, for example. Do you thinks it’s possible that i could have a ut split tear? I am wondering whether the additional tear the surgeon mentioned could have actually been a split tear and he didn’t recognize it. Finally, do you of anyone who is familiar with ut split tears in the Philadelphia area?
Thank you very much for reading about my issue.
Sincerely,
Bryan J. Kendall
Dr. Berger says:
Thank you for writing, Mr. Kendall. This could very well be a UT split tear. I believe Dr. A. Lee Osterman knows about this condition. He is at the Philadelphia Hand Center located at 824 Chestnut St. in Philadelphia (phone: 215-521-3000). If this doesn’t work, of course I would be happy to see you at the Mayo Clinic. Best wishes!
Apologies, typing on my iphone can be difficult, but i meant to say that a few tendons were tightened based on the movement of the mri dye.
Dr. Berger-
I am a former DI basketball player w/ multiple FOOSH injuries, yet nothing severe. I had a 25# plate dropped on my hand from someone not using the clamps at the gym. I was on the ground doing a pushups. The Dr. here is calling it a crush injury- broken radial styloid and 5th MC. Both healed, stable, no surgeries needed. I also have ulnar positive variance and signs of impaction.
It has been over six months and residual pain is right at the foveal region. Could this be a split tear d/t an acute on chronic type presentation or does a crush injury need longer to heal still in your opinion? My graduation from med school could get delayed from technical standards not being met, and I was also wondering if it is unreasonable to do an arthroscopy at this point instead of the wait and see approach?
Regards,
Raquel Cline
HI Raquel, we have forwarded your questions onto Dr. Berger for possible response. Thank you.
Dr. Berger & Stacy-
Wow! Thank you so much for the quick response. I had and MRI arthrogram w/ single injection into the radio-scaphoid joint. From my former falls in bball, I had residual stiffness before the crush injury. The arthrogram showed the fractures and a dorsal radio-scaphoid defect but TFCC and others appear intact.
I wasn’t sure if scar tissue could prevent contrast from extravasating, if it’s a non-communicating tear, a triple injection needed to be done, or nothing. I am not sure if you have figured out a way to see a UT ligament tear on MRI. I do know my labral tear in my shoulder did not reveal itself completely until surgery, and that the pain in my wrist is still there despite MRI results.
I’d be happy to come to MN but I may have dropped the ball on that one. I am on my mom’s BCBS insurance until July only, and then I switch to Med school insurance:( I figure you are probably booked solid beyond that. I do have incredible passion for the hand and wrist and am thinking about it as a specialty. The challenges here are way more exciting than those in the shoulder & knee. FYI…my position of function is not intrinsic plus, it’s the follow-through on the jump shot:)
Thanks again,
Raquel
Hi Dr. Berger
I have watched your videos and read all about your surgeries and am very impressed by your discovery and dedication. You seem like a very kind and compassionate surgeon. My son is playing baseball in college and is plagued with wrist pain. He had xrays, MRI arthrogram with dye with no significant findings. His pain is on the ulnar side of the wrist in the exact spot that you describe. He has seen several doctors including hand specialists and has gone through extensive PT and only has pain when swinging a bat. He goes to school in Brunswick Maine, but we live in the Boston area. He is trying to play through the pain applying a gel Voltarin (sp?) 4X day and was prescribed Celebrex. I would be an eternally grateful mother if you could recommend a doc in the Boston area to see him soon. He is a passionate baseball player and premed student!
Sincerely,
Lynne
Hi Lynne – thank you for your note. I have forwarded your questions to Dr. Berger and will post a reply once he is able to respond.
Dear Lynne,
Thank you for your inquiry. I’m sorry your son is suffering with this – I know how debilitating this can be. He’s lucky to have you looking out for him!
I don’t have a registry of surgeons who know about this condition and are doing the surgery, but I know both numbers are growing. There is a surgeon near you that trained at the Mayo Clinic who rotated with me and was exposed to this condition and surgery – I just don’t know if he is doing this in his practice. His name is Eric T. Tolo, MD and he is with the Lahey Clinic in Burlington, MA (781-744-8638). I can completely vouch for his skills, professionalism and personal approach to patient care. As a fail-safe, of course I would always be open to seeing your son at the Mayo Clinic, but I know what hardships the distances can create. Just let us know if I can help. I wish you the best.
R. Berger
Thanks so much, Dr Berger. I will try to get my son an appointment with Dr Tolo as soon as his semester at Bowdoin College ends. I appreciate your quick response and am so thankful for doctors like you who care so much.
Lynne
This is fantastic. This describes exactly, 100% what i am going through. First i had cubital tunnel release at the elbow. Now i am glad to find out that this is my wrist issue. And luckily, i am being seen at Mayo!
Dear Dr. Berger,
I watched your video regarding the UT Split tear problem. You describe my pain exactly. I have had this pain for over a year and have splinted on an off with little relief. One thing I did notice is the problem seems to be getting more painful the longer this goes on. I am now having some pain transfer to the ulna in the arm also. Is there a doctor in the South Dakota area that is familiar with this problem and procedures to repair it? I am willing to travel to Mayo if needed. Thanks
Jan
Hello Jan. We have forwarded your question on to Dr. Berger and will provide you with a response soon. Thank you for your question.
This message is directly from Dr. Berger:
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Dear Jan.
Thank you for your inquiry. Starting sometime in August of this year, Dr. Hillary Becker will be starting a practice with Sanford in Sioux Falls. She is finishing her Hand Surgery training at Mayo Clinic and has studied directly with me. She is an excellent surgeon and compassionate, caring individual. She is very familiar with the diagnosis and treatment. Unfortunately, I don’t have her future contact information. I don’t know of anyone else in South Dakota doing this. Of course, if preferable for whatever reason, I would be happy to see you as well.
I wish you the best.
R. Berger
Thank You, I will do a follow up with a phone call.
Jan
My son Kane is a D1 college baseball player and has had r ulnar wrist pain for about 2 years, started when he tore his UCL in R elbow and subsequently had Tommy John surgery. The wrist never got better. Sports med dr suspected TFCC tear but MRI/arthrogram was negative. Did cortisone shot and had good relief for a few months. 2nd cort shot not helpful at all. Naproxen and Celebrex make no difference. He has to take pain killers just to keep playing ball. He bats left handed, throws right. His symptoms sound exactly like what Jayson Werth had. He nearly drops the bat at times after swinging due to the severe sharp pain. We really need this fixed, he has scouts looking at him, and dreams of being drafted after his junior year (he is a sophomore). He is still batting .380 for his team, despite the tremendous pain! I have requested an appointment with Dr Berger in Minnesota, we live in southern IL. Are there any docs doing this procedure in the Illinois or St Louis area? Thanks!
HI Diane, I will forward your message to Dr. Berger for a possible response. Thank you.
This message is from Dr. Berger.
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Thank you for writing, Ms. Sweeney. I’m sorry you son Kane is hurting – I know for sure how this can effect the extremity, both on and off the field. We can’t tell until we do an exam, but all of the indicators point to a likelihood of a UT split tear. I don’t have a registry of who does this surgery, other than surgeons who have trained with me since the discovery of the problem and development of the solution. Unfortunately, there aren’t any in your region. Have you been successful in securing you appointment in my clinic? Please let us know if we can help. I look forward to meeting your son and seeing what we can do to get him better. Thank you again for writing.
R. Berger
My daughter is a fastpitch softball pitcher. Back in November she threw a rise ball and had a bad snap. She had bad wrist pain on the ulna side. We went to the doctor and were prescribed rest. We shut her down from all softball activities for about 2 months. When we started up again the pain came right back and she pitched for about 6 weeks till we shut it down again. We had an x-ray (negative) and an MRI. We met with the hand specialist about the MRI and he said we need to put it in a cast for 6 weeks. He said specifically that there is a split tendon and that putting it in a cast is the answer. After watching your video here I am starting to doubt his treatment. Is there anyone in the San Diego area that is familiar with this injury and your treatment methods?
HI Rich, I will forward your message on to a specialist for possible response. Thank you.
This sounds like what my daughter has been experiencing. Is there someone performing this procedure in the San Diego, CA area?
Hi. I have read about the UT split tear and believe it may be the issue I am having. I’ve had varying levels of pain since February 2012. I tend to have a lot of pain with gripping and writing. I typically can’t write longer than a few minutes without terrible pain on the ulnar side. I had an x-ray & MRI last year, both negative. I live in the Twin Cities, but am wondering if I can send the CDs of my x-ray & MRI to Dr. Berger to take a look out before I make an appointment?
Please let me know and where I can send them. Thanks!
Hello, please contact the Appointment Office in Rochester, 507-538-3270, and the representatives will be able to best assist you. Thanks for your question!
Is Dr. Berger aware of any physicians in Virginia that is familiar with this? I would love to know; so it would be greatly appreciated!!
If not, if a patient is unable to travel to Minnesota to see Dr. Berger himself, is Dr. Berger willing to work with other physicians on such cases (like offering guidance to physicians that are not familiar with this)??
Thank you for your note. I will forward your questions on to Dr. Berger and post his response for you.
A couple of questions. Can the split tear issue occur in other ligaments of the wrist? And if so, is there any information available that you can recommend?
Also, it doesn’t look like there has been a response to the questions about NY / NYC doctors that are familiar with this – are there any that you know of?
HI Vicotria, Thank you for your questions, I will pass them along to Dr. Berger for possible response.
Message from Dr. Richard Berger.
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Dear Ms. Manning,
Thank you for your inquiry. I have not seen any split tears in any other ligaments. I believe the mechanism of injury is related to the location of the ligament relative to the “axis of rotation” of the forearm. No other ligaments are in a similar situation. We see splits in tendons not infrequently, but that is an entirely different story.
Regarding the question of NYC doctors, we do not have a registry of which physicians/surgeons are familiar with this diagnosis and treat it. I know this makes it difficult, but we just don’t have a way to verify this. There is always an open invitation for patients to see me here at the Mayo Clinic, but beyond that, it’s trial and error to find someone.
I hope this information helps.
R. Berger