TOPIC:

Julie from here,

ISa trained & skilled Physiotherapist & She got Mid Carpal Instability in both hands/wrists,

She's had to have time off work & to under go Surgies,

& Her Consultant Orthopeadic & Trauma Hand & Upper-Limb Surgeon - Mr. Charles A Pailthorpe - tinyurl.com/8d8z9o

He believe's Julie suffered Mid Carpal Instability to both her wrists/hands through Repetive Movements/Tasks & Her Job.

If you have an E-Mail Address, I can send you copy of Page: 30 of Wrist Instability Ueli Buchler - 1997,

States:

Midcarpal Ligament Tear Or Attenuation

*Pain & 'Clunk' In Hyperlax Young Patient After Light Injury Or Repeated Stress

*After Rotational Significant Injury I Normal Patients

& From other medical journals I have read & people I've spoken online & Consultants, Confirm MCI can be caused by Repeated Stress, Or a light injury that patient had years ago or doesn't even remember as the injury was nothing bad.

Hi Ryan

Thanks for sending me this thread.
I can completely relate to your story as similarly to you I started getting pain in my wrist for no apparent reason other than due to the work I was doing.
I had been a physio for ~10 years with no problem and then without injury ~4 years ago I started to get pain in my R wrist followed ~1 year later with pain in the L wrist. My first consultant didn't diagnose me and I went through 2 years of rest, splinting, injections and physio but nothing helped. With xrays, MRI and an arthroscopy he then discovered arthritis in my R triscaphoid joint and I had a joint replacement but this didn't stop any of the pain. After another ~1 year with no improvement he referred me to a collegue who instantly diagnosed me with MCI. He performed a laser capsular shrinkage on my L wrist ~9 months ago but unfortunately that also has not stopped any of the pain even though the joints are now stable. I never knew I had any instability as I never really experienced any popping or clunking only clicking in my thumbs and pain. My consultant is now unwilling to perform any more surgery to try to alleviate the pain as my previous surgeries did not improve it and he is referring me to another specialist.
The consultant said that although I had MCI and possibly more generalised hypermobility I would never have had a problem with it if my job had not been so physically demanding on my hands and wrists. (Most people who complain of symptoms of MCI without injury are manual workers of all sorts). I imagine the same may be said of you. I can't imagine that you will be able to go back to work as before unless something is done to stabilise your MCI. My consultant felt if I had been treated effectively earlier I could have had a much better outcome. Has anyone ever spoken about giving you an MRI or performing an arthroscopy to really see what's happening in your wrist? If it is MCI a capsular shrinkage should be effective as your problem is so new. You may even become completely stable and pain free. As for continuing typing I'm not sure it would be the best job for you as it obviously puts a lot of stress on your wrist and hand joints.
I had to be medically retired 4 months ago and am waiting to hear if I will get permanent injury benefit (if it is accepted that my condition was aggrivated by my job). At present I am unable to work as I am too limited by the pain and am waiting to see what the new specialist says.
It seems that you have good access to specialists so if I were you I would keep pushing for a true diagnosis and plan of action and that may well help with your workers compensation.
It's good to talk to you and if I can be of any help please do ask as we seem to have similar cases.

Take care
Julie

Hi Ryan

Thanks for sending me this thread.
I can completely relate to your story as similarly to you I started getting pain in my wrist for no apparent reason other than due to the work I was doing.
I had been a physio for ~10 years with no problem and then without injury ~4 years ago I started to get pain in my R wrist followed ~1 year later with pain in the L wrist. My first consultant didn't diagnose me and I went through 2 years of rest, splinting, injections and physio but nothing helped. With xrays, MRI and an arthroscopy he then discovered arthritis in my R triscaphoid joint and I had a joint replacement but this didn't stop any of the pain. After another ~1 year with no improvement he referred me to a collegue who instantly diagnosed me with MCI. He performed a laser capsular shrinkage on my L wrist ~9 months ago but unfortunately that also has not stopped any of the pain even though the joints are now stable. I never knew I had any instability as I never really experienced any popping or clunking only clicking in my thumbs and pain. My consultant is now unwilling to perform any more surgery to try to alleviate the pain as my previous surgeries did not improve it and he is referring me to another specialist.
The consultant said that although I had MCI and possibly more generalised hypermobility I would never have had a problem with it if my job had not been so physically demanding on my hands and wrists. (Most people who complain of symptoms of MCI without injury are manual workers of all sorts). I imagine the same may be said of you. I can't imagine that you will be able to go back to work as before unless something is done to stabilise your MCI. My consultant felt if I had been treated effectively earlier I could have had a much better outcome. Has anyone ever spoken about giving you an MRI or performing an arthroscopy to really see what's happening in your wrist? If it is MCI a capsular shrinkage should be effective as your problem is so new. You may even become completely stable and pain free. As for continuing typing I'm not sure it would be the best job for you as it obviously puts a lot of stress on your wrist and hand joints.
I had to be medically retired 4 months ago and am waiting to hear if I will get permanent injury benefit (if it is accepted that my condition was aggrivated by my job). At present I am unable to work as I am too limited by the pain and am waiting to see what the new specialist says.
It seems that you have good access to specialists so if I were you I would keep pushing for a true diagnosis and plan of action and that may well help with your workers compensation.
It's good to talk to you and if I can be of any help please do ask as we seem to have similar cases.

Take care
Julie

Hiya Julie, Ryan

2008 - The Non-Dissociative Clunking Wrist: A Personal View - M. GARCIA-ELIAS - tinyurl.com/8x9xk3

DIAGNOSIS:

Intrinsic clunking rarely results from a specific traumatic event having caused severe ligament rupture.

Most patients have congenital laxity with repetitive stress or mild injury, altering the necessary neuromuscular control, thus triggering the initiation of symptoms.

Yet, unless there is discomfort, asymptomatic clunking wrists should not be considered pathological (Anatomy and Biomechanics Committee of the IFSSH, 1999).

Indeed, despite exhibiting a different pattern of motion, most of these wrists have excellent proprioception and achieve stability through a complex but efficient neuromuscular control.

In both the anterior midcarpal and combined radiocarpal–midcarpal clunking forms, there is an obvious sag of the wrist in the palmar direction, which is actually the consequence of a palmar translation plus supination of the distal row relative to the forearm, a misalignment that corrects itself in ulnar deviation (Fig 2).

In the posterior midcarpal clunking, the wrist appears normally aligned except in ulnar deviation and slight flexion, when a dorsal subluxation of the capitate appears, often with a clunk, which may be painful, or not, depending upon different factors such as the status of the cartilage, the presence of localised synovitis, etc.

Mid Carpal Instability Journals, Websites, Or Wrist Sprains Journals/Websites @ wristinstability.multiply.com/journal

hi julie thanks for joining the discussion,

your case does indeed sound very similar to mine.

i have not yet had an MRI or arthroscopy. i have to go to another doctor and hopefully he or she will refer me to the hand and upper limb orthopaedic doctor that i want to see (i think he is the best in the city).

i never plan to return to my job typing, my wrists would surely be destroyed!

hearing your story gives me hope of a proper diagnosis. the last doctor i saw claimed that carpal instability can only happen from a severe traumatic injury to the wrists (such as a motorcycle accident).

take care ~

bombadil wrote:

hi julie thanks for joining the discussion,

your case does indeed sound very similar to mine.

i have not yet had an MRI or arthroscopy. i have to go to another doctor and hopefully he or she will refer me to the hand and upper limb orthopaedic doctor that i want to see (i think he is the best in the city).

i never plan to return to my job typing, my wrists would surely be destroyed!

hearing your story gives me hope of a proper diagnosis. the last doctor i saw claimed that carpal instability can only happen from a severe traumatic injury to the wrists (such as a motorcycle accident).

take care ~

Hiya Julie & Ryan

Have you read Mick's Post AT: tinyurl.com/MICKSPOST

I am little bit worried, As I've not heard from in awhile & I've sent him a few Private Messages through Ablehere.Com

Julie have you heard or seen Mick???...

I hope his ok, The last time we spoke he was a bit down

Hi Scott

I am afraid I haven't heard anything from Mick. I do hope he is ok. Please let me know if you do hear from him.

Julie

Julie wrote:

Hi Scott

I am afraid I haven't heard anything from Mick. I do hope he is ok. Please let me know if you do hear from him.

Julie

Thanks Julie

Well hopefully his ok or just not got internet as present.

I'll keep everyone updated

I've made a post at: www.ablehere.com/component/option,com_jo...ew/id,16162/catid,22

Hi again everyone,

Got back from seeing another doctor at a clinic today. I went to see if i could get a referral to the orthopaedic doctor I want to see.

The clinic doctor told me that the doctor i want to see is no longer accepting referrals or patients...

I told this doctor that i think i have carpal instability, and he said \"well the x-rays don't show anything\". I told him about dynamic carpal instability and how it does not show up on x-rays at first, and that physical examination and arthroscopy are the only ways to diagnose it.

He said that \"no one\" is going to do arthroscopy on me, because the waiting list is too long... what the hell?

This doctor ordered more blood tests, this time to see if I have arthritis. He also said that he doesn't think I have joint hypermobility, and i think he is right.

I am not sure what to do now. I guess go looking for another doctor?

in peace & love ~<br><br>Post edited by: bombadil, at: 2009/01/27 20:59

bombadil wrote:

Well today I got some really bad news and am completely stressed out.

Workers compensation will not cover me at all because the x-rays don't show anything.

I saw my doctor again today and he told me that he agrees my condition was pre-existing (hypermobility) and that it was just temporarily aggravated by the repetitive typing at my job. He says he can't find any objective evidence that my condition is permanently worse.

For some reason now he is saying I don't have carpal instability, just hypermobility.

I am so angry right now and scared and upset.

There is no way I can go back to typing 110 words per minute for 30 hours a week. Just slowly typing this post is hurting my wrists.

Basically all I can do now is look for some minimum wage job, and one that doesn't involve repetitive movements like a cashier or something.

All of my training and skill sets revolve around computer use.

It pisses me off because clearly something is worse, something is different in my wrists than before. ARG

Hiya,
Ryan,
Sorry to hear about your more bad news, I feel The Hospitals are taking The Piss.

I am glad this Doctor/Consultant doesn't think you have hyper mobility syndrome (HMS),

But sending away for Arthritis Blood Tests so soon after you've noticed signs of Dynamic Carpal Instability, Its very unlikely to have any signs of Arthritis or Osteoarthritis at this early stage, But Julie developed Arthritis before me & I've been suffering from The Clunking, Snapping, Clicking, Popping, after the accident/injury to my left hand/wrist on: 13-10-2002,

You can ask you Doctor for this though, As it wouldn't be up to him or you decide weather you can have Wrist Arthroscopy, As any Consultant Orthopeadic & Trauma Hand & Upper-Limb Surgeon, Would need to do this after the following standard tests:

Physical Hand & Wrist Examinations - www.maitrise-orthop.com/viewPage_us.do?id=153 & www.maitrise-orthop.com/corpusmaitri/ort...3_saffar/index.shtml & emedicine.medscape.com/article/1241610-overview & emedicine.medscape.com/article/1241610-overview

Midcarpal shift - To test for midcarpal instability on the right wrist, the examiner stabilizes the patient's forearm, with the left hand in a pronated position. With the patient's wrist in 15° of ulnar deviation, the examiner's right thumb exerts volarward pressure at the level of the distal capitate. The wrist is then simultaneously axially loaded at the metacarpals and ulnarly deviated. The result is positive if a painful clunk occurs that reproduces the patient's symptoms.

Special Test & Stress Plan X-Rays - www.maitrise-orthop.com/corpusmaitri/ort...3_saffar/index.shtml & wristinstability.multiply.com/journal/item/14 & www.radiologyassistant.nl/en/42a29ec06b9e8 & www.wheelessonline.com/ortho/mid_carpal_instability

Videofluoroscopy & Ultrasonography & Arthrography & Computed tomography & Magnetic resonance imaging, with and without Arthrography & Wrist Arthroscopy

Read This Website: emedicine.medscape.com/article/1245322-overview

An Consultant Orthopeadic & Trauma Hand & Upper-Limb Surgeon, Will often not need to do all the above tests, I've only had Physical Wrist & Hand Examinations, 2 MRI Scans, Stress/Special Plan X-rays, & on old Videofluoroscopy, & Wrist Arthroscopy.

I hope this will help, I'll post this on Ablehere.Com too.

Wish You All The Best, Don't be ignored.

Keep Your Chin Up

Take Care & Take It Easy

Scott & Jon

Hello Ryan

So sorry to hear your bad news, it seems you are being blocked at every turn.
My advice would definately be DON'T GIVE UP.
Get another doctors name and a referral and keep going until you get a doctor who understands and can really help you.
It took me ~2 years to get a proper diagnosis, from my 3rd doctor.
I did have arthritis and a joint replacement for it before I was diagnosed MCI. Therefore, even if your tests for arthritis do come back positive it doesn't help with your diagnosis of MCI - you can have MCI with or without arthritis. The arthritis can be a symptom of MCI or there independently and it's important to know which to get the correct treatment.
You really do need a doctor to carry out the proper tests. I can't believe you have been told you can't have an arthroscopy just for the reason of a long waiting list. I don't know what your health service is like in Canada but in England you can not give a reason like that.
I wish there was more I could say to help but I do know what it's like living like this - constant pain and inability to perform simple manual tasks and not being able to work at what you love and have trained for. Just ~4 years ago I had no problems and was enjoying my life and my work and now everything is so much more difficult. It is really hard to reevaluate your life but take time, get advice and lean on friends and family if you can.
Good luck. My thoughts are with you.
Julie

Well Said Julie

Hello Julie & Ryan

Hope your both ok

I've finally got a copy of Mr. Darwish's letter to My G.P., But not the one sent to Miss. Ang.

My G.P. has carried out Miss. Ang's request letter dated: 24-12-2008, Where she asked him to refer me to a Pain Clinic & He sent this letter out on: 27-01-2009 & I'd be going to tinyurl.com/PainClinic If I get on there waiting list,

Or if Miss. Ang manages to contact Mr. McCarthy who is away on sabbatical for 6 months & not left clear guidlines what should happen to my MCI/PMCI if the Arthroscopic thermal capsulorrhaphy for palmar midcarpal instability/Thermal Capsulorrhaphy for Midcarpal Instability Operation was unsuccessful from: 24-07-2008,

& I've had to write to My own Local Labour MP - Mrs. Meg Hillier & ask why My Ex-Employers Marks And Spencer Plc's Chosen Private & Retired Medical Expert - Mr. James Campbell Semple - Consultant Orthopeadic Hand & Upper-Limb Surgeon & Legal Team have been able to effect my limited or full wrist fusion, Which would stop The Clunking, Snapping, Clicking, & Popping, From My Left Hand/Wrist, & Arm,

& Thus hopefully reduce alot of Pain & Discomfort & hopefuuly increas strength/power in the hand/wrist & the maybe followed by Pain Managerment & More Physiotherapy, s long as I've had a limited or full wrist fusion.

I am full aware that no MCI/PMCI will ever be 100% Pain Free or 100% Disability Free, Wrist operations only delay the worsening of the Wrist Disability & to delay Osteoarthritis.

I've been doing twice a day Physiotherapy & Hand, Wrist, & Finger, Strengthening Excerises since: 13-10-2002 - Present, Painkillers (8 Tylex & Other PAinkillers A Day), Hot & Cold Therapy, & Counselling,

Which are all bloody forms of Pain Managerment

Studies by Mr. David M Lichtman - Consultant Orthopeadic Hand & Upper-Limb Surgeon, The Worlds Leading Expert In Mid Carpal Instability (MCI)/Palmar Midcarpal Instability (PMCI) do much better with a limited or full wrist fusion & Pain Managerment,

Than those with Ligament Tightening Wrist Operatons or Pain Managerment on its own,

As MCI/PMCI is a Structural Problem & needs surgery to correct it.

wristinstability.multiply.com/journal

BLOODY My Ex-Employers Marks And Spencer Plc's Chosen Private & Retired Medical Expert - Mr. James Campbell Semple - Consultant Orthopeadic Hand & Upper-Limb Surgeon & Legal Team.