The Natural History of Undiagnosed Wrist Pain in Young Women

Abstract

43 young women with undiagnosed wrist pain were followed up for a median of 13 years (range 3 to 19). 26% were now free of pain and 35% had improved; 30% were unchanged and 9% were worse. Overall, 40% were still significantly troubled. There was no evidence that those patients suffered or had suffered from emotional or psychiatric disturbance which might have been responsible for the pain. Only three patients had developed ganglia.

The Diagnostic Utility and Clinical Implications of Wrist MRI in the Pediatric Population

“…34 Although the majority of wrist injuries with negative radiograph have a good prognosis, these “wrist sprains” can lead to long-term pain and/or impaired function. 4,29 In the setting of negative radiographs but persistent pain, cross-sectional magnetic resonance imaging (MRI) enables improved identification of occult injuries to osseous and/or soft tissue structures such as cartilage, ligaments, and tendons. 4,14,24,27,30,32 However, MRI is a time-intensive and resource-intensive imaging modality that may require sedation for young children.…”

Nicholas Barton (1935–2023): a curious man

“…This was written before other papers that stressed the importance of what were subsequently designated as the A2 and A4 pulleys; he was particularly proud of this paper and perhaps aggrieved it did not gain more widespread recognition. Although his main focus was on scaphoid fractures, his versatility was demonstrated in his comments about the misinterpretation of the hand markings on the Shroud of Turin (Barton, 1980) and a study of the neglected topic of undiagnosed wrist pain in young women (Ryley et al, 1992). All his writing was notable for its clarity and fluency.…”

Treatment Recommendations for Suspected Scapholunate Ligament Pathology

“…For instance, young adults with lax ligaments can experience ongoing wrist and anterior knee pain in healthy and structurally sound joints. 10,11 In the circumstance of a low prevalence of pathology such as SLIL rupture, even highly specific and sensitive diagnostic tests can be misleading (Bayes' theorem). Furthermore, there is likely some variation in wrist ligaments and other structures, which likely increases with age, expanding the bate rate of accommodated pathology which, in turn, magnifies the influence of false positive tests and unreliability, thereby increasing the potential for misdiagnosis and unhelpful treatment.…”