Discussions By Condition: I cannot get a diagnosis.

Richard_Wayne2b - Arthrography

Posted In: I cannot get a diagnosis. 4 Replies
  • Posted By: JCottleMD
  • February 3, 2009
  • 01:37 AM

Richard,

I thought I would start a thread specifically between us to try and refrain from breaking the continuity in both our own discussion and that of the persons within their own posting. I'm sure the proctors will be grateful.

I recommended an arthrography because you previously mentioned that she had already underwent an MRI with negative findings. I would, at some point, considered something like an early osteonecrosis of the lunate that can produce pain like sprained wrists and yet indicate negative imaging results, but whether this could present itself bilaterally would not be within my realm of experience.

The tricompartmental arthrography is naturally a three-injection technique, with infiltration into the radiocarpal, midcarpal, and distal radial-ulnar joints. Bilateral tricompartmental arthrography is often recommended because bilateral intercarpal communications are not uncommon. With this test, we're looking for damage to the ligaments that would typically not be revealed with other imaging studies.

I suppose the concern here would be that prior to arriving at a diagnosis of exclusion, it would be warranted to obtain the arthrography to determine the patency of the ligaments which could characteristically produce bilateral wrist pain subsequent to insult.

If the arthrography does not yield positive results, then combined with the negative MRI, you may well have greater support for the diagnosis of conversion, although again I will share with you that I've never encountered such a presentation. But then again, I am without question not the repository for all things encountered in the world of medicine to be certain.

I hope that helps to offer some direction. Please let me know how things proceed and I'm glad to hear that you joined Medscape. I very much enjoy it because it provides access to the broadest spectrum of literature, research and updates that I've encountered. You can also keep up your CME credits to some extent if you're still in practice. It's just a safe haven for old birds like me.

Best regards,

J Cottle, MD

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4 Replies:

  • I am bumping this, to prevent you two from hijacking others' threads :)
    Felsen 510 Replies
    • February 4, 2009
    • 10:02 PM
    • 0
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  • Thank you Felson. Goodness knows we obviously need restraint factored into our participation here. Incidentally, I've read your posts from time to time and find them to be informative and relevant to the questions posed. I only wish such continuity were the general rule rather than the exception on this forum. I'm certain that a few feathers get ruffled because I tend to be a bit gruff, but I've been around medicine long enough that my predilections are quite firm. Both my immediate and extended family were all heavily steeped in the medical profession and that much exposure is likely to narrow my views to a good extent, but I make no apologies for who I am. Without provication, I'll again state here that I care nothing for charasmatic practices and over the years have witnessed the truth which underlies the old adage Where the desperate toil, so too lurks the healer. While it may be a fact of life, it certainly doesn't merit the nod. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • February 4, 2009
    • 11:48 PM
    • 0
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  • Thank you, dr Cottle. But please feel free to correct my posts. Although genuinely interested in medicine, I am not a doctor. Could I kindly ask you to take a look at the thread “Undiagnosed Muscular Disorder?”. It’s a young girl (a friend of a friend). Maybe you have any ideas? I am bumping her thread. Thank you. :)
    Felsen 510 Replies
    • February 5, 2009
    • 06:08 PM
    • 0
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  • By all means. I will search out the thread and take a look. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • February 5, 2009
    • 11:57 PM
    • 0
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