Discussions By Condition: I cannot get a diagnosis.

Undiagnosed Wrist Pain.... Arthroscopic surgery on Wednesday

Posted In: I cannot get a diagnosis. 0 Replies
  • Posted By: JCapriotti
  • June 13, 2010
  • 04:58 PM

Hello,
I have had moderate but sometimes extremely obtrusive left wrist pain for 5 years. Over time, mostly in the last 2-3 years, it has "migrated" into the hand and sometimes my pinky and ring finger. But the core wrist pain is still a big issue. I also have less frequent pain in my elbow. This pain is not present in my right wrist.

Something that may or may not be important is that I had a ganglion cyst surgically removed from the same wrist 8-9 years ago.

In the last few years I have tried the following to get a fix or diagnosis:


Initial hand doctor/surgeon visit 2.5 years ago. Included x-ray, then PT (flexibility testing, ultrasound, basic stuff)
MRI of wrist 2 years ago; no result or diagnosis.
Saw a different hand surgeon 1 year ago, recommended exploratory surgery. Didn't want to do it.
Saw an acupuncturist end of last year. After a few treatments with no results, he referred me to a pain management specialist.
Pain management recommended another MRI, which I did 4 months ago. There was still no clear cause for the pain.
Hand doctor (original from 3 years ago) did a "nerve block"; injected a local anesthetic into the posterior interosseous nerve (PIN). Apparently, this nerve is mostly a pain receptor within the wrist and "would tell you if you break your wrist". This gave me about 85% relief (almost too fast, according the the doctor, which makes me wonder if it had a small placebo effect) but some of the hand pain was still there.

Here is what I am doing on Wednesday (6/16):


Doctor recommended arthroscopic wrist surgery to find problems within the wrist, and then correct them (if he finds something).
Doctor also said if he does not find anything he thinks is a problem, I can elect to have a PIN nerve resection (at the same time, on Wednesday), which I think would sever the nerve. This would effectively take away most of the pain, but would not "fix" anything.

Here is my question:
I am not sure if I want to do the PIN resection, especially with the presence of these new/different symptoms (hand/finger pain, elbow pain). I figure I can get more/additional investigation (maybe a nerve conduction study, investigation of possible ulnar nerve problem in elbow, etc) and maybe that will yield a true fix. But, I get stuck on questions like if any of this pain is referred pain (either from the wrist or to the wrist), could there be more than one problem, etc.

I think going through with the arthroscopic surgery is a good idea. But is the nerve resection? Should I wait and see if there are other possible causes of this pain.

I'm sorry for the slightly complex/ambiguous question. Just looking for any possible opinion that may help.

Thanks,
Jason

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