Do I need surgery for my tendon injuries?

Question

Hello doctor,

It has been three weeks since falling from a height on a straightened dorsally bent palm. Considerable swelling and hematoma appeared near the anatomical snuffbox and on the elbow. The doctor diagnosed a scaphoid fracture and suspects damage to the triangular fibrocartilage complex (TFCC), ligaments lunotriquetral (LT), and scapholunate (SL). I am in a cast currently. I had a follow-up magnetic resonance imaging (MRI). I request you to interpret it carefully.

Is MRI the final call for the doctor to decide?
Or do you need to operate as he says?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thanks for writing in, and I understand your concern. Based on your reports (attachments removed to protect the patient's identity), there is no fracture of the scaphoid bone. There is soft tissue contusion in the lateral part of the wrist and is extending to the palm. There is tendon injury in the extensor carpi ulnaris tendon and mild soft tissue contusion. The triangular fibrocartilage complex (TFCC) is showing mild sprain but is relatively intact. Surgery is usually not required in the above injuries. However, your doctor will do a clinical evaluation and let you know of their updated opinion.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com. I was more focused on the possible scaphoid bone fracture, which is absent. I shall provide a more detailed interpretation below concerning the points raised by you.

1. The scapholunate ligament is showing (attachments removed to protect the patient's identity), thinning of the lunate attachment with the irregular contour in the volar band of the ligament. It might be a concern for a partial tear and sprain of the ligament. There is a small amount of fluid in the area. However, the dorsal band of the ligament looks intact.

2. There is a mild irregularity in the area of the volar band of the lunotriquetral ligament, but the dorsal band of the ligament looks intact.

3. There is no bone edema or fracture of the scaphoid bone.

4. The triangular fibrocartilage is intact, but medially there is suspicious intrinsic hyperintensity in the medial part of the ligament.

5. Soft tissue contusion in the lateral part of the wrist surrounding the extensor flexor pollicis brevis, abductor pollicis longus (APL), flexor radialis, and longus palmaris tendons.

6. Intrinsic linear hyperintensity in the longitudinal axis of the extensor carpi ulnaris tendon suggestive of tendon injury in the medial part of the wrist.

I hope this helps.

Thank you.