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Сообщение от savannah
я получила ответ от доктора :
As we discussed in the clinic visit on Friday and at previous visits, there appear to be two issues causing Alex's left wrist pain: the cartilage (TFCC) inside the wrist with a tear, and the tendon passing over the wrist on the dorsal ulnar (back side toward the pinkie finger) that snaps when he moves his wrist in certain directions. The plan for surgery will be to start with repeating his exam again in the holding area to try to gauge the contribution of each of the two factors to his pain. I will then plan to do an arthroscopy to evaluate the torn cartilage in the wrist and debride (smooth off the rough edges) is, with the less likely need for repair. Depending on the findings of his preoperative exam, I may also need to stabilize the snapping wrist tendon through a small (about 1 inch) open incision on the back of the wrist. The goal of the surgery is to maximize the chance that what we do will improve or eliminate Alex's pain while putting him through no more steps than necessary during the surgery. For the right wrist, I would inject a local anesthetic called bupivacaine. During the office visit, you were opposed to me also injecting a steroid (triamcinolone). Assuming you have not changed your mind, I would not inject the steroid at the same time
И еще:
Cortisone is a general term for the type of medicine (corticosteroid) that is often injected into joints to relieve pain from inflammation. Triamcinolone is the name of the specific corticosteroid I use for injection. When I inject and adult for joint pain, I normally inject both triamcinolone and bupivacaine. Because Alex is very close to his full adult size, I do feel it would be safe to do an injection of bupivacaine and triamcinolone to his right wrist, and this would have a very small risk of affecting growth. The goal of the injection would be to interrupt the cycle of inflammation. In the ideal circumstance, once the cycle of inflammation is interrupted, his right wrist pain might decrease and stay decreased.
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Теперь понятно: доктор точно не знает, отчего возникают боли в области лучезапястных суставов. В принципе, в медицине такое случается часто. Поэтому доктор хочет выполнить артроскопию и "подчистить" триангулярный хрящ, не пришивая его на свое прежнее место. Кроме того, доктор хочет стабилизировать вывихивающееся сухожилие локтевого разгибателя запястья. Все вроде бы логично. Соответствует ли это действительности, то есть реальной клинической картине? Трудно сказать по инету. В этом, думаю, лучше разберется очный врач.
И еще. По поводу проблем с триангулярным хрящом-комплексом в отечественной литературе работ таких практически нет, особенно по артроскопии хряща. Не уверен, что кто-то из отечественных врачей имеет большой опыт в этом деле и без труда различит белую и розовую зоны триангулярного хряща при его повреждении. Может быть я и ошибаюсь.