UT tears, often misdiagnosed as carpal tunnel and arthritis

Each year millions of people are diagnosed with Carpal Tunnel Syndrome and Arthritis. However, one doctor says some of them may have the wrong diagnosis.

Dr. Richard Berger discovered a new source of wrist pain, and for some professional and everyday athletes, like Barbara Metcalf, the solution saved their joints and their games.

"It was just a persistent, aching, occasional, sharp pain,” said golfer Barbara Metcalf.

She found a solution for her wrist pain when she found Dr. Richard Berger.

"Up until a few years ago, I didn't know this condition existed,” said Dr. Berger.

It doesn't show up on a plain x-ray or a CT scan.

Dr. Berger discovered what is now known as a UT Tear. The ligament that runs from the lower arm to the pinky side of the hand twists and splits down the middle

Dr. Berger developed a minimally invasive surgery to cure the wrist pain. He makes three small holes and inserts an arthroscope and razor to shave down the inflamed tissue. Then, he puts stitches across the ligament.

"We simply pull them tight, and as we do so, it folds the ligament back up into its normal position," explained Dr. Berger.

It's a discovery Philadelphia Phillie, Jayson Werth, credits with saving his career.

"To go from where I came from and a short few years later be a world champion," said Werth-a change that is truly amazing.

Barbara says the surgery saved her retirement plans, and after her surgery her first hole of golf was quite memorable.

"It just made a beautiful arch and then it came down and made one bounce and went into the cup," said Metcalf. “I got a hole in one.”

Patients must wear a cast on their forearm for six weeks after surgery. The surgery is an outpatient procedure. Dr. Berger is now teaching the technique to other doctors.


BACKGROUND: Mayo Clinic orthopedic surgeons are the first to identify a new
type of tear in a wrist ligament called the ulnotriquetral or UT ligament. It's
a ligament that connects a person's two forearm bones. Injury to the UT can
split the ligament length-wise where it still connects the two bones, but
remains ripped. It causes pain and can prevent someone from playing sports,
opening a jar, or turning a key.

In the past, many patients were misdiagnosed with other conditions such as
carpal tunnel syndrome or arthritis. However, a UT wrist tear has specific
indications when it comes to pain. "It can be a very sharp pain. It can be a
pain that makes you stop in your tracks. Whatever you're doing, it creates a
sense of weakness," Richard Berger, M.D., of the Mayo Clinic, told Ivanhoe.
Carpal tunnel syndrome is more of a nerve pain that creates numbness or
tingling. Arthritis is mostly an aching pain on the thumb-side of the wrist.

These UT split tear injuries cannot be detected by normal imaging techniques.
"This doesn't show up on a plain X-ray at all. It doesn't show up on a CT scan,
and it doesn't even show up with special tests that we order sometimes called
arthrograms," said Dr. Berger. Dr. Berger says he finally discovered the tear
after talking with many patients who indicated exactly where their pain was
located. He performs a simple exam where he presses down on a patient's ulnar
fovea to determine if the pressure causes pain similar to that experienced by
the patient when he or she uses the wrist. Symptoms of a UT split tear are
typically noticed soon after the injury. Low-impact movements like shoveling
snow and playing golf or tennis can cause this tear.

TREATMENT: A treatment option for this injury is minimally-invasive surgery.
Doctors suture the torn ligament arthroscopically and immobilize the patient's
forearm to allow it to heal in a cast. Most patients return to activities
without pain six weeks after surgery and are able to use their wrists at full
strength within a few months. "I'm never going to claim that this is saving
lives. This isn't a breakthrough in cancer. This isn't as dramatic as bringing
someone back from cardiac arrest, but I like to think of it as saving a
lifestyle," said Dr. Berger.

BASEBALL CONNECTION: Dr. Berger performed this surgery on Pro baseball player
Jayson Werth who plays for the Philadelphia Phillies. Werth now credits Dr.
Berger with saving his career.

Natalie Sobotta, Secretary to Richard Berger, M.D., Ph.D.
Mayo Clinic
Rochester, MN
(507) 284-3664

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