Examination / diagnostics

(Meanwhile the guideline of the DGH adopted since 2005 under the coordination of Prof. Dr. med. Margot C. Wüstner from Ulm. Simplified "translation" by me into lay German) The guideline was officially adopted in 2005. I also got this information from the start.

Since there is still no new one in the DGH guidelines, no agreement has been reached so far that specifies a clear treatment of lunate malacia according to given rules! However, there is an interesting attempt online, lunate malazia with all hand diseases and interesting summaries of other diseases, which from my point of view are not quite so perfect and are being revised again. Anyone who takes the trouble to translate the "technical jargon" and so on will definitely enjoy the doctors' strike;)

Medical history: Most findings start with a patient's medical history, which is an important part. In many cases, the doctor can use the descriptions to make a presumptive diagnosis, based on which the final diagnosis can be made through appropriate measures (e.g. x-rays, etc.). Here you can also ask about trauma or work with vibrating tools; these questions may indicate a risk for lunate malacia.

Clinic: The doctor will address the symptoms and question or check when the pain occurs. Spontaneous pain? Stress pain? Both? The pain point, the flexibility and also the strength are checked.

X-ray / MRI: The wrist is X-rayed in 2 planes. This means that an X-ray image is taken both from above and from the side of the hand / wrist. A staging can be made on the basis of the native x-ray. Only in the first stage of lunate malacia can usually no lunate malacia be determined on the basis of an X-ray. In the first stage, an MRI (= magnetic resonance tomography) with and without contrast agent administration is necessary for the diagnosis. When x-raying, the carpal height, the radioscaphoidal angle (=?) And the ulnar variance (= ratio of the radius and ulna to each other) must be taken into account. One differentiates in:

Ulnaminus-Ulnanull- undUlnaplusvariante

An MRI with and / or without a contrast agent is only useful in stages I to III.

In individual cases, an X-ray of the other hand or a computed tomography (CT for short) is useful. The CT is mainly used sagittally (= running in the direction of the arrow; ie from front to back or vice versa) for more precise staging and therapy planning in the event of a carpal collapse (= displacement of the carpal architecture due to a so-called incorrect rotation of the navicular bone).

Superfluous measures for diagnosing the LN:

Angiography (= vascular examination using X-rays and contrast media) Sonography (= ultrasound) MRI in stage IV - the X-ray image is sufficient

Forecast:

Changes that have occurred can come to a standstill up to stage IIIa (left Lichtmann - see stages). From stage IIIb the disease leads to arthritis of the wrist if left untreated.