Question Title: Congenital vs. Avascular Necrosis?

Forum: Neurology Forum
Topic: Pain

Posted by ccf neuro M.D. on November 11, 1997 at 00:46:40:

In Reply to: Congenital vs. Avascular Necrosis? posted by Bradley B. Hughes on October 27, 1997 at 22:59:38:

I am a doctor......was involved in MVA on 7/3/96. Was commuting to my office on county rd., traveling at approx. 55-60 mph.....when a large panel truck failed to yield my "right of way", and pulled out in front of me. My skid marks were measured at 54 ft. I was talking on cellphone with left hand &
"braced" my right hand on steering wheel upon impact. Force transmitted through wrist/hand was calculated to be nearly 800lbs.

I have Klippel-Feil syndrome....fit type II: non-segmentation at C2-3, C4-6.
Also, associated right sided deafnesss, absent radial artery, hypoplastic thenar muscle and atrophic or hypoplastic scaphoid.

The reason for my writing, is that we have filed quite a large lawsuit against the company, who's driver was 100% at fault. Therefore they have already admitted to FULL LIABILITY! However, the defense attorney is putting up a fight on "damages". The only question now, is amount of damages owed by liable ins. co.!

I am 38 yrs. old, and have weightlifted for many years. By the way, the MVA
has rendered me 100% disabled as a treating doctor. I sustained severe damage to my hand & wrist......however, symtoms were "delayed". Right hand went totally numb approx. 6-8 weeks after accident. Due to my Klippel-Feil w/assoc. variance in anatomy, the Neurosurgeons were reluctant to perform endoscopic surgery. The Median nerve was "flat",
upon EMG studies....questioned me having a Median nerve.....thought perhaps, that it was congenitally absent also. I suggested MRI, it confirmed that the nerve was THERE! Neurosurgeon referred me to Orthopaedist, who specialized in hand! He performed full, exploratory surgery & subsequent carpal-tunnel release.....prognosis was very guarded! Hand remained completely numb for 4 months post-op! Now sensation is almost normal along Median nerve distribution. However, after regaining "feeling" & minimal use......had severe right wrist pain! I'm assuming that wrist symtoms
were "over-ridden" by numb hand. Anyway, MRI studies then showed moderate-severe chondromalacia and "torn" intercarpal ligaments! No alternative, but to perform total arthrodesis on wrist. I'm now, approx. 5 months post-op......regarding right wrist fusion.....not doing to bad. Just am unable to do occupational duties, as well as, limited recreational activities!

Ok.....issue at hand......the defense attorney is alleging the use of anabolic steroids on my part, and is questioning whether or not my injuries and associated sequelae would or would not have been this serious. I know that certain bones are at risk for the development of avascular necrosis, however, my wrist & hand have always been "small" when compared to my left. Understanding the arterial supply to the various bones at risk, such as, the femoral head, talus and especially the involvement of the "long" bones...I question the assumption of avascular necrosis of the scaphoid... knowing that it, as well as, the capitate, t's and sometimes lunate can be at risk. My surgeon's opinion, is infarct to the Median nerve & congenitally atrophic scaphoid. MRI differentials were AN vs. congenital?

Considering my history of MVA, without prior trauma to the right wrist.....wouldn't the evidence lead to the conclussion of congenital atrophic scaphoid as opposed to avascular necrosis?

Are there any publications in the "medical literature" that would directly "link" avascular necrosis to the scaphoid with the use of anabolic steroids,
without trauma?

Need your input, regarding your opinion as to the most likely "cause" of my atrophic scaphoid! Also, would bone scan be beneficial in making a determination, or is MRI sufficient?

Thanking you in advance, for your anticipated efforts and opinions.

Brad

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Brad,

Regrettably we are unable to answer your question as it is forum policy to not provide information in cases with ongoing or pending litigation, secondary to obvious medicolegal concerns. The forum is intended to provide general medical information about neurologic conditions. Sorry!!!

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