Persistent Joint Clicking After Soft Tissue Surgery

Soft tissue is trapped in the joint, but it still makes a cracking sound after surgery?

Hello, Doctor! At the end of March this year, I injured my right thumb due to external force.
After undergoing X-rays and an MRI, I was diagnosed with a ligament tear.
After more than half a year of rehabilitation, my finger still cannot bend, and it makes a cracking sound when straightened.
At that time, the attending physician suspected that there was soft tissue trapped in the middle of the thumb joint, which could explain the situation I mentioned.
Concerned about early joint degeneration, I accepted the attending physician's recommendation and underwent surgery in mid-November.
The surgery was performed on the back of the thumb, and it was indeed found that there was soft tissue (possibly the periosteum) trapped inside.
After the surgery, the attending physician stated that the soft tissue had been removed (without any pins), and once the wound healed, I could begin rehabilitation.
The previous cracking sound was likely caused by that trapped soft tissue.
Initially, I was hesitant to move my finger too much and tried to avoid large movements.
However, during the last two rehabilitation sessions, I noticed that my finger still makes a cracking sound when straightened, just like before the surgery, and it still cannot bend.
Q1: Could it be that something is trapped in the middle of the joint again? If so, what kind of examination can confirm this? (Since the previous MRI did not reveal anything, can an ultrasound detect it?)
Q2: Is it possible that there is also soft tissue trapped on the other side of the joint (the palmar side)?
Q3: If another surgery is necessary, will multiple surgeries affect the recovery of the finger joint in the future? Will there be any long-term consequences?
Q4: Can the surgery be performed arthroscopically? Thank you for your answers, Doctor.
Wishing you good health!

Hui, 20~29 year old female. Ask Date: 2018/12/13

Dr. Li Yongheng reply Orthopedics

Q.1 There is a possibility, but it is indeed difficult to diagnose using MRI or ultrasound.

Q.2 There is a possibility.

Q.3 Multiple surgeries may adversely affect the recovery of finger joint mobility.

Q.4 Currently, there is no arthroscope available with such fine specifications.

Reply Date: 2018/12/13

More Info

It sounds like you have been through quite a journey with your thumb injury and subsequent surgery. Let's address your concerns regarding the persistent clicking in your joint and the potential implications for your recovery.

Q1: Is it possible that something is stuck in the joint again? What tests can confirm this?
It is indeed possible for soft tissue or other structures to become entrapped in a joint, even after surgical intervention. If you are experiencing the same clicking sound as before, it may suggest that there is still some form of mechanical interference. While MRI is a powerful imaging tool, it may not always capture subtle soft tissue issues. An ultrasound can be beneficial in assessing soft tissue structures around the joint in real-time and may provide additional insights into any abnormalities that could be causing the clicking. If your symptoms persist, discussing further imaging options with your physician is advisable.

Q2: Could there be soft tissue trapped on the palmar side of the joint?
Yes, it is possible for soft tissue to be present on the palmar side of the joint. The anatomy of the thumb is complex, and various ligaments, tendons, and other soft tissues can contribute to joint function. If the clicking is due to a structure on the opposite side of the joint, it may not have been addressed during your initial surgery. A thorough clinical examination and possibly imaging studies can help identify any issues on that side.

Q3: If another surgery is needed, will multiple surgeries affect recovery and lead to complications?
Multiple surgeries on the same joint can indeed have implications for recovery. Each surgical procedure carries risks, including scarring, changes in joint mechanics, and potential for stiffness or decreased range of motion. However, many patients undergo multiple surgeries successfully. The key is to ensure that each procedure is necessary and that you follow a comprehensive rehabilitation program afterward to optimize recovery. Discussing your concerns with your surgeon can help you weigh the risks and benefits of any further interventions.

Q4: Can the surgery be performed arthroscopically?
Arthroscopic surgery is a minimally invasive technique that can be used for various joint issues, including soft tissue problems. If your surgeon believes that the clicking is due to a specific issue that can be addressed arthroscopically, this may be a viable option. Arthroscopy typically results in less postoperative pain and quicker recovery compared to open surgery. However, the decision will depend on the specific findings during your evaluation and the surgeon's expertise.

In conclusion, persistent clicking after surgery can be frustrating and concerning. It is essential to communicate openly with your healthcare provider about your symptoms and any changes you notice. They can guide you through the appropriate diagnostic steps and treatment options. Rehabilitation is also crucial; ensure you are following a structured program to regain strength and mobility in your thumb. With the right approach, many patients can achieve significant improvements in function and quality of life after such injuries. Wishing you a smooth recovery and the best of health!

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