Weight Bearing Wrist Injury

[clarew]

Hi All.

I am hoping for a little advice. In December 2006 I hurt my wrist, or should I say it started hurting very badly suddenly. I had been suffering from chronic pelvic pain at the time and when I sat on the floor I would lean all my weight down on my right wrist. This went on for several months. I cannot now bear weight down on my wrist. It also hurts with pulling things or any movement involving gripping. The pain extends from the little hollow behind the thumb up the side of my wrist. It also hurts through the top of my hand and down the fingers when I bear weight. It feels very stiff. The flechy part between the thumb and first finger also hurts.

I enjoy surfing and had stop stop for ages as I couldn't weight bear. It improved quite a bit as long as I did not weight bear as this hurt. However the pain has come back as I have changed my job and am nursing elderly patients which involves bearing weight on it. I am really worried about it. I don't know why it won't heal up. Could anyone advise me on this? When I spoke to my doctor about 6 months ago he said that there was no point doing an xray as it was so long after the injury. Will this heal on its own eventually and what on earth can I do to treat this myself? Advice on exercises and the like would be really great.

Many thanks.

Clare

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[Canuck Physio]

hmm... I'm sure there are others here who are slightly better hand experts than me. Will allow them to provide better answers.

Have you seen a physio? Can you get a referral to a Physio?

[clarew]

Hi there.

Thanks for replying. No I haven't seen anyone yet as I would need a referral through the doctor to see a physio. I need to do something as it really hurts and is affecting my work.

Thanks

Clare

[IceMan]

Judging by your description of the mechanism of injury the most likely explanation would be a "scapholunate" injury. The scaphoid and the lunate are 2 of the small bones that can be found in the wrist. The scaphoid is situated by the "hollow" at the base of the thumb that you are describing and the lunate is next to that bone closer to the midline of the wrist. Extension of the wrist while it is under a load would certainly stress the scapholunate ligament and if done repetitively could lead to a tearing of the ligament with subsequent instability and even possible dislocation (or dissociation as it is commonly referred to) of the 2 bones.

Instability may not necessarily be picked up on x-ray films but certain clinical tests by a physio skilled in treating wrist and hand conditions or an orthopedic surgeon could shed some light on the issue. If you have a scapholunate dissociation this would be evident on x-ray films. Left untreated this could lead to arthritic changes occurring in the wrist.

The other possibility is that you have a scaphoid fracture but I would think that this is the least likely scenario judging by your description of the cause and onset of pain.

By the way do you have any numbness or tingling in the hand (more specifically the thumb and index finger) or weakness of the thumb and index finger? If any of these signs or symptoms are present it may be suggestive of carpal tunnel syndrome which is caused when the median nerve which passes through the wrist becomes impinged.

I think your best course of action would be to find somebody who has treated wrist conditions and who could do specific tests in the clinic which would be of diagnostic value (these tests are very simple and basically involve pressing on the bones and shifting the one bone in relation to the other - pain, clicking/clunking or excessive movements would indicate a positive test). I think an x-ray would also be of value.

See if you can get somebody to prescribe or fabricate a wrist splint which will prevent excessive hyperextension of the wrist. Gently squeezing a ball or a towel roll will help to stabilize the wrist to an extent and help to rid the wrist of any inflammatory substances. Of course ice and rest would be of benefit to reduce the inflammation as well. Once you see a therapist who can do a detailed examination he/she may suggest more specific exercises which may be of benefit. Ultimately though if you do have a dissociation surgery may be required.

Hope this helps.

[crabgarden]

anyone can guide me on finger rehabilitation

[shasadah]

i am agreed with iceman.
you can rule out the carpal tunnel syndrom by flexing maximum ur both wrists against eachother, hold in this position for one minute. if u feel numbness and tingling in ur thumb and index finger, it is a positive sign.

most probably it will be negative.

now follow the further advice by iceman regarding scapholunate ligament tear.
wrist brace is a gud choice and u need to avoid weight bearing , pull and lifting heavy bags hanging on ur hand at least for couple of months.Meanwhile keep doing some isommetric contraction for wrist extensors and radial deviation(moving the wrist towards thumb) infact not moving ur wrist in isometric contration but just put ur other hand to resist the movement , this will keep ur wrist in the same possition but there will be muscle contration.
do this exercise initially in three sets each of 30 repetition with the pause of one minute in each set twice a day.

i hope it will work.

good luck