3 months into wrist therapy and barely any progress

[didaflam]

I broke my scaphoid in September. I had a cast for about 3 months. At the end of that, the bone didn't heal, therefore I had surgery and a screw put into my bone and I had 2 pins also. I wore a cast for a month with the pins. Then we took the pins off, then I had a third cast put on for about 2 months.
Now I have been doing physical therapy for almost 3 months, and the pain that I feel is just too much, even though I have a high tolerance for pain.
I can go down, but my range of motion upward is barely 15 degrees. I still can't move it side to side. And it really hurts, and very weak. I heard that it takes about 2-3 months to be 100%, but my 3 months are up and i feel that no progress is done at all! I've been really patient, and my therapist says that its just going to take longer then usual.
I have been seeing an athletic trainer 5 days a week and we spend about an hour a day working on it. We heat before therapy, then ice at the end of it.

Please help


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[roycar]

hi there.

sorry to hear your having so much trouble with the wrist.

from your history its pretty obvious your at the bad end of the spectrum for scaphoid fractures.

when was your last orthopaedic review? are your orthopaedic team happy that avascular necrosis isnt an issue here?

you say that you've heard that 2-3 months is the "norm" for getting back strength and function but remember that all cases differ. you have had a fractured scaphoid which required fixation and have been casted (therefore immobilised) for six months if I have read corectly. when you think about this, your wrist hasnt been put through its full range of motion for overhalf a year. there may be bony limitations secondary to the fracture and fixation and you will have a lot of soft tissue shortening and tightening in and around the wrist because of the length of time its been immobilised.

your rehab will take time.yours is certainly not a "normal" broken wrist. try to just take it day by day and make small realistic goals in consultation with your physio and aim for these.

in cases where there has been a scaphoid fracture with non union etc and there is ongoing high levels of pain after such a time one must consider an avascular necrosis however and this must be discussed with orthopaedics.

all the best.

ps i forgot to explain avascular necrosis. basically think of your scaphoid like a monkey nut. two roundish ends with a thin bit in the middle. it gets it blood supply at one end. if it breaks in the middle the other end doesnt get any blood supply which can lead to problems.

[didaflam]

Thank you for the reply!

Well my doctor hasn't talked to me that much about avascular necrosis for my case, because he said that since I am still young (19 years old), that I shouldn't worry about it, that it normally just occurs to people much older. And he also agrees with you. He says that even though its normally about 3 months for a normal fracture to be back to normal, mine is special since I haven't moved it for over 6 months. That I really need to be patient and it will come soon, even though longer then 3 months. But he says that the pain is strange. I am going to stop therapy for a week, then get back to it, and if the pain continues, he will see me and consider the avascular necrosis problem. Thanks again for the reply!