What's wrong with my WRIST???

[summit]

Complaint: Wrist hurts/feels funny (numbness/pinching when idle, pain when extending the elbow).

Background: I have an impacted radial head fracture. My insurance from my job didn't happen like it was supposed to.

Male in good health - Mountain bike accident – I landed pretty flat on my front: knocked the wind out of myself, bad R knee contusion through armor, bad R pelvis contusion, and L hand impact causing L arm injury. Apparently, looking at the thumbnail sized avulsion on the palm, I struck the palm of the hand in the landing. That was the only sign of injury on the L arm… except of course for the swollen elbow.

Immediate symptoms:
Severe elbow pain on extension and suppination.
Wrist pain for 3-4 hours after injury.
I splinted it and made a sling and took a lot of Aleve.

ER x-rayed the elbow, but decided not to x-ray the wrist.
Dx: X-ray showed possible impacted radial head fracture.
Rx: Sling, ice, referral.

Saw Orthopedist at 5 days post injury. He examined the wrist and elbow (which hadn't hurt since the first day) and decided not to x-ray anything.
Dx: He confirmed impacted radial head fx and partial interossous membrane tear.
Rx: sling for 2 weeks, no strenuous activity for 4 weeks, immediate PT on the elbow

I still typed with my left hand after the first week. After 2 weeks, I was mostly pain free except at the extreme ranges of motion caused some pain midshaft on the forearm (membrane I think). Strong hand grip also caused the midshaft pain. Elbow extension (still a few degrees short of anatomical) caused temporary tingling in the index and thumb down to the wrist.

I removed the sling and swath. My activities were limited to normal daily activities like driving, eating, typing, and taking the elbow through its range of motion. After a day or two without the sling, I started to notice some minor irritation around the radial part of the wrist.

I went to PT at 16 days. PT was impressed with elbow ROM and did some exercises (elbow flexion, extension, suppination, pronation) after which point my wrist started to hurt. She examined the wrist and didn't think it was a big deal. She contacted the orthopedist anyways. Apparently, he didn't think much either.

Now: 17-22 days post impact

At idle:
There is an area of decreased sensation the size of half my thumb right over where you would take a radial pulse.
Palpation will produce minor soreness midline on the palm right at the most proximal point of the fleshy part.
It feels like a very slight pinch at the crease in the wrist, palm side, between the midline and thumb.

The problems around the wrist are exacerbated greatly to the point of pain when doing elbow extension exercises. The idle symptoms are stronger too and last for a few hours. Elbow pronation bothers it only a little bit (ie accompanying full thumb flexion produces soreness midline proximal palm).

Elbow flexion and suppination do not cause problems. Using the hand and wrist doesn't really seem to bother it either. Wrist/hand strength and wrist/hand ROM are 100%. Nothing feels funny during motion.

What's wrong with my wrist? Is this a ligament, tendon, or bone? Does having an impacted radius mean that the bone is shortened such that it is pulling on the wrist joints?

[bklyn]

Overuse injury...
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.
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(I'm getting this joke out of the way for you early)

vibes, hope you get better soon

[summit]

*nod* it would be nice if it was something that healed on its own, but I worry if my elbow rehab is making that wrist injury worse so that it won't heal... the wrist is certainly is preventing me from rehabbing the elbow properly!

bkyln: tnx... and as for the expected jokes, I'm right handed and this is the left wrist.

[Elkhound Odin]

My wife tripped while running with the dogs and fell forward. Hands hits first. She complained of elbow pain for months (way to long a story, but I'll share if you want). The short of it turned out to be a tendon torn from the bone @ the elbow. Surgery fixed the elbow, but then she complained of wrist pain and was diagnosed with carpel tunnel (left wrist, she is right handed). Got that fixed. No more wrist pain.

[BurnHard]

Sounds like maybe pinched nerves in your neck? Those can cause pain and numbness in wrists & hands. Just an idea.

[Vinman]

the numbness and tingling in the wrist and palm extending into the thumb and index finger make me think radial nerve irritation. Maybe swelling or the fracture itself has compressed the radial nerve in some way, or the elbow injury has caused irritation to the radial nerve at the elbow.

Are the nerve sx. getting better/worse or not changing?

[summit]

Orthopedist:

Dx: uhh.... that's weird... I dunno... I'm gonna go with partially torn ligament in wrist and some nerve damage? Anyways, come see me in 6 weeks if it isn't better.

[ren]

There are roughly a little over 30 bones in your wrist and tendons and ligaments that connect your fingers back to your elbow and beyond. It could be a bone displacement that is pressing against a nerve, a ligament/tendon issue. It could be anything...just keep pressing your physician to send you to a specialist or you could end up like me who carpel bone pops out of place ever time i move it the wrong way.

[Dantheman]

Decadal bump:

So, took the kiddo skiing back on Dec. 27. Skied hard for about 3 hours, jumped off lots of stuff, etc. One little tumble but nothing serious. Everything feels completely normal the rest of the day. Wake up the next morning and my right wrist is sore as hell and a bit swollen. Huh, weird. Seems to loosen up and feel better the more I use it, so I try to move/elevate and avoid things that hurt. It improves by maybe 50% after about a week, and it's pretty much plateaued since then.

I got 3-view x-rays last week that showed nothing abnormal. There's some minor swelling at the base of my radius, just enough to mostly fill in my "snuff box" (see pics at bottom of post). Most of the pain is on the radius side, but the ulna side is a little sore, too. Loaded extension (i.e., pushups) creates the most pain, followed by external rotation to the end of ROM. No pain under tension, i.e. pullups feel fine.

All I can figure is that I punched my hand off some hard snow skiing that day and did...something. But, no pain in my knuckles or any other part of my hand. Any ideas on what the hell I did? The local sports medicine clinic I went to for the x-rays farms wrist stuff out to a 3rd-party imaging center, so I haven't actually seen someone in person for a physical exam. Before anyone says "Go get a physical exam", I have high-deductible insurance and asking you kooks is free so why not check here first. Besides, most likely I'm going to pay good money just to get this kind of response:

Orthopedist:

Dx: uhh.... that's weird... I dunno... I'm gonna go with partially torn ligament in wrist and some nerve damage? Anyways, come see me in 6 weeks if it isn't better.

Probably with a "Well, it's hard to say without getting a MRI" thrown in which would cost me $500 minimum.

Swelling pics. Not much to see, but shows pretty well how much less visible my snuff box is on the injured wrist.

Bad wrist with thumb fully extended


Good wrist for comparison

[ex-powderbroker]

Decadal bump:

So, took the kiddo skiing back on Dec. 27. Skied hard for about 3 hours, jumped off lots of stuff, etc. One little tumble but nothing serious. Everything feels completely normal the rest of the day. Wake up the next morning and my right wrist is sore as hell and a bit swollen. Huh, weird. Seems to loosen up and feel better the more I use it, so I try to move/elevate and avoid things that hurt. It improves by maybe 50% after about a week, and it's pretty much plateaued since then.

I got 3-view x-rays last week that showed nothing abnormal. There's some minor swelling at the base of my radius, just enough to mostly fill in my "snuff box" (see pics at bottom of post). Most of the pain is on the radius side, but the ulna side is a little sore, too. Loaded extension (i.e., pushups) creates the most pain, followed by external rotation to the end of ROM. No pain under tension, i.e. pullups feel fine.

All I can figure is that I punched my hand off some hard snow skiing that day and did...something. But, no pain in my knuckles or any other part of my hand. Any ideas on what the hell I did? The local sports medicine clinic I went to for the x-rays farms wrist stuff out to a 3rd-party imaging center, so I haven't actually seen someone in person for a physical exam. Before anyone says "Go get a physical exam", I have high-deductible insurance and asking you kooks is free so why not check here first. Besides, most likely I'm going to pay good money just to get this kind of response:



Probably with a "Well, it's hard to say without getting a MRI" thrown in which would cost me $500 minimum.

Swelling pics. Not much to see, but shows pretty well how much less visible my snuff box is on the injured wrist.

Bad wrist with thumb fully extended


Good wrist for comparison

damnit man, i read this shit and it just makes me not want to move back to the states ever. fucking health care is a joke. i hope you heel up and it doesn’t cost you an arm and a leg too.

[TBS]

Several years ago I went over the bars on my MTB, came away concussed and my hand swollen to the point I could barely move my fingers. Was like somebody injected a shitload of fluid into back of my hand. Skin was stretched tight, couldn't see the knuckles, and fucking tender. No idea how I landed on it, I was mostly focused on how fast the ground was coming at my face.


(sorry, best pic from a long time ago)

Went to emergency next day, xray was negative. Told me to rest it and ice it. Which I did

Three weeks later it was back to normal, full range of motion.

Good luck

[old goat]

Is it very tender when you press on the snuff box or just swollen. Sometimes scaphoid fractures don't show up on initial xrays but do show up later. Important injury to not miss.

[bourbonisgood]

Oddly enough my scaphoid fracture (at the waist) wasn’t nearly as tender in the snuffbox as I would have expected compared with other fractures I’ve had. Either way it still got me 18 weeks in a cast...

Agree with old goat, do not just wait it out if the pain continues. AVN is not something to mess around with

[Dantheman]

Is it very tender when you press on the snuff box or just swollen. Sometimes scaphoid fractures don't show up on initial xrays but do show up later. Important injury to not miss.

No, no real pain in the snuff box to speak of. Xrays were taken 12 days after the injury, seems like it would have shown up by then.

[iamTRuTH]

Which fingers get numb and tingle? Thumb side or pinky side? Mine is on the pinky side

I broke my radial head 10+ years ago and have fought the pain, numbness and loss of strength (randomly would drop things, mostly beer) ever since. About a year ago I finally had good enough insurance to go see a Dr. and OT. They solved the numbness with nerve flossing stretches. Your nerve sits in a sleeve and that sleeve can tighten over time. After a few weeks of the exercises the numbness has gone away. The pain is still there, and the strength is getting better, which they are working on (MRI is next). Google never flossing exercises, they made a large improvement for me and are very simple.

Good Luck

[Dantheman]

No numbness/tingling for me. That was the (very old) OP.

[iamTRuTH]

Oops, didn’t even look at the date for the OP.

[Dantheman]

I started wearing a brace on Monday. I'm working on a bike project and did a lot of sanding and buffing over the weekend which did it no favors. Reading up on common soft tissue wrist injuries a scapholunate ligament tear seems possible to probable (dorsal and radial-sided wrist pain and swelling - check; pain increased with extensional loading across the wrist - check; painful/weak grip - check). The fact that my x-rays looked completely normal (no gap between the scaphoid and lunate bones) is a good sign that it's probably only a partial tear that doesn't need surgery, but I'm looking at 4-6 weeks in the brace. Fuck me.

[muted]

Bummer. Can you ski though, presuming you won't fall on it?

[Dantheman]

Yeah, sure, I can ski fine with the brace. Should I ski is another question entirely. I'm sure any doc is going to advise me not to. It seems like a big gamble since I could be putting not only the rest of ski season at risk but bike season as well, especially if I were to do more damage to the point that operative repair is required. Considering that, Option B of writing off the next month and being GTG by March seems like the intelligent choice.

ETA: Biting the bullet and getting a professional opinion tomorrow.

Update: Saw a PT. Dx is some damage to thumb extensor tendons and he thought anything worse than a mild partial tear of the scapholunate ligament seemed unlikely. Skiing was "Don't crash." Taking it easy is easier said than done for me, though.

[Dantheman]

Update:

3 weeks in the brace and taking it as easy as I possibly can and the swelling is almost gone. Despite that, I still have no snuff box to speak of. My Holiday Inn Express/Google U diagnosis is a ruptured EPL tendon (the upper/dorsal tendon of the two that form the snuff box). Why, you ask? Let's consider the following:

http://www.wheelessonline.com/ortho/...longus_rupture

- Exam:
- palpate length of tendon, look for any signs of rupture;
- ask pt to place hand flat on table, & lift only thumb off surface;
- w/ rupture, patient will be unable to raise the thumb in line w/ the second metacarpal;

We'll start with item 2a and 2b. With my hand lying flat on a table I cannot lift my thumb at all, it might as well be glued down. As to item 1, if I try to palpate the tendon there is simply nothing to palpate, it's like it's just not there. EPL rupture without a fracture, rheumatoid arthritis, or severe tendonitis seems to be rare but not unheard of. I don't know how else you explain the apparent absence of my EPL.

Appointment with a hand surgeon at TOSH scheduled for next Tuesday. If there's a silver lining, it's that it seems that there's no rush to do surgery. It sounds like I can't really make it any worse. I'll see what the surgeon has to say but everything I'm reading indicates that I can pretty much do whatever pain and ROM allow. Many people opt to skip surgery altogether and just live with it.


ETA: Found these today. Not an unheard of injury from skiing, apparently. You can sign up for a free 2-week trial and read the full texts.

Skiing-Induced Rupture of the Extensor Pollicis Longus Tendon: A Report of Three Cases
https://www.deepdyve.com/lp/wolters-...ongus%2BTendon

Spontaneous rupture of the extensor pollicis longus tendon in a professional skier
https://www.deepdyve.com/lp/springer...ongus%2BTendon

[Dantheman]

Update:

Full EPL rupture confirmed. No MRI or ultrasound, in the surgeon's words "it's clearly gone." Surgeon also said my thumb function is "shockingly" good for this injury and recommended not having surgery for now.

[Kopi_Red]

Caught a pedal and went OTB a few weeks back. It looked like I was going to land on my neck/head on some logs/rocks so I put my arm out in order to roll with the impact. My arm got caught in a hole under some logs and I ended up with some hardware as a souvenir. I should be healed up enough to be able to enjoy ski season come winter time.

[::: :::]

wow, that's some hardware
heal up, man

[Dantheman]

Damn, that's a lot of screws. Good luck with recovery.

The postscript to my last few posts from 2019 is that despite what the ortho thought my EPL must have been hanging on by a thread. It's grown back quite a bit and I have a visible snuff box again, albeit much less pronounced than before the injury. Thumb function is totally good.