Post-Surgery Pain in Uninjured Areas of the Hand: What to Know

Postoperative issue: Pain in the hand without any injury?

Three weeks ago, I fell down the stairs and fractured the bones in my left wrist joint.
I have already undergone surgery to insert bone screws and am currently in a cast while the bones heal.
However, there is a painful area that is not injured (as indicated in the image) http://imgur.com/01uShop.
This pain started after the surgery and feels like bone-related pain.
Every time I have to remove the cast for a dressing change, it becomes extremely painful, while the surgical site is not very painful unless I move it.
I have consulted my attending physician, who believes it is a psychological issue and that the area should not be painful.
I would like to ask if it is advisable to go to another hospital for an X-ray and to see another doctor for a second opinion.
Also, can I get an X-ray while wearing a lightweight cast?

Xiao Guai, 20~29 year old female. Ask Date: 2016/10/14

Dr. Shi Guozheng reply Orthopedics

It is common to experience pain near a fracture of the elbow joint, and there is usually no need for further X-ray examination.
You should follow up with your original surgeon's clinic.
A large cast can also be evaluated with X-rays.

Reply Date: 2016/10/14

More Info

Post-surgery pain in areas that were not directly injured can be a perplexing issue for many patients. In your case, after undergoing surgery for a fracture in the wrist area, you are experiencing significant pain in a non-injured part of your hand. This situation can arise due to several reasons, and it’s essential to understand the underlying mechanisms to address your concerns effectively.

Firstly, it is not uncommon for patients to experience pain in areas surrounding the surgical site, even if those areas were not directly injured. This phenomenon can be attributed to several factors:
1. Referred Pain: The nervous system can sometimes misinterpret pain signals. The brain may perceive pain in areas that are not directly injured due to the interconnected nature of the nerves. This is known as referred pain, and it can occur after surgeries or injuries.

2. Nerve Irritation or Compression: During surgery, surrounding tissues, including nerves, can be irritated or compressed. This irritation can lead to pain in areas that were not directly involved in the injury or surgery. If the pain persists, it may be worth investigating whether there is any nerve involvement.

3. Complex Regional Pain Syndrome (CRPS): In some cases, patients may develop CRPS, a condition characterized by prolonged pain and changes in the skin, often following an injury or surgery. Symptoms can include swelling, changes in skin color, and sensitivity to touch. If your pain is accompanied by these symptoms, it would be prudent to discuss this possibility with your healthcare provider.

4. Psychological Factors: As your doctor suggested, psychological factors can also play a role in post-surgical pain. Anxiety about the injury, fear of movement, or previous experiences with pain can amplify the perception of pain in non-injured areas. This does not mean the pain is not real; rather, it highlights the complex interplay between physical and psychological factors in pain perception.

Regarding your question about whether you can get an X-ray while in a lightweight cast, it is generally possible to perform an X-ray with a cast on, especially if it is a lightweight or removable type. However, the ability to do so may depend on the specific type of cast and the protocols of the imaging facility. It’s advisable to discuss this with your healthcare provider, who can guide you on the best course of action.

If the pain in the non-injured area continues to be severe or if you notice any other concerning symptoms, seeking a second opinion or further imaging studies may be warranted. It’s essential to communicate openly with your healthcare provider about your symptoms and concerns, as they can help determine the best approach to manage your pain and ensure proper healing.

In summary, while it can be frustrating to experience pain in an area that was not directly injured, it is a recognized phenomenon that can occur post-surgery. Understanding the potential causes can help you address your concerns with your healthcare provider effectively. If the pain persists or worsens, do not hesitate to seek further evaluation to rule out any underlying issues.

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