Thumb Stiffness After Distal Radius Fracture Surgery

Postoperative abnormal flexion of the thumb following distal radius fracture?

Hello Dr.
Chen, four years ago I had a distal radius fracture in both wrists and underwent surgery with a self-funded bone plate.
The recovery was good until two years ago when I suddenly lost the ability to bend my thumbs, and they became completely immobile.
At that moment, I felt a tightness in the tendons around my wrists.
After the stiffness, the range of motion in the distal phalanx of my thumbs decreased.
Over the past two years, the range of motion has gradually increased, but when I exert force to bend my left thumb, I feel a tightness at the site of the bone plate, sometimes accompanied by pain.
I also have a worsening sensation of not being able to grip objects.
My right thumb only has a problem with insufficient bending.
Dr.
A diagnosed me with trigger finger, but I had no symptoms prior to this incident, and both hands experienced this simultaneously.
The stiffness feels like a stretching sensation without pain, and the only pain occurs when I exert force with my fingers, while bending with assistance does not cause pain.
After researching trigger finger online, I found that my condition seems different, so during my follow-up visit, I expressed my differing symptoms and requested effective treatment, even considering the removal of the bone plate.
Dr.
A advised against removing the plate for two reasons and referred me to a surgeon.
Dr.
B suggested two possibilities: 1.
trigger finger, 2.
arthritis.
I have undergone physical therapy with no results.
I asked if minimally invasive surgery was an option, and Dr.
B said it was possible to remove the bone plate through minimally invasive surgery.
After reiterating Dr.
A's concerns about removing the plate, I felt that the surgical option was no longer available.
As I was leaving the consultation room, I asked Dr.
D if a steroid injection would be effective, and he administered one along with anti-inflammatory medication.
At a different hospital, after explaining my symptoms, I was again told I had trigger finger.
I mentioned that physical therapy was ineffective and that the steroid injection had no effect.
Dr.
B's comments about minimally invasive removal of the bone plate and the differences in symptoms were noted.
The doctor suggested I see a plastic surgeon or return to the original hospital, but no medication was prescribed.
I would like to ask: 1.
Which specialty should I consult? It feels like I'm in a confusing situation, and is there any hope for recovery? 2.
Are the differences in symptoms I presented incorrect? 3.
If it truly is trigger finger, why have the physical therapy and subsequent consultations only resulted in anti-inflammatory medications? This seems passive.
The suggestions for steroids and minimally invasive surgery were all initiated by me, and my understanding of the minimally invasive surgery for trigger finger is quite different from what is presented on Taiwanese medical websites.
My work and daily life have been severely impacted, and I really do not want to delay any further, nor do I have the capacity to do so.
I hope Dr.
Chen can provide some advice.

A Long, 40~49 year old female. Ask Date: 2017/10/12

Dr. Chen Yongxue reply Orthopedics

Hello, it sounds like you may have trigger finger, which is unrelated to the previous surgery.
Local injection can be attempted, as it serves both diagnostic and therapeutic purposes.
Thank you.

Reply Date: 2017/10/12

More Info

Understanding thumb stiffness after a distal radius fracture surgery can be quite complex, especially when considering the various factors that contribute to recovery and rehabilitation. In your case, it seems that you have been experiencing significant issues with your thumbs, particularly stiffness and difficulty in movement, which have persisted for two years following your initial surgery.
Firstly, it’s important to recognize that stiffness in the thumb after a distal radius fracture can arise from several factors, including scar tissue formation, joint inflammation, or even complications such as trigger finger or arthritis. Trigger finger, which you mentioned, occurs when the tendons that bend the fingers become inflamed, leading to difficulty in bending the thumb or fingers. This condition can indeed cause pain and a sensation of tightness in the wrist and thumb, particularly when force is applied.

The fact that you have been experiencing these symptoms bilaterally (in both hands) is noteworthy. It could suggest a systemic issue or a common mechanical problem resulting from your initial injury and subsequent surgery. The stiffness you described, especially the inability to bend your thumb and the sensation of tightness in the wrist, could be indicative of tendon issues or joint stiffness resulting from prolonged immobilization or inadequate rehabilitation.

You mentioned that physical therapy has not yielded the desired results. This can be frustrating, but it’s important to understand that rehabilitation after such surgeries can be a slow process, and sometimes, it may require a multi-faceted approach. If conservative treatments such as physical therapy and corticosteroid injections have not provided relief, it may be time to consider further evaluation by a specialist.

1. Which Specialist to See: Given your symptoms and the complexity of your case, it may be beneficial to consult with a hand surgeon or an orthopedic surgeon who specializes in upper extremity conditions. They can provide a more focused assessment of your thumb and wrist issues and determine if there are any underlying problems that need to be addressed. A hand therapist may also be helpful in providing targeted rehabilitation strategies.

2. Differentiating Symptoms: Your concerns about the differences in symptoms and the diagnosis of trigger finger are valid. It’s crucial to communicate clearly with your healthcare providers about your symptoms and how they have evolved. If you feel that your symptoms do not align with the diagnosis of trigger finger, it’s important to advocate for further investigation. This could include imaging studies like an MRI or ultrasound to assess the soft tissues around the thumb and wrist.

3. Treatment Options: If trigger finger is indeed the diagnosis, treatment options can vary. While corticosteroid injections are a common first-line treatment, they may not always be effective. If conservative measures fail, surgical options, such as tendon release, may be considered. However, if the stiffness is primarily due to scar tissue or joint issues, then a different surgical approach may be necessary, such as arthroscopy to remove scar tissue or to address any joint problems.

In conclusion, while it can feel overwhelming to navigate through multiple opinions and treatment options, it’s essential to find a specialist who can provide a comprehensive evaluation of your condition. Don’t hesitate to seek a second opinion if you feel that your concerns are not being adequately addressed. Your quality of life and ability to perform daily activities are paramount, and there are treatment options available that can help improve your symptoms and restore function.

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