Complications After Distal Radius Fractures: Pain in Shoulder and Back

Distal radius fracture sequelae

Hello Dr.
Shi, thank you for your response.
I am the one who inquired about the distal radius fracture in my right hand on February 13.
You mentioned that typically, bone screws are not removed and do not affect function.
In the absence of any functional impact, what could be the reasons for the pain in my right shoulder and right upper back? Could it be possible that during the car accident or the surgery, tendons, nerves, or other areas were injured but did not fully recover? Thank you again for your response.

Miss Hsieh, 30~39 year old female. Ask Date: 2018/02/14

Dr. Shi Guozheng reply Orthopedics

Pain in the right shoulder and right upper back may be related to a contusion or strain, as well as a fracture near the right wrist.
Additionally, using a sling can affect the tendons or nerves in the right shoulder or back, potentially leading to impaired movement.

Reply Date: 2018/02/14

More Info

After a distal radius fracture, it is not uncommon for patients to experience pain in areas beyond the immediate site of injury, such as the shoulder and back. This phenomenon can be attributed to several factors, including compensatory mechanisms, referred pain, and potential soft tissue injuries that may have occurred during the initial trauma or subsequent immobilization.

1. Compensatory Mechanisms: When a person sustains an injury, they often unconsciously alter their movement patterns to avoid pain. For instance, if your wrist is injured, you may compensate by using your shoulder and back differently, leading to strain and discomfort in those areas. This compensatory behavior can result in muscle fatigue, overuse, and pain in the shoulder and upper back.

2. Referred Pain: The body’s nervous system can sometimes misinterpret pain signals. For example, an injury to the wrist may cause discomfort that is felt in the shoulder or back due to the interconnected nature of the nervous system. This is known as referred pain, where pain is perceived in an area different from its source.

3. Soft Tissue Injuries: It is possible that during the initial injury (such as a car accident) or during the surgical procedure, there may have been damage to surrounding soft tissues, including muscles, tendons, or ligaments. If these structures were not adequately addressed during treatment, they could lead to ongoing pain and dysfunction. For instance, if the rotator cuff muscles or tendons were strained during the accident, this could manifest as shoulder pain even after the wrist has healed.

4. Post-Surgical Complications: After surgery, immobilization is often necessary to allow for healing. However, prolonged immobilization can lead to stiffness and weakness in the shoulder and back muscles. If you were using a sling or other immobilization device, the lack of movement could contribute to muscle atrophy and discomfort in those areas.

5. Nerve Impingement: In some cases, the positioning of the arm during recovery or the presence of swelling can lead to nerve impingement, which may cause pain radiating to the shoulder or back. This is particularly relevant if there was any swelling or hematoma formation around the surgical site.

Given these potential causes, it is crucial to communicate your symptoms to your healthcare provider. They may recommend imaging studies, such as X-rays or MRIs, to assess for any underlying issues that may not have been evident initially. Additionally, physical therapy may be beneficial to address muscle imbalances, improve range of motion, and strengthen the affected areas.

In summary, while the distal radius fracture itself may not directly cause shoulder and back pain, various factors related to the injury, surgery, and recovery process can contribute to these symptoms. It is essential to have a thorough evaluation to determine the underlying causes and develop an appropriate treatment plan to alleviate your discomfort and promote recovery.

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