Effective Recovery Strategies for Wrist and Elbow Injuries

How to recover after wrist and elbow injuries?

Hello Doctor, my question is about my right wrist, which I sprained over two years ago.
At that time, I injured it by pushing off the ground with my hand, causing my arm to twist backward.
I received manual therapy and later saw an orthopedic doctor who had me push my palm up from the elbow outward.
The doctors advised me to rest more, so I didn’t seek further medical attention.
Although I can exert force, I feel that I cannot perform wrist-intensive activities as I used to.
I initially thought my right wrist had a greater range of motion (thinking it was due to better flexibility), but now I wonder if it might be due to looser ligaments.
It seems to have improved somewhat, but after more than two years, I still feel discomfort.
Occasionally, I experience soreness in my right wrist and elbow, and it seems like the joint position often shifts slightly (pressing on it provides significant relief).
When I rotate my wrist, I feel a sensation of something jumping on the ulnar side (I can feel it from the outside, but I’m unsure if it’s a tendon, blood vessel, or bone).
My right hand gets fatigued more quickly when lifting things, and I haven’t gone to see a doctor due to inconvenience.
Recently, I visited a rehabilitation specialist who said my wrist X-ray looked fine, and the ligaments felt normal and not too loose.
I was advised to find time for rehabilitation, electrical therapy, and heat treatment.
I haven’t exercised for a while but recently started again, and I find that even simple movements like pushing off the ground with my right hand (with weight on it) cause discomfort.
My right arm feels tight, and the muscles above my elbow fatigue and ache more quickly than my left side.
When I press my arm down at about a 90-degree angle towards the back of my hand, I feel tight pain at the junction of my right wrist and palm, while my left hand feels fine.
1.
The doctors' diagnoses seem to differ, possibly indicating cartilage misalignment, synovial proliferation, TFCC issues, or ligament sprains, but the rehabilitation has mostly involved electrical therapy and heat treatment, which seems ineffective.
If there is a misalignment, can it be restored to its original position? Are these symptoms similar?
2.
The doctors said the X-ray showed no issues, and some didn’t even take X-rays, but I read online that ligament or soft tissue injuries cannot be seen on X-rays.
Why aren’t more detailed examinations conducted?
3.
I know my symptoms are not severe, and I’ve encountered orthopedic doctors who said they could only help when I can’t twist a towel or bottle cap.
I feel like seeing a doctor might not yield much benefit, and it’s time-consuming and expensive.
I worry that doctors might think I’m overreacting about my wrist pain.
Should I continue seeing doctors and undergoing rehabilitation?
4.
When doctors manipulate my hand, I don’t feel pain, leading them to believe there’s no issue.
Different doctors have similar assessments, but I only feel pain in certain more forceful situations.
Why do doctors think there’s no problem?
5.
I found information stating that after a sprain, joint stiffness and muscle weakness can occur.
Would doing more (like pushing off the ground) and (pressing my arm towards the back of my hand) help improve stiffness? If I engage in weight training for my hand, will my right arm become less fatigued over time?
6.
I feel something strange in my wrist (not painful), and when I press on it a few times, I hear a clicking sound and feel relief.
Is this a symptom of dislocation? Thank you for assisting me with my concerns!

Christy, 20~29 year old female. Ask Date: 2018/10/24

Dr. Wang Zhaomin reply Rehabilitation

1.
Indeed, these diagnoses are all possible, but once they progress to chronic injuries, they often require a longer time for treatment and recovery.
Additionally, after a joint dislocation, it may not be possible to fully return to the normal position.

2.
Each examination has its indications and should be arranged by a qualified physician.
However, clinical physical examinations are equally important and do not necessarily require reliance on expensive tests.

3.
Chronic symptoms may require a longer duration of rehabilitation treatment.

4.
If basic joint range of motion and muscle strength are intact, it usually does not significantly affect daily life.
However, if symptoms arise when lifting heavier weights, it may indicate irreversible damage that cannot be fully restored.

5.
Continuously performing appropriate stretching exercises can improve feelings of stiffness and alleviate symptoms.
Weight training should indeed be progressive within a pain-free range, gradually increasing intensity, which can also help improve symptoms.

6.
This may indicate that the joint is more lax rather than dislocated, but one should not intentionally force movements to create sounds, as this could lead to further injury.

Reply Date: 2018/10/24

More Info

Effective recovery strategies for wrist and elbow injuries are crucial for restoring function and alleviating pain. Based on your detailed description, it appears that you have been dealing with a chronic wrist injury for over two years, which has led to discomfort and functional limitations. Here’s a comprehensive approach to your concerns and recovery strategies.

1. Understanding Your Symptoms
Your symptoms suggest a possible combination of soft tissue injuries, such as ligament sprains or tendonitis, rather than a simple bone injury, especially since X-rays have shown no significant issues. The popping sensation you feel when moving your wrist could be due to tendon snapping over bony prominences or could indicate issues with the triangular fibrocartilage complex (TFCC), which is critical for wrist stability.

2. Importance of Detailed Imaging
While X-rays are excellent for visualizing bone structures, they do not provide information about soft tissue injuries. If your symptoms persist, it may be beneficial to request an MRI or an ultrasound, which can better assess soft tissue structures, including ligaments, tendons, and cartilage. This could help clarify the diagnosis and guide treatment more effectively.

3. Rehabilitation and Physical Therapy
Rehabilitation is vital for recovery from wrist and elbow injuries. Here are some strategies that may help:
- Physical Therapy: Engaging in a structured physical therapy program can help improve strength, flexibility, and range of motion. A physical therapist can tailor exercises to your specific needs, focusing on both the wrist and elbow.

- Strengthening Exercises: Gradual strengthening of the wrist and forearm muscles can help support the joint and reduce strain. Start with light resistance and progressively increase as tolerated. Exercises like wrist curls, reverse wrist curls, and grip strengthening can be beneficial.

- Stretching: Incorporating stretching exercises can help alleviate stiffness. Focus on wrist flexors and extensors, as well as forearm muscles. Gentle stretching can improve flexibility and reduce discomfort.

- Modalities: Utilizing modalities such as heat therapy, ultrasound, or electrical stimulation can help reduce pain and promote healing. These should be used as adjuncts to your rehabilitation program.

4. Activity Modification
While it's essential to stay active, modifying your activities to avoid exacerbating your symptoms is crucial. If certain movements or exercises cause pain, it’s important to adjust or avoid them until you regain strength and flexibility. Gradually reintroducing activities can help you gauge your tolerance and prevent further injury.

5. Pain Management
If pain persists, consider discussing pain management options with your healthcare provider. Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. In some cases, corticosteroid injections may be considered if conservative measures fail.

6. Monitoring Progress
Keep track of your symptoms and progress. If you notice improvements, continue with your current regimen. However, if symptoms worsen or do not improve, it may be necessary to revisit your healthcare provider for further evaluation.

7. Seeking Specialist Care
If your symptoms continue to be problematic despite rehabilitation, consider seeking a second opinion from a specialist, such as an orthopedic surgeon or a sports medicine physician. They can provide further insights and treatment options, including potential surgical interventions if conservative measures are ineffective.

Conclusion
In summary, effective recovery from wrist and elbow injuries involves a combination of physical therapy, activity modification, and possibly further imaging to clarify the diagnosis. It’s essential to remain proactive in your recovery and communicate openly with your healthcare providers about your symptoms and concerns. With the right approach, you can work towards regaining full function and reducing discomfort in your wrist and elbow.

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