Rehabilitation and Nerve Issues After Wrist Ligament Surgery: A Patient's Journey

Rehabilitation and Neurological Issues Following Ligament Repair Surgery for Wrist Dislocation

Hello, Doctor.
Three months ago, I fell off my bike and landed on my wrist, resulting in dislocation of the scaphoid and lunate bones.
The doctor performed a reduction in the emergency room, and the next day, I underwent a scapholunate ligament repair surgery, where three absorbable anchors were used to secure the ligament, along with two steel pins to stabilize the lunate bone.
One of the steel pins was inserted between my index and middle fingers.
After five weeks of fixation, the pins were removed, but I found that my wrist movement is severely restricted; I can only move it slightly up and down, and I cannot move it side to side at all, although there is no pain.
The biggest issue for me is not the wrist but the fingers.
When my index finger is bent to the right, the proximal interphalangeal joint bends abnormally (the doctor suspects it may be a problem with the lumbrical muscles), and my middle finger cannot move towards the index finger at all, making it impossible to pinch these two fingers together, which greatly affects my ability to type and use the mouse scroll wheel.
My doctor has only advised me to do rehabilitation, but after a month, there has not been much improvement, especially with the fingers.

1.
What does it mean when the doctor says that achieving 70-80% recovery would be considered good?
2.
Is the issue with my fingers indicative of nerve damage? Could the insertion of the steel pins have caused nerve rupture? How can I help the nerves recover?
3.
Can rehabilitation help with nerve recovery?
4.
The doctor mentioned that my scapholunate ligament has not healed well and there is still a slight gap between the two bones.
Will a larger gap between the scaphoid and lunate affect movement or strength? What can be done to remedy this?
5.
Can traditional Chinese medicine treatments such as manipulation and acupuncture be beneficial for this condition?

A Dong, 10~19 year old female. Ask Date: 2021/10/16

Dr. Shi Guozheng reply Orthopedics

1.
The hand is not a very intricate structure, and once injured, it is difficult to fully return to normal.

2.
It may be necessary to continue rehabilitation.

3.
There is a possibility.

4.
It will be monitored, and if symptoms arise, further intervention will be considered.

5.
It may not have been helpful.

Reply Date: 2021/10/16

More Info

Rehabilitation after wrist ligament surgery, particularly following a traumatic injury like yours, can be a complex and often frustrating journey. Your situation involves not only the surgical repair of the scaphoid and lunate bones but also the potential for nerve involvement and the subsequent impact on your hand function. Let's address your questions one by one.

1. Understanding Recovery Expectations: When your doctor mentions that achieving 70-80% recovery is a good outcome, it typically refers to the functional restoration of your wrist and hand. This percentage reflects the potential for regaining strength, range of motion, and overall functionality compared to your pre-injury state. The extent of recovery can vary significantly based on factors such as the severity of the injury, the type of surgical intervention, and individual healing responses.
2. Nerve Damage Concerns: The issues you're experiencing with your fingers, particularly the abnormal bending of the proximal interphalangeal joint and the inability to move your middle finger towards your index finger, could indeed suggest nerve involvement. The ulnar and median nerves are responsible for finger movements, and if they were inadvertently affected during surgery or due to swelling and scar tissue, it could lead to the symptoms you're describing. It's essential to discuss these concerns with your physician, as they may recommend nerve conduction studies to assess any potential nerve damage.

3. Role of Rehabilitation: Rehabilitation is crucial in your recovery process. Physical therapy can help improve range of motion, strengthen the muscles around the wrist and fingers, and promote nerve healing. Specific exercises targeting the fingers, wrist, and forearm can enhance flexibility and strength. Consistency is key; even if progress seems slow, regular therapy sessions can lead to gradual improvements over time.

4. Impact of Ligament Recovery: If your doctor has indicated that the scapholunate ligament is not healing properly and there remains a gap between the bones, this could indeed affect your wrist's stability and strength. A larger gap may lead to altered mechanics during wrist movements, potentially causing pain or further dysfunction. Depending on the severity of the gap and your symptoms, your doctor may consider additional interventions, such as a revision surgery or more intensive rehabilitation strategies to address the instability.

5. Alternative Therapies: Traditional Chinese medicine, including acupuncture and manual therapy, may provide additional benefits in your recovery. Acupuncture has been shown to help with pain management and may promote healing by improving blood flow and reducing inflammation. However, it's essential to consult with your healthcare provider before starting any alternative treatments to ensure they complement your ongoing rehabilitation efforts.

In summary, your recovery journey will require patience and persistence. Engage actively with your rehabilitation team, communicate openly about your concerns, and consider exploring additional therapies that may support your healing process. Regular follow-ups with your orthopedic surgeon or hand specialist will be crucial to monitor your progress and make necessary adjustments to your treatment plan.

Similar Q&A

Post-Surgery Challenges: Managing Pain and Rehabilitation After Wrist Surgery

Hello Doctor: I suffered a comminuted fracture of the distal radius in my left hand due to a car accident last year. After surgery, where a plate was installed, I soon began to experience numbness in the thenar region of my palm and wrist, which then spread to my thumb. Additiona...

Dr. Shen Boquan reply Orthopedics
Hello, after the removal of the plate and the nerve decompression surgery following a distal radius fracture, it generally takes some time for nerve recovery, usually between three to six months, or even longer. However, since you mentioned that there has been improvement, it is ...

Understanding Ligament and Nerve Issues After Wrist Injury

Hello, I was injured by a hard object in May, resulting in internal injuries and damage to ligaments and nerves. I have a torn ligament in my left wrist (not completely torn) and nerve damage as well. I have undergone surgery and suturing, and now it has been almost three months....

Dr. Su Hongci reply Rehabilitation
Hello: Trauma may lead to peripheral nerve injury, which can cause mild symptoms such as limb numbness and sensory abnormalities, or severe consequences like limb paralysis and loss of function. Accurate diagnosis and timely medical intervention can alleviate nerve compression an...

Understanding Post-Surgery Rehabilitation Challenges After Hip and Wrist Surgery

My mother underwent an open reduction and internal fixation surgery for her acetabulum and distal radius due to a car accident. She has been actively rehabilitating after the surgery, but nearly six months post-operation, she still lacks strength when climbing stairs and squattin...

Dr. Huang Weiqing reply Rehabilitation
Hello, it may be necessary to consult the original surgeon for a diagnosis. There are many reasons for postoperative weakness. Generally speaking, in addition to the muscle endurance at the surgical site not having fully recovered, one must also consider the possibility of nerve ...

Understanding Recovery: Insights on Ligament Healing and Trigger Finger

Hello Doctor: I previously consulted you about my hand issues (carpal tunnel syndrome and trigger finger) and ankle sprains. Your response was very satisfactory. However, I came across some content on this website that made me question: when I had my ankle sprain, an ultrasound e...

Dr. Yin Xinbei reply Rehabilitation
Ankle issues: If there is a complete rupture, it will not heal on its own and can only be compensated by other tendons or ligaments. Hand problems: 1. It only provides temporary relief. 2. Frequent use of corticosteroids can lead to side effects; even if surgery is required, it i...