Post-Surgery Nerve Pain After Wrist Fracture: Causes and Solutions

Postoperative neuropathic pain after humeral fracture surgery?

Hello Doctor, I had surgery for a wrist fracture on October 4th, and it has been nearly two months since then.
During these two months, the bone and wound have healed normally, but in the past week, I have been experiencing pain in the nerves of my wrist, particularly affecting my thumb and index finger.
The pain radiates halfway up my arm, and there is also discomfort near the wrist wound.
However, when I combine my thumb with my middle finger, I do not experience the same nerve pain.
Is this due to improper rehabilitation after surgery, or is it a sign that I have not fully recovered? Is this normal? How long will it take to fully recover? What should I do about this? I am concerned that this might be a long-term complication.
Thank you, Doctor.

Shufen, 50~59 year old female. Ask Date: 2023/12/02

Dr. Shi Guozheng reply Orthopedics

Wrist fractures are typically approached through a surgical incision on the palmar side, where the median nerve is distributed.
If the median nerve is damaged, it may cause numbness, and your pain could also be due to inflammation of the first extensor tendon sheath on the lateral side of the wrist.
It is advisable to consult a physician for further evaluation.
Postoperative complications from wrist fracture surgery are rare.

Reply Date: 2023/12/02

More Info

Post-surgery nerve pain after a wrist fracture can be a concerning issue, especially when it persists for weeks or even months after the initial injury and surgery. Based on your description, it seems that while your wrist and the fracture site are healing well, you are experiencing significant nerve pain that radiates from your wrist to your fingers and even up your arm. This situation is not uncommon following wrist fractures and surgeries, and there are several factors to consider.

Causes of Nerve Pain Post-Surgery
1. Nerve Compression or Injury: During surgery, there is a possibility that the nerves around the wrist may have been compressed or injured. This can lead to symptoms such as pain, tingling, or numbness in the fingers and hand. The median nerve, which runs through the wrist, is particularly susceptible to injury during wrist surgeries.

2. Scar Tissue Formation: After surgery, scar tissue can develop around the surgical site. This scar tissue can sometimes entrap or irritate nearby nerves, leading to pain and discomfort.

3. Inflammation: Post-operative inflammation can also contribute to nerve pain. The body's healing response can cause swelling and pressure on the nerves, resulting in pain.

4. Improper Rehabilitation: If the rehabilitation exercises are not performed correctly or if they are too aggressive, they can exacerbate pain and discomfort. It's crucial to follow a rehabilitation program tailored to your specific needs and recovery progress.

5. Complex Regional Pain Syndrome (CRPS): In some cases, patients may develop CRPS, a condition characterized by prolonged pain and changes in the skin, which can occur after an injury or surgery.

Solutions and Management
1. Consult a Specialist: It is essential to follow up with your orthopedic surgeon or a pain specialist to evaluate your symptoms. They may recommend imaging studies, such as an MRI or nerve conduction studies, to assess the condition of the nerves and surrounding tissues.

2. Physical Therapy: Engaging in a structured physical therapy program can help improve mobility and reduce pain. A physical therapist can provide exercises that promote healing without putting undue stress on the wrist.

3. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help manage pain and inflammation. In some cases, your doctor may prescribe medications specifically for nerve pain, such as gabapentin or pregabalin.

4. Nerve Blocks or Injections: If pain persists, your doctor may consider nerve blocks or corticosteroid injections to reduce inflammation and pain around the affected nerves.

5. Time and Patience: Nerve healing can be a slow process. While some patients may start to feel better within weeks, others may take several months to see significant improvement. It's important to be patient and continue with your rehabilitation efforts.

6. Avoiding Aggravating Activities: Pay attention to activities that exacerbate your symptoms. Modifying your daily activities to avoid positions or movements that trigger pain can be beneficial.

Conclusion
In summary, while it is not uncommon to experience nerve pain after wrist surgery, it is crucial to address these symptoms with your healthcare provider. They can help determine the underlying cause of your pain and develop an appropriate treatment plan. With time, proper rehabilitation, and medical management, many patients experience significant improvement in their symptoms. If you have concerns about long-term effects or if your symptoms worsen, do not hesitate to seek further medical advice. Your recovery journey is important, and addressing these issues early can lead to better outcomes.

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