Post-Surgery Pain Management After Distal Radioulnar Joint Dislocation - Orthopedics

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Postoperative issues following remote distal radioulnar joint dislocation and open fracture of the radius and ulna?


Hello Doctor, I have had my cast on for three weeks post-surgery.
Initially, when using the sling, my palm was facing down.
After my follow-up appointment and X-rays, the doctor said I needed to have the cast redone and to rotate my wrist so that my palm faces up, as this would improve the alignment.
During the process of rotating my wrist, I experienced significant pain, which the doctor said was normal.
However, after getting home, the pain has not subsided; in fact, it seems to be getting worse.
No matter what position I try or how many pain relievers I take, the pain persists, almost as if someone is continuously twisting my wrist.
Is this a normal phenomenon? If so, how long is it likely to last? The pain is so severe that I can't sleep...

Xiao Cheng, 30~39 year old female. Ask Date: 2024/04/12

Dr. Zhan Xian reply Orthopedics


Hello, Xiao Cheng.
For these symptoms, you should consult your attending physician and continue to monitor your condition.
Wishing you good health.

Reply Date: 2024/04/12

More Info


Post-surgery pain management, especially after a distal radioulnar joint dislocation, can be quite challenging. It is not uncommon for patients to experience significant pain following surgical interventions, particularly when there is a need to manipulate the wrist into a new position, as you described.
Firstly, it is important to understand that pain after surgery can be attributed to several factors, including tissue trauma from the surgery itself, swelling, and the body’s inflammatory response. When your doctor adjusted your wrist position and reapplied the cast, it likely caused additional strain on the surrounding tissues, which can lead to increased pain. This is a normal response, but it can be distressing, especially if the pain is severe and persistent.

In your case, the pain you are experiencing could be due to a few reasons:
1. Postoperative Inflammation: After surgery, the body goes through a healing process that involves inflammation. This can lead to swelling and pain in the affected area. The inflammation can sometimes take a few weeks to subside, depending on the extent of the surgery and individual healing rates.

2. Nerve Sensitivity: Surgical manipulation can sometimes irritate nearby nerves, leading to heightened sensitivity and pain. This can feel like a persistent ache or a sharp pain, especially when moving the wrist or changing positions.

3. Cast Pressure: If the cast is too tight or improperly fitted, it can cause additional discomfort. It’s essential to ensure that the cast is not constricting blood flow or putting undue pressure on the wrist.

4. Psychological Factors: Pain perception can also be influenced by psychological factors. Anxiety about the injury or surgery can amplify the sensation of pain.

Given that you are experiencing increasing pain and difficulty sleeping, it is crucial to address this with your healthcare provider. Here are some steps you can take:
- Pain Management: Continue to take the prescribed pain medications as directed. If they are not providing relief, inform your doctor. They may need to adjust the dosage or prescribe a different medication. Options may include stronger analgesics or adjunctive medications like gabapentin or pregabalin, which can help with nerve pain.

- Ice Therapy: Applying ice to the affected area can help reduce swelling and numb the pain. Make sure to wrap the ice in a cloth to avoid direct contact with the skin.

- Elevation: Keeping your wrist elevated can help reduce swelling and alleviate some pain. Try to keep it above the level of your heart when resting.

- Physical Therapy: Once your doctor gives the go-ahead, physical therapy can be beneficial. A physical therapist can provide exercises to improve mobility and strength while also helping to manage pain.

- Follow-Up: It’s essential to keep your follow-up appointments. If your pain continues to worsen or does not improve, your doctor may need to reassess your situation. They may consider imaging studies to rule out complications such as malunion or nonunion of the joint.

In summary, while some pain after surgery is expected, increasing pain that disrupts your sleep warrants further evaluation. Communicate openly with your healthcare provider about your symptoms, and do not hesitate to seek additional help if your current pain management strategies are not effective. Your comfort and recovery are paramount, and there are various options available to help manage your pain effectively.

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