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

Radial Osteotomy Plate Removal and Postoperative Issues of Carpal Tunnel Syndrome

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.
Additionally, the scar from the surgery (approximately 9 cm hypertrophic scar) also became numb.
The left side of the scar developed tension blisters after the accident, and pressing on that area also causes numbness, while the right side of the scar does not.
Due to the numbness, I consulted both neurology and rehabilitation specialists.
The rehabilitation doctor performed glucose prolotherapy, but the numbness only subsided for 2-3 hours before returning.
The rehabilitation doctor suspects that the nerve may be compressed (adhesions) against the plate and believes recovery will occur after the plate is removed, while the orthopedic doctor diagnosed me with carpal tunnel syndrome.
I have been experiencing numbness 24/7 for almost a year.
Last month, I underwent plate removal surgery along with nerve decompression surgery.
Currently, one month post-surgery, I continue to perform grasping exercises with my four fingers wrapped around my thumb and occasionally squeeze a soft grip ball.
However, when I move my thumb alone, I still feel pain (and slight numbness) radiating to the thenar region, wrist, and the scar area.
Additionally, my wrist still hurts when flexed.
I would like to ask the doctor:
Q1.
I understand that after nearly a year of nerve compression, recovery may not be quick post-surgery, but could you help me assess how long the wrist pain (with slight numbness, but much improved compared to pre-surgery) might last? I would like to know when I should return for a follow-up if the pain persists.

Q2.
What would be the best approach for my rehabilitation? Recently, I have felt some tendon pain in my thumb, which seems to be affecting my index finger as well.
Should I avoid using the grip ball? (I started doing simple household chores and cooking about two weeks ago.) Should I just focus on the grasping motion with my four fingers wrapped around my thumb? Given that my wrist still hurts, should I refrain from performing flexion and extension movements? I am concerned about adhesions, so I have been trying to move that area, but it seems to cause more pain.

Q3.
Do I need to continue wearing a wrist brace? I feel that having the wrist wrapped helps reduce pain (possibly because it prevents bending).
I remove it before and after showering to let it rest and breathe, and I wear it again at night.
However, I have conflicting feelings about this...
I worry that the brace might affect the mobility of my wrist and lead to adhesions.
(For this surgery, I opted for an absorbable anti-adhesion membrane - 50*70*0.02mm.) I apologize for the numerous questions, and I appreciate your response in advance.

Miss Huang, 40~49 year old female. Ask Date: 2024/05/23

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 likely that recovery will continue.
If the pain at the surgical site is significantly affecting your daily life, taking anti-inflammatory and analgesic medications in moderation can help with your rehabilitation.
Consulting a rehabilitation physician may provide you with better strategies to manage the pain.
Early mobilization is essential to prevent adhesions.
Wishing you good health.
Best regards, Shen Baiquan.

Reply Date: 2024/05/23

More Info

Post-surgery challenges, particularly after wrist surgery, can be quite complex and frustrating for patients. Your experience with a distal radius fracture and subsequent surgeries, including the removal of the plate and nerve decompression, is not uncommon. Let's address your questions one by one, while also providing some context and additional information regarding recovery and rehabilitation.

Q1: Duration of Pain and Numbness Post-Surgery
It's important to understand that nerve recovery can be a slow process, especially after prolonged compression. The fact that you are experiencing less numbness than before the surgery is a positive sign, indicating that some improvement is occurring. However, the pain you are experiencing in your wrist, along with the associated numbness, can persist for several weeks to months post-surgery.
Typically, nerve regeneration can take anywhere from several weeks to a few months, depending on the extent of the nerve damage and the surgical intervention. If the pain continues beyond three to six months, or if it worsens, it would be advisable to return to your orthopedic surgeon for further evaluation. They may consider additional imaging studies or therapies to ensure that there are no complications such as scar tissue formation or other issues affecting your recovery.

Q2: Rehabilitation Strategies
Rehabilitation after wrist surgery should be approached cautiously, especially given your history of nerve compression and the recent surgery. Here are some recommendations:
1. Gentle Range of Motion Exercises: Focus on gentle range of motion exercises for your wrist and fingers. Avoid any movements that cause significant pain. You can start with passive movements, where you use your other hand to assist in moving your affected wrist.

2. Avoid Grip Strengthening Too Soon: While using a soft grip ball can be beneficial, it may be too soon if you are experiencing pain. Instead, prioritize exercises that do not exacerbate your symptoms. Gradually reintroduce grip exercises as your pain decreases.

3. Thumb and Finger Exercises: Continue with the four-finger grip while keeping your thumb in a neutral position. As you gain strength and confidence, you can slowly incorporate thumb movements, but be cautious of any pain.

4. Avoid Painful Movements: If wrist flexion or extension causes pain, it’s best to avoid those movements until you have more strength and less discomfort. Pain is often a signal that the tissue is not ready for that level of activity.

5. Consult a Physical Therapist: A physical therapist specializing in hand therapy can provide tailored exercises and modalities to help improve your range of motion and strength while minimizing the risk of adhesion formation.

Q3: Use of a Wrist Brace
Wearing a wrist brace can be beneficial, especially in the early stages of recovery. It can provide support and limit movements that may exacerbate pain or lead to further injury. Here are some considerations:
- Daytime Use: If wearing the brace during daily activities helps reduce pain and provides stability, it is advisable to continue using it. Just ensure that it does not restrict blood flow or cause discomfort.

- Nighttime Use: It’s common to remove the brace at night to allow for some movement and circulation. However, if you find that your wrist feels more comfortable and stable with the brace, it may be helpful to wear it while sleeping.

- Balance: The concern about the brace causing stiffness or adhesions is valid. However, the priority should be to manage pain and protect the wrist during the healing process. As you progress, you can gradually reduce the use of the brace.

Conclusion
In summary, recovery from wrist surgery, especially following nerve compression, requires patience and a tailored rehabilitation approach. Monitor your symptoms closely, and do not hesitate to reach out to your healthcare providers if you have concerns about your recovery. Engaging with a physical therapist can provide you with the necessary guidance to optimize your rehabilitation while minimizing the risk of complications. Remember, every individual's recovery journey is unique, and it's essential to listen to your body throughout this process.

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