Persistent Hand Pain After Injury: Treatment Options and Insights

Hand-related issues?

Dear Director Shi,
I would like to trouble you with a few matters.
I had a motorcycle accident last March, which resulted in injuries to my right wrist and an elbow dislocation.
I initially sought treatment from a traditional Chinese medicine practitioner for a while, but later I consulted an orthopedic doctor who performed an MRI and confirmed that I still had pain.
I then switched doctors and came to see you.
You diagnosed a ligament injury and prescribed painkillers and muscle relaxants.
During this period, my condition improved significantly; however, after taking the medication for a while (from August until the Lunar New Year), I stopped due to concerns about taking too many painkillers.
Although my condition improved, I still experience pain on both sides of my wrist and my elbow.
I tried using a wrist brace, which helped somewhat, but it becomes uncomfortable due to heat after a short period.
I later visited a rehabilitation specialist who reviewed my X-rays and indicated soft tissue inflammation, stating that the bones were fine.
They suggested that soft tissue injuries are better evaluated with a soft tissue ultrasound.
The doctor prescribed physical therapy treatments including paraffin therapy, electrical stimulation, ultrasound, magnetic field therapy, and heat application.
My inner elbow has improved significantly, but I still occasionally feel soreness.
The area around the bones near my little finger on both sides of the wrist sometimes experiences sharp pain, and I also have pain radiating down from my thumb to the wrist.
Although my condition has improved a lot, I still feel discomfort when my hand is positioned upwards or when my palm is facing up, particularly on the side near the little finger.
A few days ago, while using a kitchen knife with my right hand, I experienced significant pain for an entire day.
I discussed this with my rehabilitation doctor, who said it was okay to ride a motorcycle but advised against long rides.
However, I found that the action of refueling causes some pain on the side of my hand.
Should I wear a wrist brace?
I have also used kinesiology tape, but since there is only one therapist available to apply it and their schedule is inconsistent, I have only had it applied about six times.
It was somewhat effective; after about three applications, my hand felt less painful, but I still experienced sharp pain in my wrist.
Once, I flicked my wrist, and it hurt again.
Due to time constraints, I stopped using the tape.
The therapist advised me to practice lifting a water bottle horizontally, but I sometimes experience pain when lifting it up or down while training my strength.
They also advised against flicking my wrist.
It has been three to four months since my rehabilitation, and I have been diagnosed with synovitis, tenosynovitis, elbow tendinitis, and wrist tendinitis.
I would like to ask you, Director, why has this situation persisted for so long? Is there a possibility of lasting effects? Are there more effective treatment options available? As an unmarried person, I cannot imagine a future where I cannot use a kitchen knife for cooking or lifting things.
Additionally, I experience significant pain in my wrist when painting walls, and I have been using my right hand less for computer work.
I apologize for the lengthy message, and I appreciate your attention to my concerns amidst your busy schedule.
Lastly, I would like to thank you, Director, for your help.
Sincerely,
Doctor Q&A Teams

kiki, 20~29 year old female. Ask Date: 2004/07/02

Dr. Shi Guozheng reply Orthopedics

Recovery from wrist and elbow injuries can take a significant amount of time, and in cases of more severe injuries, it may be challenging to fully heal.
Your bones appear to be unfractured, but a dislocated elbow could potentially damage the ligaments or tendons.
Wrist injuries are particularly difficult to heal because the bones in the wrist rely entirely on ligaments for function.
If injured, it can take a long time to recover, so it is important for you to continue with rehabilitation therapy until improvement is noted.
As for the physician's diagnoses, they are generally similar; conditions like tendinitis and tenosynovitis are quite alike.
If symptoms persist, you should wear supportive devices, such as a wrist brace, to stabilize or temporarily immobilize the joint, which can help alleviate pain.
Strength training should also be continued.

Reply Date: 2004/07/02

More Info

Persistent hand pain following an injury, such as the one you experienced in your motorcycle accident, can be a complex issue that often requires a multifaceted approach to treatment. Your situation, involving wrist and elbow pain, as well as the diagnosis of synovitis and tenosynovitis, indicates that there may be ongoing inflammation and irritation in the soft tissues surrounding your joints. This can lead to chronic pain and functional limitations, which understandably affects your daily activities and quality of life.

Understanding Your Condition
1. Soft Tissue Injuries: After an injury, the body goes through a healing process that can sometimes lead to persistent inflammation. Conditions like synovitis (inflammation of the synovial membrane) and tenosynovitis (inflammation of the tendon sheath) can cause pain and swelling, particularly during movement or when pressure is applied. These conditions can be exacerbated by repetitive motions or activities that strain the affected areas.

2. Scar Tissue Formation: Following an injury, scar tissue can form in the affected area. This scar tissue can be less flexible than the original tissue, leading to stiffness and discomfort. It may also adhere to surrounding structures, causing pain during movement.

3. Nerve Sensitivity: Chronic pain can also be influenced by changes in nerve sensitivity. After an injury, the nervous system may become more reactive, leading to heightened pain responses even with minor movements or pressures.

Treatment Options
Given your ongoing symptoms, here are several treatment options that may help alleviate your pain and improve function:
1. Physical Therapy: Continuing with physical therapy is crucial. A physical therapist can provide targeted exercises to improve strength, flexibility, and range of motion in your wrist and elbow. They can also employ techniques such as manual therapy to address any restrictions caused by scar tissue.

2. Pain Management: While you have been cautious about using pain medications, it’s important to manage pain effectively to facilitate rehabilitation. Discuss with your physician the possibility of using non-steroidal anti-inflammatory drugs (NSAIDs) or topical analgesics that may provide relief without the systemic effects of oral medications.

3. Therapeutic Modalities: The treatments you mentioned, such as wax therapy, ultrasound, and electrical stimulation, can be beneficial in reducing inflammation and promoting healing. Consistent application of these modalities may help in managing your symptoms.

4. Activity Modification: It’s essential to modify activities that exacerbate your pain. Using wrist supports or braces during activities that require gripping or lifting can help reduce strain on your wrist and elbow. It’s also advisable to take frequent breaks during tasks that involve repetitive motions.

5. Gradual Return to Activities: As you recover, gradually reintroducing activities is important. Start with lighter tasks and slowly increase intensity as tolerated. If certain movements cause pain, it may be beneficial to avoid them until you have built up sufficient strength and flexibility.

6. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, massage therapy, or chiropractic care. These can complement traditional treatments and may help in managing pain and improving function.

Conclusion
Your situation is not uncommon, and many individuals experience prolonged symptoms following an injury. It’s crucial to maintain open communication with your healthcare providers about your progress and any concerns you have. They can adjust your treatment plan as needed to ensure you are on the path to recovery. Remember, patience is key in the healing process, and with the right approach, you can regain function and reduce pain in your wrist and elbow. If symptoms persist or worsen, further imaging or evaluation may be necessary to rule out any underlying issues.

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