Do I Need Surgery for My Wrist Pain After a Scaphoid Fracture?

Questions after a fracture?

Hello Doctor, I had a scaphoid fracture last year, and after treatment, the fracture has healed.
Currently, the range of motion in my wrist has mostly returned.
The fracture was treated non-surgically, but I now feel that the triangular fibrocartilage and surrounding ligaments on the outer side of my right wrist are loose.
My symptoms include occasional pain in the area of the triangular fibrocartilage, a grinding sound when I rotate my wrist, and the triangular fibrocartilage can move and make a clicking sound.
When I exert force, it becomes very painful, and my grip strength has diminished.
Does this condition require surgery? What would the treatment plan be? I would greatly appreciate your clarification.

Xiao Yi, 30~39 year old female. Ask Date: 2006/04/20

Dr. Ye Qingnian reply Orthopedics

Scaphoid fractures are among the most difficult bones in the human body to heal! If immobilized in a cast for an extended period, they often do not heal properly.
If there is any displacement of the bone, surgical fixation is necessary.
Typically, X-rays can only reveal the fracture, but associated ligament injuries cannot be detected through X-ray examination.
Ligament injuries can lead to joint instability, which may increase the risk of developing arthritis later on.
It is recommended to visit the orthopedic department's hand surgery clinic for a thorough evaluation.

Reply Date: 2006/04/20

More Info

Based on your description of wrist pain following a scaphoid fracture, it sounds like you may be experiencing issues related to the triangular fibrocartilage complex (TFCC) and surrounding ligaments. After a scaphoid fracture, even if the bone has healed, there can be residual problems that affect the stability and function of the wrist.

Understanding Your Symptoms
1. Pain in the Triangular Fibrocartilage Area: The TFCC is a structure that provides cushioning and stability to the wrist joint. If it is damaged or degenerated, it can lead to pain, especially during wrist movements or when bearing weight.

2. Clicking or Grinding Sounds: The sounds you describe when moving your wrist could indicate that there is some instability or abnormal movement in the joint. This could be due to ligament laxity or damage to the TFCC.

3. Weak Grip Strength: Reduced grip strength can be a sign of both pain and instability in the wrist. If the ligaments or the TFCC are compromised, it can affect your ability to perform tasks that require strength.

Do You Need Surgery?
Whether or not you need surgery depends on several factors:
- Severity of Symptoms: If your pain is significant and affects your daily activities, surgery may be considered. If the pain is manageable and does not interfere with your quality of life, conservative treatment may be sufficient.

- Response to Conservative Treatment: Before considering surgery, it is common to try non-surgical options such as physical therapy, splinting, and anti-inflammatory medications. If these treatments do not alleviate your symptoms, surgery may be warranted.

- Imaging Studies: An MRI or a CT scan can provide detailed images of the wrist structures, helping to assess the condition of the TFCC and ligaments. If there is a clear indication of a tear or significant instability, surgical intervention may be recommended.

Treatment Options
1. Conservative Management: This includes rest, ice, compression, and elevation (RICE), along with physical therapy to strengthen the wrist and improve range of motion. A wrist brace may also help stabilize the joint.

2. Surgical Options: If conservative treatments fail, surgery may involve:
- TFCC Repair: If there is a tear in the TFCC, it can be surgically repaired.

- Debridement: In cases of degeneration without a clear tear, the surgeon may remove damaged tissue.

- Wrist Stabilization: If there is significant ligament laxity, procedures to stabilize the wrist may be performed.

3. Rehabilitation: Post-surgery, a structured rehabilitation program is crucial for recovery. This typically involves physical therapy to regain strength and mobility.

Conclusion
In summary, whether you need surgery for your wrist pain after a scaphoid fracture depends on the severity of your symptoms, your response to conservative treatments, and the findings from imaging studies. It is essential to consult with an orthopedic specialist who can evaluate your wrist and recommend the best course of action based on your specific situation. If surgery is indicated, a well-planned rehabilitation program will be vital for a successful recovery. Always prioritize open communication with your healthcare provider to ensure you understand your options and the potential outcomes.

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