Wrist Injuries After a Car Accident: Causes and Recovery

Wrist sprain from a car accident?

Last year at the end of the year, I sustained a wrist sprain from a car accident.
The emergency room doctor said there were no abnormalities in the bones, and that I could manage it with medication and ice therapy.
At that time, my symptoms included: the ability to bend my thumb and index finger only about 80% with mild pain (the pain point was around the triangular fibrocartilage), and there was some pain when applying force or rotating my wrist.
Two months later, I had recovered at least 50%, but I started experiencing numbness in my little finger, ring finger, and just below the little finger.
Sometimes, pressing about 2 cm below the ring finger on the back of my hand would cause some pain, and I would feel pain in my wrist when dressing, reaching into my pockets, or wringing out a towel.

Five months later, my finger flexion had improved to about 90%, but the numbness persisted, and my wrist seemed to have plateaued at about 70-80% recovery.
To this day, only my little finger remains numb, and my wrist seems to have improved by about 80%.
I have scheduled an MRI for September 25, as I am concerned that the examination may not reveal the underlying cause, so I continue to search for information and consult with doctors and acupuncture therapists.
Several doctors have assessed my condition and suggested possible issues such as periostitis, tendinitis, soft tissue injury, cartilage injury, and a gap of about 0.1 cm between the ulnar and radial bones at the wrist.

The examinations I have undergone include: wrist X-rays (approximately four different angles), cervical X-rays (which showed no significant issues), and nerve conduction studies of the hand (which indicated slight slowing at the right elbow).
The treatments I have received in order include: traditional Chinese medicine electrotherapy and topical medication (for about three months), one month of traditional martial arts massage and topical medication (which was not effective), two months of hospital-based electrotherapy and wax therapy (with little progress), and two months of hospital acupuncture and medicated patches (which seem to show some improvement, so I will continue with this).
My personal speculation is that the initial ice therapy was not adequately applied, leading to ligament laxity or dislocation of the triangular fibrocartilage.
I kindly ask for your guidance, Dr.
Shi, regarding the possible causes of my condition, what further examinations may be necessary, any precautions I should take, and approximately how long it might take for recovery.
Thank you very much.

Chen Shengxiang, 30~39 year old female. Ask Date: 2013/08/26

Dr. Shi Guozheng reply Orthopedics

Wrist injury pain can persist for a long time.
Since an MRI has already been scheduled, we will wait for the results before proceeding with treatment.
Based on your description, it seems to be improving.
If it turns out to be a triangular fibrocartilage complex (TFCC) issue, we can address it later as well.

Reply Date: 2013/08/26

More Info

After a car accident, wrist injuries can manifest in various ways, often leading to pain, limited mobility, and sometimes numbness or tingling in the fingers. Based on your description, it seems that you have experienced a significant wrist injury that has not fully resolved after several months. Let's break down the potential causes, necessary evaluations, and recovery expectations.

Potential Causes of Your Symptoms
1. Soft Tissue Injury: Given that you experienced pain localized around the triangular fibrocartilage complex (TFCC), it is possible that you have sustained a soft tissue injury. The TFCC is crucial for wrist stability and can be injured during trauma, leading to pain and dysfunction.

2. Tendonitis: Inflammation of the tendons around the wrist, particularly the flexor tendons, could explain the pain during wrist movements and gripping activities. This condition can develop due to overuse or improper healing after the initial injury.

3. Nerve Compression: The numbness in your ring and little fingers may suggest possible compression of the ulnar nerve, which runs near the wrist. This can occur due to swelling or structural changes following the injury.

4. Ligamentous Injury: If there was a significant force applied to the wrist during the accident, it could have resulted in ligament sprains or tears, which might not have been visible on initial X-rays.

5. Cartilage Damage: Damage to the cartilage in the wrist joint can lead to persistent pain and dysfunction. This could be assessed through MRI, which is more sensitive than X-rays for soft tissue injuries.

Recommended Evaluations
1. MRI Scan: Since you have already scheduled an MRI, this will be crucial in assessing the soft tissues, including ligaments, tendons, and cartilage. It can help identify any tears or inflammation that may not be visible on X-rays.

2. Ultrasound: This imaging can be useful for evaluating soft tissue injuries and assessing blood flow to the area, which can indicate inflammation.

3. Nerve Conduction Studies: Given the numbness in your fingers, further evaluation of the ulnar nerve function may be warranted to rule out any nerve entrapment or damage.

Recovery Expectations
Recovery from wrist injuries can vary significantly based on the severity of the injury and the effectiveness of the treatment. Since you have seen some improvement (90% recovery in finger flexion), it is a positive sign. However, the persistent numbness and pain suggest that further intervention may be necessary.

- Physical Therapy: Engaging in a structured rehabilitation program focusing on range of motion, strengthening, and functional activities can greatly enhance recovery. A physical therapist can tailor exercises to your specific needs.

- Pain Management: Continuing with modalities like acupuncture and therapeutic ultrasound may provide relief. Additionally, anti-inflammatory medications can help manage pain and swelling.

- Timeframe: While some wrist injuries can heal within weeks, others may take several months to fully recover. Given your timeline, it is reasonable to expect gradual improvement over the next few months, especially with consistent therapy.

Precautions and Self-Care
- Avoid Overexertion: Be mindful of activities that exacerbate your symptoms. Gradually increase your activity level as tolerated.

- Ice Therapy: Continue using ice to manage swelling and pain, especially after activities that involve wrist use.

- Ergonomic Adjustments: When performing daily tasks, consider using wrist supports or braces to stabilize the wrist and reduce strain.

In conclusion, your symptoms are likely due to a combination of soft tissue injuries, potential nerve involvement, and possibly ligamentous damage. The upcoming MRI will be instrumental in guiding your treatment plan. It’s essential to maintain open communication with your healthcare providers and follow through with recommended therapies to optimize your recovery.

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