Wrist Adhesions: Navigating Rehabilitation Challenges

Wrist axis issues

I had a wrist dislocation from a motorcycle accident in September, and I had a cast on until October.
After 2-3 days, I started physical therapy.
Although my wrist has mostly healed, I now have difficulty straightening my wrist and bending it back.
During therapy, I received manual adjustments, but it was very painful.
When I asked my doctor why this was happening, he mentioned it was due to adhesions.
I continued with therapy, but it was extremely painful after each session.
The therapist also noted that my condition seemed less than ideal, so I sought a second opinion.
The new doctor mentioned there was calcification and that I had a previous fracture of the left olecranon, indicating it might be a bit complicated.
I returned to my original doctor, who performed arthroscopy and mobilization, but after 1-2 days, the issues returned.
Recently, my doctor said I could continue with therapy, but I visited another rehabilitation clinic where a different doctor reviewed my X-rays and also noted calcification.
He advised against manual adjustments and suggested I should move my wrist on my own without external assistance.

I would like to ask the doctor: 1.
With two doctors providing different opinions, how should I decide whom to listen to? 2.
If I need to perform self-mobilization, how long will it take to see improvement? I feel like I'm not making much progress on my own.
Thank you for addressing my concerns.

tomas, 10~19 year old female. Ask Date: 2014/01/22

Dr. Chen Wayda reply Rehabilitation

It is recommended to visit the Rehabilitation Department at National Taiwan University for a consultation and detailed examination.

Reply Date: 2014/01/22

More Info

Wrist adhesions can be a frustrating and painful complication following an injury such as a wrist dislocation. It’s understandable that you’re feeling confused and concerned about the differing opinions from your healthcare providers. Let’s break down your situation and address your questions.

Understanding Wrist Adhesions
Wrist adhesions occur when scar tissue forms around the joint, limiting its range of motion and causing pain. This can happen after immobilization (like being in a cast) or after surgery. The formation of adhesions can lead to stiffness and discomfort, which you are experiencing as your wrist struggles to regain its full range of motion.

Addressing Your Questions
1. Conflicting Opinions from Doctors:
It is not uncommon for different healthcare providers to have varying opinions based on their experiences and interpretations of your condition. When faced with conflicting advice, consider the following steps:
- Seek Clarification: Ask both doctors to explain their reasoning and treatment plans in detail. Understanding their perspectives can help you make an informed decision.

- Get a Third Opinion: If you’re still uncertain, it might be beneficial to consult a third orthopedic specialist or a hand therapist who specializes in wrist injuries. They can provide additional insights and help you weigh the options.

- Consider a Multidisciplinary Approach: Sometimes, a combination of treatments from different specialists (like an orthopedic surgeon and a physical therapist) can provide a more comprehensive approach to your recovery.

2. Self-Rehabilitation and Recovery Time:
If your current doctor has advised you to perform self-rehabilitation exercises, it’s crucial to follow their guidance while also being cautious. Here are some general tips:
- Gentle Range of Motion Exercises: Start with gentle movements to avoid exacerbating pain. Gradually increase the intensity as tolerated.

- Listen to Your Body: Pain is a signal that something may not be right. If you experience significant pain while performing exercises, it may be wise to stop and consult your doctor.

- Consistency is Key: Rehabilitation can take time, and progress may be slow. Consistent, gentle exercises over weeks or months can lead to improvements.

- Physical Therapy: If you haven’t already, consider working with a physical therapist who can tailor a rehabilitation program specifically for your needs. They can provide hands-on treatment and monitor your progress.

Additional Considerations
- Calcium Deposits: The mention of calcification in your wrist could indicate a condition known as calcific tendinitis or other forms of calcific deposits that can occur after an injury. This may require specific treatment, such as ultrasound therapy or guided injections, to help dissolve or manage the deposits.

- Surgical Options: If conservative treatments fail and your range of motion does not improve, further surgical intervention may be necessary to remove adhesions or address any underlying issues.

Conclusion
Navigating recovery from wrist adhesions can be challenging, especially when faced with conflicting medical advice. It’s essential to communicate openly with your healthcare providers, seek additional opinions if necessary, and engage in a consistent rehabilitation program tailored to your condition. Remember, recovery is often a gradual process, and patience is key. If you continue to experience significant pain or limitations, do not hesitate to advocate for your health and seek further evaluations or treatments.

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