Wrist Injuries: Seeking Clarity on Treatment Options

Wrist axis issues

Hello Doctor, I would like to ask for your advice.
I had a motorcycle accident at the beginning of September last year, and it was initially diagnosed as a wrist dislocation.
I was put in a cast until October when it was removed.
A few days later, I started rehabilitation, during which the doctor performed manual adjustments.
However, when it came to the ulnar aspect of my wrist, I felt significant pain.
I asked the doctor about it, and he mentioned it was due to adhesions, so I continued to have him perform adjustments.
Eventually, the doctor noted that my condition did not seem to improve and referred me to an orthopedic surgeon.
After X-rays and an imaging study, the orthopedic surgeon said I had a fracture in my left wrist that should have healed, but there was also calcification present.
He advised me to return to Taipei for better care, stating that recovery would take a long time (I study in Yilan and live in Taipei).
I went back to my original doctor, who scheduled an arthroscopy and joint mobilization on January 4th.
However, a few days after the procedure, I found it difficult to extend and flex my wrist again.
The doctor mentioned that rehabilitation at large hospitals has limited availability, so he recommended seeking therapy outside.
I found a clinic that specializes in orthopedics and rehabilitation, but the orthopedic doctor there advised me not to let anyone else manipulate my wrist; instead, he suggested I perform self-manipulation until I feel some pain.
He mentioned that I have an injury that has already calcified and used ultrasound to examine my wrist, indicating fibrosis and pointing out a white area (which I don't fully understand).
I have a few questions for you:
1.
The two doctors have differing opinions; my original doctor said my wrist can be manipulated by others, while the rehabilitation doctor advised against it.
Whose advice should I follow given the significant difference in their opinions?
2.
Currently, the rehabilitation clinic is only using hydrotherapy and electrical stimulation, and I feel that while my wrist is okay, it gets stuck when I try to bend it to a certain degree, and I don't feel any improvement.
Is this normal?
3.
I have been attending rehabilitation at the large hospital again, where they also perform manual adjustments.
After the session, they suggested that I let someone else manipulate my wrist.
Is that advisable?
Thank you, Doctor.
It has been almost five months since my injury, and I am really worried that my wrist may not heal properly.

Mr. Lu, 10~19 year old female. Ask Date: 2014/01/24

Dr. Shi Guozheng reply Orthopedics

You can bend your elbow joint within a tolerable level of pain, controlling the force yourself.
Allowing someone else to bend it may risk excessive force, which could cause injury or fracture.
After electrical therapy or hydrotherapy, gradually bending the joint may still provide room for improvement.

Reply Date: 2014/01/24

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your wrist injury and the differing opinions you've received from various medical professionals. I understand how frustrating and confusing it can be to navigate through different treatment recommendations, especially after experiencing a significant injury like a wrist dislocation and subsequent complications.

1. Differing Opinions: It's not uncommon for different doctors to have varying opinions on treatment, especially in cases involving complex injuries like yours. The first orthopedic doctor may have suggested manual manipulation (or "凹" as you referred to it) to help realign or mobilize the joint, while the rehabilitation specialist may have advised against it due to concerns about further aggravating your condition. In general, if you are experiencing significant pain during manipulation, it may be a sign that your wrist is not ready for that level of intervention. It would be wise to prioritize the opinion of the doctor who has conducted the most thorough examination of your wrist, including imaging studies like X-rays and MRIs. If there is still uncertainty, seeking a third opinion from another orthopedic specialist, particularly one who specializes in wrist injuries, could provide additional clarity.

2. Current Rehabilitation Progress: It’s concerning to hear that you feel your wrist is not improving after several months. The presence of adhesions (or "沾黏") and fibrosis can indeed complicate recovery. While some stiffness and discomfort can be normal during the rehabilitation process, if you feel that your range of motion is not improving or if you are experiencing persistent pain, it may be necessary to reassess your rehabilitation strategy. The use of modalities such as hydrotherapy and electrical stimulation can be beneficial, but they should be complemented with active range-of-motion exercises. If you feel that your current rehabilitation program is not effective, consider discussing this with your therapist and exploring other options, such as a specialized hand therapist.

3. Manual Manipulation Post-Surgery: After your arthroscopic surgery and joint mobilization, it’s crucial to follow the guidance of your orthopedic surgeon regarding manual therapy. If your surgeon has advised that it is safe to have someone else assist with your wrist mobilization, ensure that this person is experienced in treating wrist injuries. However, if you experience pain during these sessions, it may be a sign that your wrist is not ready for that level of intervention. Always communicate openly with your therapist and surgeon about any discomfort or concerns you have during treatment.

In summary, it is essential to listen to your body and prioritize your comfort and safety during the recovery process. If you feel that your current treatment plan is not yielding results, don’t hesitate to seek further evaluations or alternative therapies. Recovery from wrist injuries can be a lengthy process, and it’s important to remain patient while also advocating for your health.

Lastly, consider incorporating gentle stretching and strengthening exercises as tolerated, and ensure you are following up regularly with your healthcare providers. If you continue to feel stuck in your recovery, you might want to explore options such as occupational therapy, which can provide tailored exercises and strategies to improve function.

Wishing you the best in your recovery journey. Please feel free to reach out with any further questions or concerns.

Best regards.

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