Wrist Injuries: Diagnosis and Recovery After a Fall

Wrist fall injury

Hello, Doctor Shi: I fell while playing basketball and I'm not sure if I landed on my right wrist or if my body weight compressed it during the fall.
When I got up, my wrist was very painful.
After two days, I had an X-ray taken, which showed no fractures.
However, the area at the base of my index finger on the back of my hand is noticeably swollen, and I cannot bend my wrist up and down or apply any force.
After initial treatments including ultrasound and electrical therapy to reduce swelling, as well as acupuncture and chiropractic care, the swelling on the back of my hand has significantly decreased (it improved noticeably after the traditional Chinese medicine and chiropractic treatments, which suggested it was due to bone compression).
However, the area around the wrist joint near the thumb feels uncomfortable whenever I move my wrist, and I am now six weeks into the injury.
I would like to ask:
1.
Is it possible that there is an undiagnosed fracture? I do not feel extreme pain when pressing on it.
2.
The traditional Chinese medicine practitioner mentioned that it could be a ligament injury.
Given the current situation, could it really be a ligament injury? If it is a ligament injury, how long might it take before I no longer feel discomfort?
3.
Following up on point 2, if it is a ligament injury, can I still perform rehabilitation exercises? I saw a previous response mentioning "having to endure pain during rehabilitation." Does this pain refer to pain during movement or pain due to stiffness?
Thank you for your patience in reading this lengthy message!

David, 20~29 year old female. Ask Date: 2015/12/31

Dr. Shi Guozheng reply Orthopedics

Fractures may not be apparent on the first examination; if there is suspicion, a second X-ray can be taken.
If there is not significant pain upon palpation, the likelihood of a fracture is lower.
Ligament injuries typically take about two to three months to gradually heal.
It is not necessary to endure excessive pain during rehabilitation; it is sufficient to perform exercises within a tolerable range.

Reply Date: 2015/12/31

More Info

Injuries to the wrist, especially after a fall, can be quite complex and often require careful evaluation to ensure proper diagnosis and recovery. Based on your description, it seems you have experienced a significant wrist injury that is causing ongoing pain and limited mobility. Let's address your questions and provide some additional insights into wrist injuries, their diagnosis, and recovery.

1. Possibility of Undiagnosed Fracture: While your X-ray did not show any fractures, it is important to note that some injuries, particularly those involving the wrist, may not be visible on X-rays immediately after the injury. This is especially true for certain types of fractures, such as scaphoid fractures, which can be subtle and may require further imaging, such as an MRI or CT scan, to diagnose. The fact that you do not experience severe pain upon pressing the area is a good sign, but it does not completely rule out the possibility of a fracture. If your symptoms persist or worsen, it would be prudent to consult with an orthopedic specialist for a more thorough evaluation.

2. Ligament Injury: The swelling and discomfort you are experiencing, particularly around the area where the thumb meets the wrist, could indeed indicate a ligament injury. Ligaments are tough bands of tissue that connect bones to each other, and they can be sprained or torn during falls or impacts. If your healthcare provider suspects a ligament injury, they may recommend a period of rest, ice, compression, and elevation (RICE), along with physical therapy to aid in recovery. The timeline for recovery from a ligament injury can vary widely depending on the severity of the injury. Mild sprains may heal within a few weeks, while more severe injuries could take several months to fully recover.

3. Rehabilitation and Pain Management: Regarding rehabilitation, it is essential to approach recovery cautiously. If a ligament injury is confirmed, rehabilitation exercises can help restore strength and flexibility to the wrist. However, it is crucial to differentiate between pain that is a normal part of the healing process and pain that indicates further injury. The phrase "no pain, no gain" does not apply universally, especially in the context of rehabilitation. You should aim to perform exercises that challenge the wrist without causing significant pain. If you experience sharp or severe pain during rehabilitation, it may be a sign that you are pushing too hard or that the injury requires further evaluation.

In summary, wrist injuries can be multifaceted, and while initial imaging may not reveal fractures, ongoing symptoms warrant further investigation. Ligament injuries are common in falls and can lead to prolonged discomfort if not properly managed. It is advisable to continue working with your healthcare providers, including physical therapists, to develop a tailored rehabilitation plan that considers your specific injury and recovery goals. Always listen to your body and communicate any changes in your symptoms to your healthcare team to ensure a safe and effective recovery process.

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