Another wrist pain topic

[i_like_sun]

Are there any medical professionals on here that know about fracture remodeling in the carpal bones?

 

I've broken both of my Triquetral bones, my left Scaphoid, and left Pisiform. The fractures are healed, with the exception of my L. Scaphoid having a screw and a "notch and line" that hasn't yet calcified (after two years).

 

My wrists feel super solid for the most part... However, every time I have any sort of unexpected arrest on my LEFT hand, my scaphoid and triquetral regions just KILL ME! And it usually takes weeks for the joints to feel tight and stable again. I'm now wondering if at this point the pain is ligamental, or simply that the trauma to the bones and joints has reshaped the architecture (my scaphoid certainly "sticks out" more than it used to) so that they are not articulating the same.

 

I am so paranoid of falling down!

[tlinn]

We were learning about this in class last week and you are exactly right. I don't have the notes in front of me but basically if you have an x-ray done you can check the alignment of the carpals and you can see if this is what is causing the problem. Basically, something that you should see an orthopedic surgeon about if it is causing you a great deal of pain.

[layton]

You should have your wrist re-xray'd to make sure the proximal scaphoid (it gets less blood supply than the rest) isn't undergoing avascular necrosis. If not, have someone with sensitive hands to check the joint play to evaluate if the carpals are hyper or hypomobile. If they are hyper, then prolotheraphy may be in your future, if hypo, then see a chiropractor. If AVN...you're fucked.

[i_like_sun]

You should have your wrist re-xray'd to make sure the proximal scaphoid (it gets less blood supply than the rest) isn't undergoing avascular necrosis. If not, have someone with sensitive hands to check the joint play to evaluate if the carpals are hyper or hypomobile. If they are hyper, then prolotheraphy may be in your future, if hypo, then see a chiropractor. If AVN...you're fucked.

 

 

 

I did have an ex-ray about a year ago, and there were no signs of avascular necrosis. - I've done some reading on that condition, and apparently it wasn't too long ago that people with Scahpoid fractures would usually end up permanently disabled. So cheers and thanks to modern medicine!

 

Last year's ex-ray did however show that the original fracture line is visible to about 1/4 through the waist. I wonder if that is something that can be completely reabsorbed as my bone remodels over time (although I don't think carpals remodel all that much in the adult wrist).

 

I have found that strength training helps quite a bit. Just having all the supporting muscles built up and knarly seems to make a difference. But Layton, what exactly is prolotherapy? I've never heard of that.

 

My only real concern (rather than me being a complete nuurd) is the risk for developing arthritis...

[layton]

Is it too loose or too rigid? It all depends on the answer man!

[i_like_sun]

Is it too loose or too rigid? It all depends on the answer man!

 

 

 

It tends to be too loose.

[layton]

So ask a doctor about Prolotherapy. They inject a solution (usually glucose based) into the joint. That stimulates inflammation and fibroblastic activity to make new collagen in that joint. It's a series of injections. The real trick is the rehab therapy afterwords. Too aggressive and you'll ruin all the therapy has accomplished. Too light and you wrist will be stiff as hell.

[layton]

You also could have a rebound hypermobility from a hypomobility elsewhere. Those bones have to move more in the wrist joint complex because others are restricted.

[i_like_sun]

Thanks Layton. I will look into this.

 

My mom is an OT/certified hand therapist, so I might be able to get some free treatment. We'll see!

 

[layton]

Can she give injections and w/o a prescription?

[i_like_sun]

I'm not sure about injections. I'm seeing her this weekend, so I'll ask her!

 

I'm not sure what it is my wrist needs exactly, because it only hurts like hell when I fall down on it - as I'm sure most people's do, except mine is 10 times more sensitive than it was before the fracture. When I don't bang it, it feels (almost) fine. It just clicks and cracks a ton.

[i_like_sun]

You also could have a rebound hypermobility from a hypomobility elsewhere. Those bones have to move more in the wrist joint complex because others are restricted.

 

 

 

OK so I've been visualizing this....

 

It makes sense. If a single joint is all of a sudden hypomobile, ligaments in the surrounding joints may get stessed as they take on the new load.

[layton]

you got it!

[i_like_sun]

I'm not sure if these images are clear enough to really make any kind of assessment, but what do you think Layton? Am I completely doomed to have arthritis?

 

 

[layton]

I don't think it's a good idea for me to even look at those x-rays for liability issues, otherwise I'm responsible for everything on the film. Sorry.

 

In general, you need to stay on top of your scaphoid because it is really prone to avascular necrosis.

[high_on_rock]

Moderators, perhaps we should create a PayPal "donate to Layton" button to help fund the education behind all of this tremendous advice we get. Or perhaps just offer Layton, Sherri, Mattp, and a few of the others who are so darn helpful a larger font on their posts to give their posts greater significance than the rest of us.

 

I for one am darn grateful.

Eric

[i_like_sun]

Moderators, perhaps we should create a PayPal "donate to Layton" button to help fund the education behind all of this tremendous advice we get. Or perhaps just offer Layton, Sherri, Mattp, and a few of the others who are so darn helpful a larger font on their posts to give their posts greater significance than the rest of us.

 

I for one am darn grateful.

Eric

 

 

Eric, I agree.

[layton]

How about come to my grand opening at the end of the month when I can actually treat you guys?

[high_on_rock]

Heck Layton; now that you are "official" I cannot afford you (no insurance). Thanks for the invite, but I am currently fouling Spokane with my presence.

 

But really folks, if Layton, Sherri, or Mattp ever have to buy their own drinks, then we are failing them. I will belay slave for any of you any time.

 

Eric

[i_like_sun]

Its too bad this isn't France, seeing as health insurance is a problem here. I know you guys have probably seen sicko, but just think: the government would pay for our visits to Mr. Mike, cover the morphine cost, and pay for a vacation to the south!