QuestionHi, i would appreciate if you could please comment on my injury and treatment proposed by my Doctor.
History: Male, 33 years old, good physical condition. No prior injury to hand or wrist.
Injury: While punching, i hit the object with the last two knuckles of my right hand (ulnar side). Instead of the first 2.
Result: Immediate, moderate, constant pain and stiffness in the wrist. No swelling. No redness. COuld move my hand, wrist and fingers. For the next week, pain was diminishing. Yet i knew something was wrong.
Dx: Went to a sports medecine doctor. X-ray showed no broken bones. Yet, instability was discovered on ulnar side mid carpal level. By placing one hand on ulnar bone and the other on the pisiform (Believe to be Watson test), you can see the instability. THere is no drooping of the hand, yet you can feel that it is looser than my other hand.
Suggested treatment: Doctor opted for RICE and brace for 2 weeks. Then reinforcement exercises to strengthen the muscles around instability.
Outcome: 5 months later (today), i still have the instability, although i cannot comment on its severity, some cracking/snapping when i do certain movements, i can feel a couple of carpal bones move, pain is almost non-existent. I can do pretty much anything except certain little movements.
My questions:
1. Is this treatment option (strength exercise) common and compatible with accepted treatments? Or is surgery favored? Can it actually be fixed with surgery, or is surgery worse than the injury?
2. Can the instability dissapear totally?
3. By using my wrist in a normal fashion, can an instability get worse with time?
4. How long, on average, can i expect to "suffer" from this injury. (1 year, 2 years, lifetime) Is the healing time lengthy?
5. How prevelant is the appearance of osteoarthritis in injuries like this?
6. Since there are no muscles surrounding the wrist, how can strengthening exercises help?
7. I have taken up Kickboxing as a sport. Now, when i train and punch (with hand wrap and boxing gloves), i do not feel any pain during or after whatsoever. Am i still doing harm to my wrist?
Thank you very much for your time. Any information is quite appreciated.
AnswerHi Stephane,
This sounds like a Triangular Fibro Cartilege Complex tear. This can leand to pain and dysfunction later in life. I did this to myself in both wrists in 1980 and am now starting to have pain with hand shaking and extreme ranges of motion. Post traumatic arthritis can certainly occur. The immediate treatment was correct. Strenghtening is more for the muscles attached to the wrist in order to help stabilize it. Repetetive trauma in something like kick boxing may exacerbate the problem. I injured both my wrists in Karate and am now paying for it. It might be a good idea to have either an arthrogram or MRI of the wrist to determine the extent of injury. The instability will probably not fully disappear.
