Hi, I was wondering if anyone could help me regarding a recent event that happened to me.
On Sunday, June 26th, 2011, I fell down a set of carpeted stairs (six in total). I think that I just slipped and missed a step. I fell forward with my hands out, but fell sideways more and landed on my left wrist. I rolled ontop of my wrist and it bent with the face of my hand down(not the palm). I felt and heard a crack. I got up, and realized the only thing I hurt was my wrist. I iced it immediately appropriately for several hours. Within 30 minutes it became bruised(blue/purple/black) and swelled up where the bone in the wrist is, but it swelled up on the side of my wrist (I believe the ulnar?). After icing it, the swelling went down a little, but began to throb a lot. I couldnt move my fingers, I could move my thumb though, but it hurt to move my pinky finger and my other fingers, or make a fist. The colour of the bruises then turned to a red colour. I went to a walk in clinic, but unfortunately it was closed.
Over night I continued to ice it and keep it elevated. When I woke up in the morning (Monday) it still hurt and was swollen, and the bruising was more of a purple/red colour in the same spot (side of wrist, about 3 inches down my arm and the wrist area under my palm.) I noticed that it started bruising on the side of my hand towards my pinky finger aswell. I went to ER, waited, seen a doctor, and took an xray. One doctor said the xray appeared normal, but another one thought maybe something was wrong with it, but it was hard to determine. The radiologist said it looked normal aswell. After the doctors went back and forth, one doctor said it may be fractured, the other said sprained and another said that there was just soft tissue damage. The nurse wrapped my wrist in a bandage and I was discharged. Within an hour, my wrist started swelling immensely, and my hand became swollen aswell and I could not see my knuckles. I took the bandage off, and continued to elevate my arm but the swelling would not go down.
I went to another walk in clinic to get a referral for another xray. The doctor examined my hand and told me that I should go to emergency to get it casted as it was probably broken and the timing was crucial. After explaining to him that I had just been there, he wrote a note so the doctor at the hospital would look further into it.
Overnight I continued to ice it, take Tylenol and elevate my hand. When I woke up on Tuesday morning it was even more swollen and the bruising was the same colour ( a purpleish-red colour), and there was still pain to move my hand/wrist. When I went to the hospital I explained the situation to the doctor. I got another xray and they said that the xray appeared normal, but it may have been to swollen to tell. The doctor casted my wrist with a plaster cast and scheduled an appointment for the following week to get a bone scan on my wrist. I was told to continue taking Tylenol, and elevating my wrist.
During the week, the pain subdued a little, and the cast did support my wrist a lot. The swelling went down a lot though and the cast became loose, although I was not too sure how loose it should be. There were some sharp pains throughout the week in the bone area in my wrist.
On Tuesday, July 5th, I went in for my bone scan. They do not give the results immediately, so I had a follow up appointment with the doctor who put the cast on, on Thursday, July 7th. The pain continued two days later.
On Thursday, July 7th, I met with the doctor in the ER and had my cast removed. She examined my wrist. There was light green bruising, and my hand was still a tiny bit swollen. There was pain in the top of my hand towards my pinky finger, and not so much in the bone. I could make a fist, but it hurt a lot to. And I could move my pinky, but again it hurt to. I couldn’t bend my wrist back, as it hurt a lot. The doctor looked at the bone scan results, and said there was something but they couldn’t tell if it was the bone or just the muscle around the bone. She put a new plaster cast on. I was actually kind of surprised I got a cast back on as I was told before that it may had been badly sprained. The doctor said she was going to treat it like a break until I seen the orthopaedic doctor.
I am meeting with an orthopaedic doctor in a few weeks for them to take a look at my wrist. Since Thursday, July 7th, I get pain in my wrist (by the bone area). It ranges from sharp pains to nagging subtle pains, to annoying throbbing pains. It hurts on the bone area, and sometimes down into my pinky finger, as well on the side of my hand. Tylenol does not help too much and keeping it elevated does not help much either.
I was wondering what I should do for my wrist until I meet with the doctor, and if anyone has any idea what the problem may possibly be as I do not want to be completely blindsided.
Thanks for any input and advice.
The good thing is that there were no obvious frank fractures, either on x-ray or bone scan. The bad thing, is that ligament injuries can be just as severe as fractures. There is also, a small cartilage disc on the end of the ulna, called the TFCC (triangular fibrocartilage complex), that acts just like the meniscus in the knee. Injuries to the TFCC usually cause pain on the ulnar side of the wrist (small finger side).
It is quite common to put a cast on a wrist with ligamentous injuries. This allows the ligaments to heal and the edema to resolve.
While you are waiting to see the orthopedic surgeon, you need to get as much of the edema out as possible. The best way to do this is through as much elevation as possible. Elevation means above the heart, preferably above the head. When at home, you should keep the hand on top of your head, yes, it looks silly, but that is the amount of elevation that is required to get all that edema and bleeding you had out of your hand. When out and about, you should keep it up on the opposite shoulder as much as possible. That way it is above the heart level. You may even notice that as the bruising is resorbed back into the body, that the coloration moves into the forearm, if you have been keeping the hand elevated. Using a sling is not very good, because it keeps the hand below heart level.
The other thing that is very important is finger range of motion. While the wrist is immobilized, there is nothing in the wrist, that you can injure by moving the fingers. And, fingers get stiff very quickly. When they have edema in them, it is like trying to bend a hot dog. But, by moving them, you not only help pump the edema out of the hand, you also loosen up the joints and tendons.
It really is important to get the fingers moving. You will notice that it is uncomfortable at first, but as you get them moving more and more, the swelling goes down and they actually feel better. You may even have to help get the fingers moving with the aid of the other hand at first.
If you can't actively move the fingers, you can do what is called place and hold. Bend the fingers down as far as you can with the other hand, then actively hold them there for a count of 10. Then straighten them out as far as you can, and hold for a count of 10. Repeat this several times. You should do this at least 6 to 8 times a day.
Sitting around watching TV, you can do finger therapy. Waiting on hold on the phone or in line, do a little finger therapy. It really is that important. It is better to prevent stiffness, than to try to get it out later.
Hope your appointment with your orthopedist goes well. Good luck.