Medical Questions > Conditions and Diseases > Orthopedics Forum

Perplexing hand injury, please help

In Nov 11 I was playing ice hockey when someone hit my right hand (not sure if they "jammed" it or "slashed" it with a stick). I i felt pain but the hand never bruised, nor was it cut/visibly injured. Noticed a lump on my fourth metacarpal. I cannot say for sure if this lump was there prior to the injury or not.
If I gripped something and torqued my hand to the left (not wrist but the actual back side of it) it was very painful around the fourth metacarpal, or sometimes in the space between the 4th/5th. Also painful is using my hand bent back and turning a steering wheel, or anything that compacts the hand in a grip (like a handshake). However, doing things like lifting weights when my hand is gripping the bar but not torquing the back of the hand does not particularly hurt.

Two sets of xrays were taken (one a week after the injury, one 3 weeks after the injury). Neither showed any sign of a fracture.

After a month of Naproxen 500mg/day, icing the injury, and trying to rest it, I had eye surgery. I continued to take the Naproxen and ice the hand injury while I was recovering. In January, I noticed that the hand injury was still present with little improvement.

The results of an MRI showed a palpable abnormality near the 4th metacarpal, but no tendon, ligament, or other damage. The overall result of the MRI was "normal". My hand was still not improving so I was sent to an orthopedic surgeon. The surgeon attempted to do tests on my hand to notice any obvious injury. He could not find anything wrong. The surgeon placed my hand under a "real time xray" (I don't know the technical term). The doc attempted to stress my hand while looking at the xray (such as pulling my fingers, moving my hand, etc) and could not see anything wrong.

He said that it was possible that I had a very slight dislocation that wasn't showing up on the xray or MRI. They ordered a CT scan, which was also negative. The doctor spent 45 minutes looking over the scans with the assistant, looking for even the slightest indication of an injury, but could not find anything.

The docs gave me an injection of Cortisone in the joint of the fourth metacarpal about 1/4" away from the wrist and upped my dosage of Naproxen to 1000mg per day. While the Cortisone/Naproxen has helped the injury significantly in terms of day to day pain, I can still feel that the hand is injured.
Did you find this post helpful?
|

replied February 8th, 2012
no one has any idea?
|
Did you find this post helpful?

User Profile
replied February 11th, 2012
Especially eHealthy
Matth3w,

It sounds like the orthopedic surgeon basically told you what happened to your hand. You have had the "million dollar" work-up: x-rays, MRI, CT scan, and dynamic stress testing under fluoroscopy. It appears that when the hockey stick hit your hand you sustained both a direct blow (resulting in a deep contusion) and a subluxation of the CMCJ. The ligament tore a little, the bone moved a little out of place, then snapped back into place. Now the ligament has healed, so the surgeon can no longer push the bone out of place.


The fact that the antiinflammatory medicines are helping is a good sign.


But, you have had a significant injury to your hand. It may feel better, and it may actually get better with time, if you are lucky. But, it also may never actually feel "normal", whatever that is. If you have developed some scar tissues around the area, it will not stretch like regular tissues, so it may always feel a little tight. But, then again, with time, the scar tissue may mature and stretch out. Who knows. (It takes about a year for significant scar tissue to mature and stretch out.)


But, the good thing is that the bones are located in the proper place and you do not need surgery to fix anything. Hands that have to be operated on usually get better, but always have scars and sometimes chronic pain.

You may just have to learn to live with the "feeling" that you have in the hand. If it really bothers you, you might ask to see the occupational therapist (hand therapist) and they can do some inotophoresis, ultrasound, or friction massage on the spot that bothers you.

But, if it is deep scar, that may just be part of you from now on.


Hope your hand "feels" better. Try not to get hit again when you are playing hockey. If you are going to play, tape that hand up really well. Good luck.
|
Did you find this post helpful?

replied February 11th, 2012
The lump was a soft bone that cannot be noticed by xray that poped out. Your hand consists of lots of soft bones(almost like ligaments) especially in your wrist area.
You need to get to a good Chinese bone doctor and they can skillfully help that to sink in and heal it naturally. I did have someone who has a walnut size softbone pop out at her wrist area. Not painful but bothering her and she is almost going to have surgery to remove it. THe Chinese doctor skillfully relax the surrounding area and push that back in without any pain. Wrap it around to fix its position so it didn't pop out again for a week or so and everything is back to normal.
|
Did you find this post helpful?

replied February 12th, 2012
So I went to see the Occupational Therapist and she thinks there MIGHT (not 100% sure) be a fracture at the base of the fourth metacarpal that no one else saw. So she put me in a splint for four weeks but stated that the pain could remain for the rest of my life if it's not healed properly by the end of the four weeks.

I understand living with some pain, but it's tough to swallow that I would be living with THIS pain, as it peaks around 6-8 on the scale of 10 when tweaked, which severely limits my day-do-day activities.
|
Did you find this post helpful?

User Profile
replied February 12th, 2012
Especially eHealthy
Matt3w,

You are only three months out from what was probably a pretty good whack. You still have some enlargement of that scar tissue that has formed. It can actually take up to a year for scar tissue to mature, soften, and smooth out.

But, again, some scar may remain even then, so you may still have some problems. However, with your everyday activities in the military, you are probably putting more stress on the hand than most civilians would be. So, you may be keeping the area somewhat inflamed.


I doubt that you would have a fracture that was not picked up by MRI and CT scan. They are so sensitive. The MRI can even pick up what are called Grade 0 fractures. These are ones that show marrow edema (bone bruising), but no frank defect in the cortical bone. But, as long as you do not get stiff in the splint, it is fine to immobilize it for a little while, if it helps with the discomfort.

But, you most likely have the residuals of a torn ligament which caused the slight joint subluxation. This most likely will get better with time, but it is going to take some time. Your activity level may also be causing the continued discomfort. But, it is hard to not use your hands.


Hopefully, this will get better. As always: Hope for the best, plan for the worst.

Hang in there.
|
Did you find this post helpful?

replied February 12th, 2012
Thank you for the response yet again. It does seem weird to be in this splint and my hand appears to be stiff as hell when I take it out for showers and whatnot. Not sure if this thing is doing more harm than good. You are correct about having more activities.
|
Did you find this post helpful?

User Profile
replied February 12th, 2012
Especially eHealthy
Matt,

Be sure to do some gentle range of motion while in the shower, when your hand is nice and warm. Warm tissues stretch better than cold ones.

If the splint keeps your sergeants from abusing you, then it is doing something worthwhile. But, as you have noticed, it can cause stiffness. So, work on the ROM.

Again, hang in there and good luck.
|
Did you find this post helpful?

replied February 12th, 2012
Haha thanks you've been a big help. Fortunately I'm the second highest enlisted in my company (sergeant first class) so no issues from abuse lol
|
Did you find this post helpful?

User Profile
replied February 12th, 2012
Especially eHealthy
Matt,

Yea, but you have to lead by example, so you guys tend to abuse yourselves!! Again, hope for the best and plan for the worst. Good luck.
|
Did you find this post helpful?
Must Read
Think you might be experiencing bone loss? Check out this Intro to Osteoporosis and evaluate your risk for developing bone weakness. ...
Although bone mass loss is normal as we age, some people are more at risk of developing osteoporosis than others. Are you at risk? More here....
Do you have severe back pain? Do your bones break frequently or with little pressure? You might be experiencing osteoporosis. Found out more here....