I fell over the other day! First time in 50 years I reckon – and I landed on my left knee and left wrist.
Grazed knee, sore wrist and a cursing Jan! I got home and put an ice pack on my wrist and thought it would recover in a day or so. It didn’t. I couldn’t push on my thumb, grip or touch my thumb to my little finger without pain but it wasn’t swollen and as the pain was not that bad immediately after I fell so I diagnosed ligamentous sprain. That was three weeks ago… and I am an impatient person so I thought I would write a post about how long you may expect these things take to recover and how you can help to speed things up and what you should really do if you fall on a wrist!
How can you injure your wrist?
Your wrist is a collection of 8 small bones known as carpals. They link your forearm to your hand and provide a shallow ‘tube’ through which the nerves and tendons pass into your hand. This tube is the ‘carpal tunnel’.
You can get wrist pain from doing activities repeatedly such as playing a musical instrument, typing, playing tennis or activities like sewing.
If you fall on your hand with your arm outstretched in front of you, you can fracture one of the carpals. One is called the scaphoid and is just below the thumb and is particularly prone to fracture in this way.
You may develop arthritis in the joints between the carpals and your forearm joints or even gout.
Ligaments that link some of the carpals can give rise to pain if you sprain them or tear them. Ligaments hold the bones together like tape and can be sprained as can any ligament. The most common ligament to sprain is the scapho-lunate ligament then the triangular fibrocartilage complex. Sprains can occur when you fall and land on your wrist
Symptoms
Repetetive strain gives you pain when you use your wrist to perform the activity that gave you the pain in the first place. It will not necessarily hurt when you are not doing those things.
Pain from fracture is usually felt immediately upon impact. Sometimes, however, it does not show up if you go immediately for an x-ray. You may just be aware that the pain does not go away over weeks and you feel sharp pain if you tap the bone or use it.
Arthritis will give you an aching sensation and you may feel the joints crunching or creaking.
You may develop pain if you have inflammation within the carpal tunnel, and as there is not a lot of space in the tunnel, this inflammation can press on the median nerve that passes into the hand. You will feel tingling in your thumb and first few fingers or pain in the palm of your hand. Pregnancy can commonly give rise to carpal tunnel syndrome as you tend to retain fluid when pregnant.
Pain from sprain can develop gradually or after a fall. You may see bruising, swelling and feel pain on movement.
Case History
Back to my wrist pain and what I did to help myself. It hurt but I could grip. It hurt to tap it but not as bad as what I imagined a fracture would feel like and the pain subsided quickly. I could prod it and stretch it and make it hurt but again it didn’t last too long if I stopped. I thought about a wrist support but decided against it. I thought I would pretend I was my own patient!
If a patient had come to me within the first week of such a fall I would assess the amount and type of pain and palpate the wrist to see if I could feel anything untoward. Depending on findings I would either try conservative treatment for a week or so or refer for x-ray or scan. If conservative treatment results in a significant reduction in pain then a fracture is unlikely, if not then I would refer on.
A few years ago a keen golfer who I hadn’t seen for a long time came to see me. He said ‘Jan, a few months ago I hit the ground instead of the ball with my club and my wrist hasn’t been the same since’. He had continued to play golf because he was determined and loved golf. I palpated his wrist – it felt like broken biscuits. I hit it with my little rubber reflex hammer. It hurt! I put my tuning fork over the bone – it hurt! I sent him immediately for an x-ray.
Why him and not me?
The scaphoid is a funny little bone. It has a peculiar blood supply. The average fracture takes 6 weeks to heal. A scaphoid fracture can take 12 weeks however if treated immediately or 6 months if you walk around without treatment. The fractured bone just fails to heal sometimes. I said that if you go for an immediate x-ray they may see nothing. This is when there is no bony displacement. If a scaphoid fracture is suspected though, you may be put into plaster for 10 days then another x-ray taken at which point the healing process will be visible if there is a fracture and the fracture will appear wider and therefore more visible as a result.
If you suspect that you have a fracture it is important to apply a cast quickly as if properly applied then you have nearly 100% chance of healing – but again that can take 12 weeks.
My patient had a scan and was told that he had several fractures of his scaphoid that had not healed. He needed an operation to screw these pieces together as after all this time, they were not going to heal on their own. He was less than happy with me because he couldn’t play golf! It was better to bite the bullet and repair the bone though, otherwise you may develop arthritis and more long term pain.
I did not feel pain until I got home. Ice helped to relieve the pain. After a week I started to use soft tissue techniques on the area, believing I had sprained my ligaments. I mobilised the wrist and continued to avoid pushing with my thumb but other than that I carried on.
Three weeks on I can now push with my thumb and stretch my palm without pain and touch my little finger with my thumb without pain. It hurts still if I ‘catch’ it on something but only for a second. SO – I am content that it will fully resolve in another couple of weeks.
My point to you all is that if you do develop wrist pain, do come in to see one of us so we can assess it for you. You do not want to end up like my golfer patient, in pain for months and then require an operation. You need to know what you have done in order to best treat it.
Treatment
Avenue Clinic practitioners will perform tests to try to determine what is causing your pain. If they think that treatment may help, they will try a short course of treatment and review your progress. If you are not recovering as you should then you will be referred on or sent for x-rays or a scan depending on your symptoms. They will never continue to treat you if you are not improving.
Wrist pain can be helped by therapeutic ultrasound, soft tissue work, splinting, stretching and advice about how to change what you do if repetitive strain injury was the cause of the pain.
Ligamentous sprain does take time though as I have found. It will not just go away in a couple of days. I keep treating myself and gradually I can do more and more with it without pain – if that had not been the case, rest assured I would have gone for an x-ray or scan by now.
Call us for advice any time regarding wrist pain or any other joint pain that bothers you.