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hand injury

 
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PostPosted: Thu Apr 15, 2010 12:55 pm GMT +0000    Post subject: hand injury Reply with quote

I recently got thrown over the bars when a defective rim (it was a DT Swiss and they replaced it under warranty) buckled along the seem. I threw my arms out in front of me to catch myself and prevent a face plant. I came down pretty hard on my right hand, and the hand has been swollen just above the wrist where the thumb bone connects to the wrist (by the meat of your hand). I saw a doctor, and he said that there is no fracture; it is a hematoma or some type of cyst - both benign. It's been almost a month now and the swelling isn't going down much - there is a pronounced lump just above my wrist - and can still be painful to lift heavy objects. Any advice or experience?
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PostPosted: Fri Apr 16, 2010 3:30 pm GMT +0000    Post subject: Reply with quote

wittduncan:

The injured area you are describing could inolve the scaphoid bone which is just below the tumb joint in what is called the "snuff box" where two tendons make a box when the thumb is extended fully to the side. Scaphoid fractures are easy to miss on regular X-rays of the hand and require special views (called scaphoid views) to identify the fracture. Sometimes they cannot be seen on the initial X-rays and repeat films in 3-7 days may need to be taken. The problem with a scaphoid fracture is there is a high frequency of nonhealing. Ask your doctor for an orthopedic evaluation. You should not still be hurting one month later if it is only a bruise. I am concerned you have scaphoid fracture with nonunion (not healed). Let me know what the orthodoc has to say.

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cxagent
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PostPosted: Mon Sep 06, 2010 10:18 pm GMT +0000    Post subject: More info on the scaphoid nonunion please Reply with quote

As you described, my wife has a scaphoid nonunion that wasn't found on the Xrays after the crash three months ago or 3 weeks ago but was found on a flouroscope (sp?) last week. At this point the new doctor is recommending a screw to pull the scaphoid back together. My wife is resisting surgery because the wrist is just now starting to feel better.

Three months after the fracture, what are the chances the scaphoid will heal without the surgery? Does it make a difference that the flouroscope showed a callous forming at one end of the fracture? Any long term consequences of surgery or not having surgery?
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The Bike Doc
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PostPosted: Tue Sep 07, 2010 11:38 am GMT +0000    Post subject: Reply with quote

cxagent:

One of the problems with a scaphoid bone fracture is that the distal (far) end of the fracture often gets cut off from the blood supply that is required to allow healing. That is why a non-union (failure to heal) is common to this bone. There may be callous formation on the proximal (near) side of the scaphoid bone but if the callous does not bridge the gap of the scaphoid fracture, there my be non-union. It is tough for me to give you an accurate answer without looking at the films. Visit with your wife's orthopedic doctor about your question. If she has not yet been seen by an orthopedic doctor, get a consultation with one.

Thanks,
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cxagent
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PostPosted: Tue Sep 07, 2010 7:22 pm GMT +0000    Post subject: Reply with quote

Thanks for the reply. She originally went to the orthopedic doctor we had used previously for sports related injuries. We now have moved on to another.

I know it would be tough to impossible to diagnose from only my description here - but you nailed it. The callous is forming on the proximal side only. We will be asking all kinds of questions of the new orthopedic doctor. The most important questions are the long term implications with and without the surgery. Put another way, are the long term improvements worth the near term pain of surgery and PT?
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The Bike Doc
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PostPosted: Wed Sep 08, 2010 8:37 am GMT +0000    Post subject: Reply with quote

cxagent wrote:
Thanks for the reply. Put another way, are the long term improvements worth the near term pain of surgery and PT?


cxagent:

That would be a question you should direct to your Ortho Doc. He or she would be better versed in giving you an answer. Most Ortho Doc do not jump to the surgery option if there is an alternative option with fewer risks. A scaphoid bone fracture frequently does not heal well without surgery and requires careful consideration of the options by your wife and her Ortho Doc.

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cxagent
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PostPosted: Wed Sep 08, 2010 4:05 pm GMT +0000    Post subject: Reply with quote

Thanks Doc! Your responses have been a MAJOR help.
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cxagent
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PostPosted: Sat Sep 11, 2010 2:04 pm GMT +0000    Post subject: Reply with quote

Thanks Doc. Surgery is scheduled for 9/23.

When we found that if the scaphiod bone dies (which is possible for a non-union like this) it and several other bones would need to be removed and the wrist fused, the decision was easy. Let's endure the short term issues to avoid the longer term ones.
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PostPosted: Sat Sep 11, 2010 8:11 pm GMT +0000    Post subject: Reply with quote

cxagent:

Glad to have helped you along the way. Give shout back in a few months to let me know how your wife does with the surgery and rehab.
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cxagent
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PostPosted: Tue Nov 16, 2010 9:13 am GMT +0000    Post subject: Reply with quote

Update on my wife's scaphoid non-union -

Surgery went fine but had all the usual issues of pain, nausea, etc. During surgery the doctor found a large area of dead bone in the scaphoid (my terms, not his). He removed all of the dead bone but then had to put a second screw in the scaphoid because the one screw was mostly in the void created by removing the dead bone.

As of last week the cast is off and the flouroscope (sp?) shows the non-union has healed. X-rays have been ordered to confirm the flouroscope. The wrist is very tight and immobile so PT has started.

I think we have avoided a major problem by finding the non-union and getting it fixed before any more tissue died. We felt like we had done everything needed by going to the Ortho Doc when we thought there was a problem a week after the fall. If we had not pushed for PT then and the PT hadn't said there must be an underlying problem, we wouldn't have found the non-union until the bones died and her wrist had to be fused. I want to encourage everyone to seek help for problems that don't seem to heal.
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The Bike Doc
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PostPosted: Tue Nov 16, 2010 10:46 am GMT +0000    Post subject: Reply with quote

cxagent:

Thank you for the update. I am glad your wife and you stuck it through. I hope to meet you at some of the races in the future.
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