Please comment on the severity of my wife's wrist x-ray.

Question

Hi doctor,

My wife is 42 years old. She is feeling pain in the right wrist while moving the palm laterally outward. The movement gets somewhat obstructed slightly and it is not smooth. This has been started after an occasion when she tried to pull or carry one heavy bag a week ago. X-ray has been done on her right wrist which is enclosed herewith. Please comment on the severity of the wound and its medication. Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your clinical history and x-rays (attachment removed to protect patient identity) and there is actually no obvious fracture, which is visible. Also, I need to see clinically the site of maximum pain, so it will be helpful for me to better understand your X-ray. Meanwhile, you do intensive ice packs, wrist brace for immobilization, and anti-inflammatory medication as per your body's suitability. To me, it looks like a case with a ligamentous sprain, which can happen while attempting to lift a heavy weight. Anyway, kindly send me your clinical picture so that I can reply accordingly.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I have gone through the clinical picture (attachment removed to protect patient identity) sent by you and as I had mentioned earlier, it appears to be soft tissue insult, which can happen with the mechanism of injury described by you. Most commonly it is the TFCC (triangular fibrocartilage complex), which is a soft tissue ligamentous support on the inner side of the wrist. It can get sprained which has to be initially managed like any other ligament sprain. So, my advice will be as follows. Consult your specialist doctor, discuss with him or her, and take the medicine with consent. Wrist brace for three to four weeks. Intensive ice packs for local application three to four times a day for 10 to 15 minutes every time. You can ask her to take any good anti-inflammatory medication. I suggest a tablet of Hifenac P (a combination of Aceclofenac and Paracetamol) one tablet twice a day after meals for three to five days and then one tab SOS (as and when necessary) for pain. Be sure that there should be no pregnancy or any allergy to the medication. Physical therapy can be initiated under the supervision of a trained physical therapist, but only with modalities like laser therapy or ultrasonic and no exercises. Also, I say just a few words of caution for which you will have to let me know. There should be no increase in pain, swelling or skin discoloration, or any other local signs and symptoms of inflammation like local warmth, etc., during the course of treatment otherwise a physical examination and a few blood tests would need to be done. I think with the above-mentioned treatment protocol, she should feel relieved in the next two weeks to 20 days, but ask her to use a brace until the pain disappears. Also, any heavy physical activity needs to be avoided with the affected hand.

Thank you.