Hand pain from past injury.

[comebackkidd]

I'm getting pretty sick of how I am still not very able to have full use of my left hand like I did before I broke it. Three years ago, I got into a scuffle and acted in self defense..somehow, I got a Boxer's Fracture, it was to my 5th metacarpal..except, it wasn't fractured (not sure why the doc said both of these things), it was totally broken in the middle of the metacarpal. Adding to that, I fractured my ring finger knuckle...now I am left with a bad deformity of my dominant hand and no pinky knuckle. I've been in and out of the same ortho's office and they always say "it's just a contusion that's causing your swelling, go to a physical therapist". I was in two different casts for a total of 9 weeks, was in physical therapy for 5 weeks..that didn't help. Whenever I write a lot ( I have to since I am in high school) or I play my guitar (I was taught the right handed way, just my luck) there's MAJOR swelling. I hardly even notice the bruise colors on my bad hand anymore! When I have the swelling around my knuckles (ring finger and middle finger), my pinky starts to jam up..I guess because I don't have a knuckle anymore (how my hand healed was goofy, my 5th metacarpal curves up then indents majorly where the pinky knuckle was), plus my wrist snaps a lot now and that radiates up my forearm...I don't know what to do anymore.

Is there ANY kind of answer besides it's just bruising. There must be more than that. Is there any surgery to correct this? knuckle replacement? anything? PLEASE help.

[Tom Plamondon PA-C]

Hello,
Thanks for writing in.
You have described right hand dysfunction (pain, swelling, loss of mobility) due to boxer's fracture (aka break in bone) and MCP damage.

It is difficult to advise about surgical options since I can not see the xray but it would be important to evaluate the radiograph of the hand to look for alignment of the metatarsal bones and MCP joints. An MRI may also be helpful to look at the soft tissue structures of the hand.

Hand can be difficult to rehab. First things first: make sure the hand is structually intact (bones are straight, no dislocations, and ligaments and tendons are secure).
Next, focus on restoring normal range of motion and controlling swelling. Finally, regain strength.
An occupational therapist (one who has experience with hand rehab) can best guide you through the rehab. But first make sure all structures are intact - using radiographs, MRI, and clinical assessment.

The wrist clicking and pain is probably due to compensatory movements of the hand ie secondary to the boxer's fracture.

Let us know how it goes. Take care.

[comebackkidd]

Last year I had an EMG on my hand and it came back fine. no nerve or muscle damage, which is good, but the doctor still didn't give me an alternative answer. I definitely need to go to a different doctor for this because the old one definitely
did not help. One night probably in February of 08, I went a local ER and the doctor looked at it and told me the x-ray came back with no broken or fractured bones (which was a given at the time) but the lack of my knuckle not being there caused my the left side of my hand to not have much support which is why it slumps. And yes, the bone healed with a slight downward curve that you can definitely see...not to mention is very odd to feel. I think when it was in the cast, the bone was a little rotated...but I'm not a doctor so I do not know.
I have one of those grippers in effort to make my hand strong again but unfortunately that doesn't help. But I'll definitely look into going to a different doctor and seeing what they can really do...If you have anymore advice, it's much appreciated!