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Fell down on hand. X-ray showed no fracture. Getting pain and numbness from splint. Ligament injury?

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Orthopaedic Surgeon
Practicing since : 1994
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My 12 year old son fell on his outstretched hand six days ago. He cannot move his thumb, his thumb is numb, his wrist is too painful to move, if you rub his forearm he gets a pins and needles sensation in his hand (thumb side), if you press on his wrist, the pain is excruciating. Xrays on the day of injury did not show a fracture. He saw a ortho a couple of days ago who placed his hands gently on my son's wrists and turned his palms upward - with that, my son began to tear up and wince in pain - the Ortho doc said his pain was "exaggerated" and said my son couldn't possibly be in that much pain and said we could bring him back in 10 -12 days - and hesitantly agreed to at least splinting him. He said the numbness and pain was from the splint that had been on since the ER visit after the injury. I did explain that his pain and numbness has been the same since the moment of the injury and that I did take the splint off for an hour or so on Saturday- that did not help. He then told his PA to splint it loosely and after a half hour or so, the splint literally fell off of his arm. His pediatrician ordered him re-xrayed yesterday (only five days post injury) and no fracture was seen. However, it does appear that he has a possible rotary subluxation of the scaphoid. My concern is that he has possible torn some ligaments or maybe tendons as well as possible damage to his medial nerve. I don't want this to be permanent. Am I being unreasonable with my concern? I have copies of the radiographs to upload if need be.
I failed to mention that he has felt a "popping" sensation in his wrist twice now.
Posted Wed, 22 May 2013 in Arthritis
Answered by Dr. Praveen Tayal 4 hours later
Thanks for posting your query.
From the description you have provided, a ligament injury or scaphoid subluxation with a pinched median nerve is likely. The X-rays are normal. So, a major fracture or a nerve injury is not likely.
To detect the minor injuries, MRI scan is one of the best investigations. Some hairline fractures and soft tissue injuries or joint subluxations are difficult to detect on X-rays.
Meanwhile he can use an elastic wrist brace to provide support to the area. Avoid lifting anything with the hand.
Most of the soft tissue injuries heal with adequate rest in 3-4 weeks. The nerve related symptoms also gradually disappear once the injury related swelling subsides. Any serious long term damage is not likely.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
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