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Dr. Andrew Rynne

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Screw fitted to repair a torn ligament. Noticed swelling, pain and numbness. Looking for cure

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Dr. Rajesh Gajwani

Orthopaedic Surgeon

Practicing since :1975

Answered : 72 Questions

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Posted on Tue, 18 Dec 2012 in Back Pain
Question: Three years ago I had a screw put in big knuckle on index finger to repair a torn ligament. Surgery went well, repair great. I developed lots and lots of scar tissue which resulted in constant swelling, pain, and loss of motion. Last year they went back in and cleaned out the site and freed up the tendon that was a bit bound from scarring. During surgery I had 100% range of motion, up from the 40% before I went in. About a month into physical therapy things started to go down hill. Same thing, constant swelling, pain and losing motion. Now, a year later, I have very little motion, my index finger naturally stays a bit bent, I have pain and constant swelling. I have had an ultra sound, xray and mri. Things look good except for the inflammation and thickening. I have been to my surgeon and two other hand specialists to see if anyone can figure this out. No answers. Then I suddenly realized that I have had reactions to metals in the past. Jewlery, snaps on pants, etc. Went to allergist. Very allergic to nickel. She said my knuckle is most likely an allergic reaction to the nickle in the implant which I now know only contains 1-2% nickel. Surgeon says he doesn't know for sure and the only way to find out it to remove the screw. He also says he has found no other reason for my present condition so maybe that is the reason. Trying to decide if it's worth it to go through the surgery and the painful, long recovery again. I am an active 50 year old woman. I do landscaping for work and my hand hurts every day. i go to the gym and can't wrap my finger around weights. Also when there is any pressure on the underside of knuckle, like using a shovel or holding weights, it is very painful and sometimes get numbness in finger. Just looking for more insight on my issues to help me decide about surgery. Thanks.
doctor
Answered by Dr. Rajesh Gajwani 2 hours later
Hi,
Thanks for your query.

After reading your symptoms, i feel that it seems to be a metal allergy case as mentioned in your history as well. In my opinion the screw should have been removed earlier during the second surgery.
I would strongly suggest that you get it removed immediately to reduce pain and further discomfort. After the removal of the screw you must start physiotherapy after a gap of 15 days.
Wish you a speedy recovery.

Do let me know if you have any other queries.
Regards


Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Rajesh Gajwani 5 hours later
Thank you. Have you done this procedure or know about any that were performed. What was the outcome? I have been looking online on the web for any write ups about this condition and haven't been able to find anything that really relates to me. I found plenty on heart stints but nothing just specific to reaction right around screw in a hand. Can you guide me to any info? In my decision to have surgery it would be reassuring to be able to read or hear about any successes or failures with this procedure relating specifically to the metal allergy. Thanks.
doctor
Answered by Dr. Rajesh Gajwani 13 hours later
Hi,

Yes, I have done this procedure a couple of times before with successful results. But metal allergy was not the case with those patients. Still the procedure is the same and should not have any issues.
I am certain it can be handled without too much difficulty.

Metal allergy may be the cause for your problem; but surgery for screw removal is done commonly with decent results.

I do not have any write ups pertaining to metal allergy to share but I am fairly certain that it is the right treatment plan in your case.

Hope this suffices. I will be available for further discussion if needed.

Regards

Above answer was peer-reviewed by : Dr. Prasad
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