A 39-year-old female asked:
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i have sharp pain from my thumb knuckle to my wrist. took a fall months ago, was told i was fine. should i still be having pain? just before thanksgiving i slipped on the ice and went down several stairs, trying to catch myself with my one free hand. thou

4 doctor answers
Dr. Howard Fox
42 years experience Podiatry
Wow. : Wow. Nothing like looking up stuff in a book on how to take an x-ray to impress your patient! given what you said, i wouldn't place too much confidence in the diagnosis. And even if the x-ray was perfect, tiny hairline fractures often don't show up on a 2-dimensional x-ray, so it's entirely possible you had a little fracture that just didn't show up on the x-ray. When a fracture is suspected and not seen on an x-ray, the protocol is to re-x-ray the patient in 14 days and look for bone callus, which takes 14 days to develop after a break. I would encourage you to return to a doctor (perhaps one who knows the book), and have it x-rayed again. Clearly, something isn't right for you to still be in pain at this point with a painful lump.
Answered on Oct 3, 2016
1
1 thank
Dr. Jeffrey Wint
35 years experience Hand Surgery
You : You might have had a small fracture but likely that would not be as symptomatic now. Other things include a bruise to or near an arthritic joint which may yield more long term effect than expected additional x-ray views of the base of your thumb and your wrist mat be helpful as an exam by a hand surgeon.
Answered on Oct 3, 2016
Dr. Monica Wood
28 years experience Hand Surgery
There : There are a number of injuries that can occur in this area. The other respondents have listed some of them. Going through the anatomy from the wrist to the thumb: tendinitis can occur betweent the wrist extensors and thumb extensors at the "intersection". It can also occur along the thumb tendons in the first dorsal compartment--called dequervain's tenosynovitis. A fracture can occur along a small part of the radius, called the styloid. When it is not out of place, it can be easily missed. These small fractures are often overlooked or discounted, but can be associated with a much more serious injury involving a tear in the scapholunate interosseous ligament. This ligament is part of the cornerstone of the wrist. When it tears, the whole wrist can collapse in a condition known as scapholunate advanced collapse (slac). Just past the radial styloid is the scaphoid. This is a difficult bone to assess and it's even harder to heal. Often, the first x-rays will not show a fracture. After a couple of weeks, a faint line may appear, but not always. If not immobilized promptly, they have a tendency to not heal (non-union). This process can also destroy the wrist in what is called scaphoid non-union advanced collapse (snac). As you move toward the base of the palm, there is a joint called the basilar joint, trapeziometacarpal joint, or carpometacarpal joint (all the same thing). There is a stout ligament, called the beak (or volar oblique) ligament, that can be torn. In a young person, this should be reconstructed. Again, disruption in this area can lead to arthritis. This joint frequently causes arthritis symptoms in the hand. Beyond that is the thumb metacarpophalangeal joint. There are several stout ligaments that can be injured here. The ulnar collateral ligament is most common--located on the side toward the index finger. When acutely injured, it is known as "skier's thumb." chronic injuries become known as "gamekeeper's thumb." depending on the severity, these may or may not require surgery, but do better with immobilization. The radial collateral ligament can be injured in a similar way. It is on the side opposite the index finger. Also, the volar plate can be torn on the palm side of the joint and allow the thumb to bend backwards. Also at the metacarpophalageal joint, you can have a sesamoid fracture--fracture of a small bone that "anchors" the ligaments and tendons in the area. You can also develop a trigger thumb (catching of the tendon) or a flexor tendon sheath ganglion--a cyst that forms from leakage of fluid from around the tendon. On rare occasion, these can occur after a trauma. Further toward the thumb tip, you can have a mallet thumb (unable to extend the tip because of a tendon rupture) or a flexor tendon rupture (unable to bend). Ligaments in this area may be injured as well. There are also a series of bands, called pulleys, that hold the flexor tendon in place. A rupture of one of the pulleys can be painful and cause the tendon to deviate from its normal position. The conditions above assume "normal" x-rays or small fractures that can be missed. Other fractures can occur as well. The bottom line is that there are a lot of things that can happen to a thumb that do not necessarily show up on x-ray. Evaluation by a hand surgeon can help you locate the injured structure(s) and determine a treatment strategy.
Answered on Oct 3, 2016
4
4 thanks
Dr. Christopher Henley
20 years experience Hand Surgery
It's : It's hard to tell exactly where your pain is but if it's where the thumb joins up with the wrist, deep down inside, it's possible you've broken your scaphoid bone. You can check yourself by googling "where is the anatomic snuffbox?" and pressing on this area. I'm just imagining the worst thing it could be. If you have pain here, you need a series of x-rays by a hand and wrist surgeon. It may just be a ganglion cyst, which can sometimes become noticeable after a fall like this.
Answered on Oct 4, 2016
3
3 thanks

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