Houston Methodist. Leading Medicine

Hand FAQ

Question:

I fell yesterday right onto my left wrist. And wouldn't you know it? It's the same wrist I had carpal tunnel surgery on last year. Now my carpal tunnel symptoms are back. How can that happen?

Answer:

Rapid or immediate symptoms of carpal tunnel syndrome after a fall may be a sign of nerve compression from a bone fracture or dislocation. It would be best to have an X-ray and examination of the injury. Early recognition of the problem is needed to avoid long-term problems and complications. When there's enough force, ligaments are torn and the lunate (a wrist bone) is then forced into the carpal canal. With the lunate bone in the carpal canal, pressure is placed on the median nerve causing CTS. There may also be a loss of blood flow to the median nerve below the level of the injury. If this happens, the hand and fingers may become cold and pale or blue/purple in color. The American Society for Surgery of the Hand recommends that all hand injuries should be X-rayed. More than one radiographic view may be needed. A posteroanterior (back-to-front) view will not show a lunate dislocation. It is necessary to take a lateral (from the side) view. The lateral radiograph will clearly show the extent of the injury. The physician will check the pulses to look for any vascular (blood vessel) damage. With a bone fracture and/or dislocation, there is usually loss of normal motion. Pain and swelling limit motion. With ligament damage, dislocation, and/or fracture, the wrist is unstable. Surgery may be needed to repair and reconstruct the wrist. With early detection, the prognosis is good for this type of injury. Missed injuries with a delayed diagnosis do not respond as well. Injuries that are not properly diagnosed until two months or more after the injury may require more extensive treatment. Restoring motion, strength, and function is often not complete or possible. Edward J. Armbruster, DO, et al. Perilunate Dislocation: Case Studies of a Frequently Missed Diagnosis. In The Journal of Musculoskeletal Medicine. August 2008. Vol. 25. No. 8. Pp. 390-395.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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