CRPS – Pain After Wrist Fracture

Notes From A Fracture Clinic

You always get one eventually.

One after another the assembly line of wrist fractures goes through the clinic. They arrive in their backslabs (half plasters) that Accident and Emergency have put on. Once seen by the doc they have the plaster completed. Then they get the advice and exercises and an appointment for five weeks.

On return the plaster is taken off and we get the first look at the whole hand and forearm. Most are ok although they could do with a good wash. Some however are not.

This one wasn’t. The lady in her 60s came along with her daughter. She held her hand out stiffly for me to look at.

The hand and wrist were puffy and a little shiny as the swelling had eliminated some of the wrinkles. She held her fingers in a slight bend and couldn’t do much to change them.

The hand was painful to attempt to move and when I touched it. Movement was limited and the hand could not be used effectively.

She was, not surprisingly, being protective with the hand as it was so painful.

After the assessment I had to decide what to do. This lady’s instinct would be to do as little as possible with the hand due to the pain. I had to get through to her how serious this could be.

I explained about the hand and what the potential problems could be. I encouraged her to do the exercises and not to pay too much attention to how bad it felt. Then I said “If you don’t do what I suggest then your hand could become worse than you can possibly imagine”.

The look of shock on their faces was clear. I felt the risk was worth it because CRPS is bad. Very bad. “Come back in four days and show me your progress” I said as I wrote the physio referral. I couldn’t risk her sitting for weeks on a physiotherapy waiting list. I had to see what changes she was making in the short term, to get her going.

When she came back the hand was much more mobile, less swollen and more functional. She said “You really shocked me when you said that about my hand last time”. “Sorry”, I said “I wanted to be sure you knew what could happen if you didn’t get over the pain and do the work”.

Sometimes it’s worth being really, really frank. Because the result of it turning out badly can be well, really really bad.


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