Perplexing Hand Injury

In Nov 11 I was playing ice hockey when someone hit my right hand (not sure if they "jammed" it or "slashed" it with a stick). I i felt pain but the hand never bruised, nor was it cut/visibly injured. Noticed a lump on my fourth metacarpal. I cannot say for sure if this lump was there prior to the injury or not.
If I gripped something and torqued my hand to the left (not wrist but the actual back side of it) it was very painful around the fourth metacarpal, or sometimes in the space between the 4th/5th. Also painful is using my hand bent back and turning a steering wheel, or anything that compacts the hand in a grip (like a handshake).  However, doing things like lifting weights when my hand is gripping the bar but not torquing the back of the hand does not particularly hurt.

Two sets of xrays were taken (one a week after the injury, one 3 weeks after the injury). Neither showed any sign of a fracture.

After a month of Naproxen 500mg/day, icing the injury, and trying to rest it, I had eye surgery. I continued to take the Naproxen and ice the hand injury while I was recovering. In January, I noticed that the hand injury was still present with little improvement.

The results of an MRI showed a palpable abnormality near the 4th metacarpal, but no tendon, ligament, or other damage. The overall result of the MRI was "normal". My hand was still not improving so I was sent to an orthopedic surgeon. The surgeon attempted to do tests on my hand to notice any obvious injury. He could not find anything wrong. The surgeon placed my hand under a "real time xray" (I don't know the technical term). The doc attempted to stress my hand while looking at the xray (such as pulling my fingers, moving my hand, etc) and could not see anything wrong.

He said that it was possible that I had a very slight dislocation that wasn't showing up on the xray or MRI. They ordered a CT scan, which was also negative. The doctor spent 45 minutes looking over the scans with the assistant, looking for even the slightest indication of an injury, but could not find anything.

The docs gave me an injection of Cortisone in the joint of the fourth metacarpal about 1/4" away from the wrist and upped my dosage of Naproxen to 1000mg per day. While the Cortisone/Naproxen has helped the injury significantly in terms of day to day pain, I can still feel that the hand is injured.

[Matth3w]

no one has any idea?

[S. Kaul, MD]

Hi there!

Well, since the physical exam and detailed imaging has not showed anything wrong, a major injury is unlikely. In such situations one may have to look at minor subluxations or neuro-muscular damage. Without a detailed clinical evaluation it would be difficult o comment specifically on the situation. If primary tests for neuro-muscular injuries turn out t be fine, physiotherapy may be an option worth considering. It would be best to discuss this with your treating orthopedician.
Hope this is helpful

Take care!