Ulnar Shortening Gone Bad

[AlaskaMegan]

In May o 2007 I broke my radius and ulnar styloid.  It was treated with reduction and casting.  It ended up healing short and slightly tilted (about 5mm shorter) which caused a positive ulnar variance.  I had constant pain for the first 6 months after the break and was recommended for an ulnar shortening. The doc that performed the surgery botched it and put in a plate that was too long, too far distal, and I went from full range of motion to 5 degrees of supination.  I was stuck for six months at which time a hand surgeon went in, replaced the plate with a smaller, more dorsal plate, performed arthrolysis, and sent me home.  I finally got supination back after three months in a DynaSplint, but have never been pain free.  I cannot supinate without mild pain, but the main pain occurs when supinating and holding something in my hand. The pain is dorsal, around the DRUJ and sometimes radiates down my arm to my elbow.  Testing in PT shows mild pain in pronation with resisted flexion, moderate pain in supination with resisted flexion, no pain in neutral. I am unable to hold even a book or a dinner plate in my hand without pain, and this is ten months after initial ulnar shortening, five months after the replacement.   Could it just be irritation from the hardware?  There is no arthritis on Xray, or any other apparent abnormalities. THere is point tenderness above the DRUJ.  The pain is worse in the morning, and worse with activity.  ANy ideas?  I live in a rural town in Alaska and do not have access to MRI, CT scan, hand therapists, or hand surgeons without a long and expensive trip out of town.  Any thoughts would be greatly appreciated.  I am a nurse and have explored many options.  But it does not see to fit the criteria for anything!  It isn't consistent with ECU tendinopathy, DRUJ incongruity, extensor tendonitis, etc.  

[AlaskaMegan]

Thanks for the reply.  I have consulted my GP and had an Xray.  The Xray looks good.  I also take Ibuprofen when the pain is bad.  The problem here is that in order to see a Specialist, I have to fly to Anchorage.  ANd none of the doctors here really know what is going on. I can opt to have the plate taken out next March, which I will definitely do!  Is it possible that one or several of the extensor tendons are rubbing on the plate, causing the pain?

[dr_simran]

Hello AlaskaMegan,

Most likely there has been some problem in the alignment of the plae. But how come you have been in so much pain since so long? Haven’t you consulted your GP. Take ibuprofen for the symptomatic relief. Also get an X ray whenever it is feasible.

Best