Wrist frozen after cast was removed

It’s been hectic again, I travel so much! I was in Western North Carolina teaching at the World Massage Festival and the entire time I was there I was unable to get online. It seems the entire school’s internet service was out so everyone was stuck…bummer! In any case, I’m only finally getting caught up with email, etc., and I apologize for the delay in both this blog and in my forum answers (if you posted something there).

A woman posted a message on the Hand/Wrist Forum that I think is really important, so I’m going to copy it here and then post the message that I gave her.

The answer I’m giving her is about treating a locked wrist after the cast is removed, but the theory is exactly the same regardless of which joint was broken. If muscles are tight, that joint isn’t moving until they are released.

Here’s the message:

I broke my wrist..the radius, in two places. The over the elbow cast was replaced after 3 weeks, the shorter one taken off at 6 weeks. Had significant tightness/loss of motion in elbow/better now but still slight pain/tightness. My hand after getting cast off 7 days still quite swollen. Cannot flatten my palm, can not move my palm up at all and only slightly down. I have been massaging my hand, still icing it, trying to move it gently. I see a tiny bit of improvement. I am getting scared, it is my dominant hand. The resident that discharged me gave me nothing to guide me, just said, start using it. It is extremely weak, as well. I bought your book and was getting ready to work on problems that cause my right pinky and ring fingers to be numb and then I broke my wrist. I have had that for 2 years. So, I am wondering if that problem is impeding healing. I don’t want to damage my hand. The resident said to come back in 6 weeks and if not better..THEN physical therapy. That does not seem right to me.

I agree with you that you shouldn’t be leaving it for six weeks, but I also believe that you are definitely on the right track by thinking about releasing the tight muscles so they will stop putting pressure on your wrist joint.

When you break a bone the muscle that inserts into that bone will snap back and suddenly become short, putting a strain on the insertion point at the joint. when the bone was then set, I would be surprised to hear that anyone released the tension in the muscle fibers, so it was/is still pulling on the insertion point. Think about pulling your hair hard and then trying to move your head in the opposite direction. That is exactly what happens when the muscles are pulling tightly on the joint and you try to move it in the opposite direction.

Just from what you are describing I would say your flexor (underside of your forearm) and extensor (top side of your forearm) are both tight. Another analogy is to think of having a stick and then pulling hard on attached ropes that go in both directions. As you are pulling you are unable to move the stick either way because you are pulling in both directions. Same thing with the flexors (move your palm down so you can press your hand into a table top) and extensors (move your hand up so your fingers are pointing at the ceiling). You may like to do an internet search to look at both sets of muscles, or you can go to http://www.carpaltunneltreatment.org and then look at the section called Anatomy Lessons.

You don’t need to do any exercises, that will only make the muscles even shorter, you do need to find the spasms, apply direct pressure, and then after all the spasms are released you can begin to stretch.

I just came back from breaking both of the bones of my ankle (my foot wasn’t attached to anything) and I worked on the muscles the entire time I was in the hard cast (reaching as far into the cast as possible), and then when I was out of the hard cast and could reach my leg by unbuckling the boot, I worked on every muscle from my knee to my toes. It was painful, it was very focused and slow, but within two weeks of being out of the hard cast I had full range-of-motion in my ankle (even though I was still non-weight bearing for another two months). The doctors were shocked, but when I tried to show them what I had done the doctor said “that’s not my field, I don’t deal with muscles, just bones.” I couldn’t believe it!

YOU are your own best therapist in this situation. You need to work on all of the muscles from the front of your shoulder all the way down to your thumb muscle in your hand (the rest of your fingers are moved by your flexors and extensors). Massaging your hand is like pulling your hair as hard as you can and then massaging your scalp to stop the headache. Your hand movement comes from your forearm and that’s the only place that will work when you are trying to make a difference.

I suggest you read the entire website thoroughly so you can understand what is happening, and if you didn’t read the Home Page of http://www.julstro.com, it will definitely be worthwhile for you to do so. Also read the sections titled “Muscles and Pain” and “What’s Happening Exactly.” You can release the spasms, I’m sure of it. By the time you go to the PT (who is going to give you exercises) you’ll have full movement of your hand and wrist again and be ready to do the strengthening exercises to finish off the situation.

Wishing you well,
Julie

2 thoughts on “Wrist frozen after cast was removed

  1. twobad11

    Dr. Donnelly,

    I am a senior Warrant officer in the Army. I just had a long 8 week period in a cast for a wrist fracture/Dislocation surgery. Was wondering if my Doc is telling me everything I need to know. Is it usual to have a very stiff wrist after cast removal? I have been working my muscles…. but it does not seem to affect the mobility. If you coud help me understannd what exercises in the forearm i should be doing, it is appreciated. I cant move my hand more than a couple centimeters either up or down. Howeer, been trying to keep my sexy at the gym. thanks

    Chief

  2. Julie Donnelly Post author

    Hi Chief,

    I totally understand the stiffness when the cast is removed. The problem is that your muscles snapped back into spasms when you had the initial break, and then the bone was fixed but the muscles weren’t released. As you were in the cast the muscles just got tighter and tighter. The analogy I use is, if you pulled your hair hard on the right, and also pulled it hard on the left, you wouldn’t be able to turn your head in any direction, but all you need to do is let go of your hair.

    It’s the same with muscles. When they snapped back into the spasms, it was the muscles on the top of your forearm (the extensors; lifts your flat hand up off a table toward the ceiling) and your flexors on the under side of your forearm (brings your hand down). Because they are both tight you can’t move up or down. Plus there is a muscle called brachioradialis that brings your hand to the side (thumb moving sideways). With the muscles pulling in all three directions you can’t move. You need more than just a massage (doesn’t get to the deepest fibers, even if it’s called a deep tissue massage).

    Have you looked at http://www.CarpalTunnelTreatment.org? You can self-treat the muscles properly and successfully. The treatments are very deep, and focused on specific spasms, but it’s not hard to do. Don’t get discouraged, I know you can make it 100% better by releasing the tension in these muscles.

    Wishing you well,
    Julie

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