Pisiform fracture healed, but I have chronic pain after a year, doctor says nothing is wrong

Hello,

This is going to be very long, but I think all the information is important. Thank you in advance if you are able to help!

Some background on me before I begin- I am a 25 year-old female. My height is 5’4” and I’m about 140-145 lbs (BMI is around 24%). While my BMI is higher, I do not find myself to look anywhere near obese. I exercise almost daily and try to eat healthy (always cook meals at home, I avoid sugar/excess carbs). I don’t have any allergies that I know of. I have Thalassemia (not sure if it’s minor/intermedia, beta/alpha) with my normal hemoglobin count being about 9.5-10 grams per deciliter. My mother has hypothyroidism, and my maternal grandmother had breast cancer and a stroke. My father’s side has high blood pressure, some with heart attacks.

I’m writing this because I’ve had a long and painful journey healing from my injury. I was in a car accident 4/3/19, so it has been one year now. My right hand was flat on the wheel while honking the horn, then I t-boned another vehicle at 35-40 mph, and the airbag did go off. The impact went right into my wrist and arm, as I tried to hold my head and body in place.

I got a pisiform fracture (which is apparently very rare, only about 1-3% of all wrist injuries), as well as a concussion and neck muscle spasm. The ER did not see the fracture in the X-Ray, so I did not get a cast like I should have. Three weeks after the accident I found out about the fracture. As of right now, while the fracture does appear healed and all tests look normal according to the doctors, I am still experiencing chronic pain in my wrist and elbow, and sometimes in my shoulder and neck.

I did everything recommended by my doctors. I’ve been going to the doctor’s regularly since the accident. I started taking B Vitamins as directed by my doctor, as well. However, all the care I’ve received has only helped up to a point. Around June of 2019, the amount of pain I had plateaued, and has not improved since.

I had multiple X-Rays of my wrist, one of my elbow, another of my neck and spine, an MRI of my wrist, and an EMG of my right wrist/arm. I also did Occupational Therapy in October 2019, and while the therapy improved my overall function (strength and flexibility) it caused a significant amount of pain. The pain did not improve after that.

The pain is concentrated at the site of the injury, in the left side of the ball of my right hand (when looking at if from the palm). The main thing that causes pain is pressure on my wrist and elbow, and doing repetitive dexterous movements. It seems to get irritated and inflamed from these actions, and causes pain for a time after the fact. Sometimes I’ll get random bouts of pain that are intense and throbbing. The pain also frequently goes up into my pinky. The level of pain can be anywhere from a 1-2 out of 10, to 3-4 out of 10.

I am almost completely numb at the site of the injury. From there, going down to my elbow, my skin is desensitized. That’s not completely numb, but it certainly doesn’t feel the same as my other arm. My wrist also pops abnormally compared to my other wrist.

During this journey of caring for my wrist, I feel like all my doctors have not truly cared to find what’s wrong. Of course at first, I thought I might just need extra time. But at the six month point, it seemed like I was on a goose chase, with no helpful answers. Now at the year mark, I find it nearly impossible that I could be experiencing this pain without something being wrong. It is extremely frustrating to go to all these appointments and spend all this money with no solid answer, and also not being taken seriously by doctors. Unfortunately, I find it hard to trust many doctors after these experiences.

I think it is important to mention that my Orthopedic Surgeon Hand Specialist doctor recommended I see a Rheumatologist to rule out a possible autoimmune disease causing inflammation. The Rheumatologist looked at me like I had three heads when I came in. I’m not sure if that was incompetence on the part of my Orthopedic Surgeon for recommending it or the Rheumatologist for not taking me seriously. However, I do wonder if an autoimmune disease is possible. I researched common symptoms of diseases like Lupus, and chest pain is one of them. I’ve had unexplained sternum pains since about 8 years ago. At the time, my PCP diagnosed Costochondritis with no specific cause. I had an Echocardiogram performed to rule out a heart issue. While this isn’t definitive evidence of me having an autoimmune disease, it does seem like it’s possible.

I hope this information helps. I am truly desperate to find some sort of solution to this. I want this situation to be over. I suppose I may just be stuck with this pain for years or life, but I want to do anything I can to prevent that.

If it helps, here is a dated list of all the doctors I saw and the what/why:

• 4/3/19 - ER visit
• Did an X-Ray and examination on my right wrist, diagnosed a wrist sprain. Received splint.
• 4/4/19 - PCP visit
• General checkup, diagnosed a concussion and neck muscle spasm, as well as contusion of right wrist. Prescribed extra strength naproxen sodium
• 4/11/19 - PCP visit
• General checkup (needed a medical excuse note for work).
• 4/24/19 - Sports Medicine Physician visit
• Did an X-Ray and examination of the right wrist, diagnosed a nondisplaced pisiform fracture. Changed from splint to wrist brace. Said it should heal within 3 weeks.
• 5/7/19 - Orthopedic Surgeon (#1) visit
• Went in for right elbow pain related to the accident. The pain was initially only in my wrist, but began traveling up my arm, and was concentrated around my elbow. He took X-Rays of my right elbow, but did not diagnose anything other than tendonitis.
• 5/23/19 - PCP visit
• Went in for a second opinion of wrist and elbow pain, and to get a recommendation for a new orthopedic doctor. Sports Medicine doctor and Orthopedic Surgeon (#1) both suggested I should be healed by this point, but I was still experiencing pain. The pain certainly improved from the initial encounter, but not close to being completely alleviated. PCP recommended another Orthopedic Surgeon (#2).
• 5/29/19 - Sports Medicine Physician visit
• Follow-up appointment. Took X-Rays and he said it looked healed and normal. He ordered Occupational Therapy and MRI Arthrogram of right wrist. I did eventually get these things done, but it took forever because I lost my health insurance, and auto insurance has a long process to approve procedures. He had me take the wrist brace off.
• 6/3/19 - Orthopedic Surgeon (#2) visit
• Came in for a second opinion on wrist fracture and elbow pain. Recommended an MRI, OT, and possibly a CT Scan. Said to wear brace during higher risk activities. No additional diagnoses, but he said I should be healed by that point, and that there’s probably nothing serious going on.
• 7/3/19 - Sports Medicine Physician visit
• Follow-up appointment. Still experiencing the same level of pain at this point. He still wanted me to do the MRI and OT, but understood the auto insurance would prolong it. He said I should not still be experiencing pain like I was. He ordered me to see an orthopedic hand specialist.
• 7/9/19 - Orthopedic Surgeon (#3) Hand Specialist visit
• Did an examination of my right wrist and elbow. He noticed the spots that were tender and said it is possible there is a TFCC tear, so he also wanted an MRI. He did a lidocaine injection in my right wrist to help the pain. This did not actually help.
• 8/22/19 - MRI Arthrogram
• Finally was able to get the MRI Arthrogram performed. Report states there is a ganglion cyst, but does not report TFCC tear. Pisiform healed normally. The ganglion cyst was likely already there before the injury.
• 8/29/19 - Orthopedic Surgeon (#3) Hand Specialist visit
• Follow-up after MRI. Dr. Palumbo reviewed the report and said there is nothing to diagnose. Pain is still the same. He suggested following through with the OT. Until my next appointment with him, we had several phone conversations, in which he recommended that I see a spine specialist and also get an EMG performed. He said the pain may be caused by something in my back or neck, and/or it’s nerve damage.
• 9/30/19 - PCP visit
• Came in for sudden neck pain and headaches. He suggested Physical Therapy for my neck. The pain subsided after two weeks, so I did not follow through with the PT. This pain came back a few times randomly after this, however.
• October 18, 2019 to October 30, 2019. Total of 6 appointments - Occupational Therapy
• Before the appointments, we had a consultation, in which he provided me with at-home exercises. I did them from September 9, 2019 through the end of OT. After OT, he gave me another set of at-home exercises which I continued for about three weeks. Occupational Therapy and the exercises helped with strengthening, but caused much more pain. Orthopedic Surgeon (#3) gave the ok to stop exercises after reporting this.
• 12/12/19 - Spine Specialist visit
• Around this time I started experiencing shoulder pain. Went in to have my back/spine examined (suggested by Ortho #3) to see if that could be causing my wrist and elbow pain. Did a whole spine X-Ray, did not find any problems. He ordered Physical Therapy for my back.
• 12/20/19 - Neurologist - EMG test
• Performed EMG nerve test, did not find any nerve damage. Diagnosed Paresthesia of skin.
• 12/27/19 - Orthopedic Surgeon (#3) Hand Specialist visit
• Follow-up after EMG. Looked at tests and reported everything was completely normal. He said healing may just take more time. Also had shoulder pain at the time, and he recommended PT. Pain was otherwise the same in my elbow and wrist. He said if pain continues, I should see a Rheumatologist to rule out a possible autoimmune disease, which could be causing inflammation..
• 2/13/20 - Rheumatologist
• Looked at routine blood work and said everything is normal. There is no rheumatological issue that she could find.

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