Patient: Late last March, I sustained a hand injury, a half inch rope was under great strain and snapped, the backlash his the back of my right hand through two layers of gloves.It caused a lot of swellings and yellowing on the area of impact, mainly around the fourth metacarpal of my right hand. I went to the local health center and had them take some x-rays of my hand, 3 from different angles. They told me the lab results showed my hand to be “perfectly fine.” It has been a little over four months since the injury, I still have a small lump where the injury was and I noticed that my fourth metacarpal appears to have shortened about 1/4th to 1/3rd of an inch. The knuckes of my ring and pinky joints appear to be perpendicular to my wrist, rather than being slanted and lined up with the middle joint (like my left hand appears). I was wondering if I should be concerned about the apparent shortening of this bone(?), considering the health center told me that my hand was “perfectly fine.” Do I have anything to worry about? Or should I get another checkup and see if everything really is fine? (By the way, I have full range of movement of that hand and there is no discomfort, i’m mainly concerned about long-term problems this might cause_
Doctor: HelloThanks for posting your query at ATDIt is a unusual case with shortening of Metacarpal, swelling and indurati on of soft tissue is normal and can take upto 6 months to fully resolve.Judging by no bony injury at initial evaluation and presently full range of motion there doesn’t seem to problem with your hand but I would still like to see the image of your affected hand laid flat on the table alongside unaffected hand for evaluation.My question is since when have you noticed the change in shape of your knuckles and decreasing length of bone.Kindly follow up with the image of your hand along with any doubts. Feel free to discuss.Regards
Comments / Follow Ups
Patient: Hello again, Thanks for the swift response.
I thought it appeared shorter shortly after the injury but I figured it would go away with time. I usually notice the difference with a closed fist, but maybe that’s a poor thing to go off of.
Doctor: I’m sorry to say and I understand your concern there is definitely some decrease in the prominence of knuckle in closed fist as well as when laid flat on table. Kindly get a xray of your hand and visit your local orthopaedic surgeon for clinical examination.
I’ll be glad to help you in case you can provide both recent and past xrays for comparitive evaluation. Long term effect can only be commented after confirming the diagnosis.
Feel free to discuss further.
Patient: I looked at the original xray. The bones back 2-3 days after the injury do not show anything interesting. Though these were the x-rays I took somewhat recently and something does show up.
Sorry for waiting so long to respond.
Doctor: These xray do show fracture fourth Metacarpal healed with few degrees dorsal angulation causing shortening of the ray or finger. This is the final outcome of the fracture. I expect now this hand to be pain free, with some amount of swelling felt over the dorsum/back side of the hand.