Tissue heals on a timetable.
- Bone in six to twelve weeks.
- Tendon repairs get most of their strength back by twelve weeks.
- Skin closes in two weeks.
Pain does not always follow that timetable, and when it doesn’t, the usual conclusion is that something must still be broken.
Usually it isn’t.
Pain is produced by the nervous system based on how much danger it believes the hand is in. Once tissue is healed, that judgement can stay switched on long after the reason for it has gone.
First, rule out the things that are still wrong
This article is not about ignoring pain. Persistent pain sometimes has a persistent cause, and some of them are commonly missed.
- A fracture that never united — see scaphoid fracture
- A ligament injury missed at the time — see scapholunate injury
- Nerve compression developing after the original injury
- Metalwork that is irritating a tendon — see EPL rupture
- Scar bound to the structures underneath — see scar management
- CRPS, where pain is disproportionate and comes with swelling, colour, temperature and sweating changes. This one is time-critical and should be excluded early, not late
Get examined before you accept the label of persistent pain.
What changes when pain persists
Three things, all of them reversible to some degree.
- The alarm gets more sensitive. The system turns up the gain, so normal touch and normal load start registering as threat
- The map gets blurry. The brain’s representation of the hand becomes less precise when a hand is guarded and used less. That blurring is itself associated with more pain
- The behaviour reinforces it. Protect, use less, lose capacity, hurt at lower loads, protect more. The loop is the problem, not any single step in it
Hurt is not the same as harm. After healing, pain is a statement about sensitivity, not about damage.
What actually helps
- Graded exposure. Not rest. Pick something you avoid, do a version of it small enough to be manageable, and repeat it daily. The nervous system updates on evidence, and the evidence has to be your own hand doing the thing
- Use it in real tasks. Washing up, carrying a bag, turning a key. Function retrains the map better than exercises do
- Desensitization. Different textures over the sensitive area, several times a day, a few minutes at a time. Uncomfortable at first, effective over weeks
- Sleep. Poor sleep raises pain sensitivity measurably. It is one of the strongest levers and it gets ignored because it sounds too simple
- Understanding the mechanism. People who understand why pain persists report less of it. That is a real effect, not a consolation prize
- Pace by quota, not by feel. Decide the amount in advance and do that amount whether it is a good day or a bad one. Boom-and-bust keeps the system on alert
The patients who get stuck are almost always the ones waiting to feel ready before they use the hand. The hand does not get ready first. It gets used, and then it gets ready.
What doesn’t help
- More scans, once the structural causes have been excluded. Each one finds more incidental findings to worry about — see your hand MRI report
- Resting until it stops hurting
- Escalating pain medication indefinitely. Diminishing returns and real costs
- Being told it is all in your head. It is not. It is in your nervous system, which is a physical organ doing a physical thing
Go back to someone if
- Pain is getting worse rather than plateauing
- New weakness, numbness or visible wasting appears
- Swelling, color change, temperature difference or altered sweating
- Night pain that wakes you consistently
- You have stopped using the hand altogether
And if this is affecting your mood or your sleep, that is a normal consequence of months of pain and worth saying out loud to your doctor.
A healed hand that still hurts is not a hand that failed to heal. It is a hand whose alarm has not yet been told the emergency is over.
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.