By Tedler D. Depaynos, MD
The 72 year old lady patient was climbing their house steps when she slipped as she was about to reach the last step. To caution her falling down, she automatically raised her hands which landed on the floor protecting her face. She quickly recovered her pace but her right wrist became painful and started to swell. The following day because of the severity of the pain, she consulted their neighborhood “hilot”.
Her injured wrist was massaged and home made medical ointment concoctions were applied. She was told to have a severe “sprain” and she was advised to return every other day for “massage therapy” and application of the “ointment”. She faithfully followed the advice of the “hilot” but after 4 sessions, the pain became unbearable and despite the severe swelling her grand children noticed her wrist to be more deformed. They finally convinced her to be brought to the hospital which is 4 to 5 hours drive from their place.
Just by the looks of her wrist, a fracture was entertained. A plain x-ray confirmed the diagnosis but a more complicated pathology was seen. The distal ends of the bones called radius and ulna were fractured and the hand bones to which they were connected to were displaced or dislocated. She was immediately referred to an orthopedic surgeon who sought the assistance of a colleague with a hand surgery sub-specialty.
The attending MDs cannot imagine the pain that the patient underwent during her “massage therapy”. It probably caused or worsened the “dislocation”!
In “sprain” there may be temporary dislocation of the joints tearing the tissues or ligaments and capsules that bind the joints together. Depending on the severity of the trauma, the tear may be slight, partial or even complete but no resulting dislocation or fracture.
Being elderly already, the patient is prone to have fractures due to weakening of the bones called “osteoporosis”. Some may even slip and fall on their buttocks causing pelvic fractures. She was lucky she did not land on her face.
Fractures may have concomitant tearing of the blood vessels manifested by bleeding. In open fractures the bleeding may be obvious and continuous depending again on the site of fractures. In close fractures where there is no open wound, the blood may accumulate forming a hematoma. After sometime, the pressure of the accumulated blood may stop the bleeding but the area of injury obviously is severely swollen. This is what happened to the patient. She had a huge hematoma in her wrist probably enhanced by the massage.
The orthopedic surgeons decided to at least reduce the swelling before they do any operative surgery.
Being a “hilot” is supposed to be a natural talent. Some even say that it is inherited. We are familiar with several “hilots” who are even presumed to be guided by “unseen spirits” because they start their therapy process murmuring words usually in the dialect only they could hear or understand. Most of them however are wise enough to refer some cases that they think needs medical treatment to the hospital. In fact some of them even allow themselves to be hospitalized! The patient’s neighborhood “hilot” probably was an amateur.**
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