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pup_on_the_mountain

Wrist pain (not Carpal tunnel)

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I've been having some pain in my right wrist for more than six months now. It hurts most when I lift loads with my wrist twisted down - think about carrying a heavy suitcase, but holding its handle higher up than when your hand is pointing straight down from your shoulder. Another (possibly better) illustration might be hanging (or pulling hard) on my quark (ice tool). It also gets soar from typing a lot on my laptop or PC. I really cannot avoid typing (and I'm right handed), and hence I shake my hand out frequently when typing for a long time. It does not hurt if I'm pulling on loads straight up or down (such that my wrist is not twisted). So, it doesn't bother when doing push-ups, as long as I'm careful not to twist or load my wrist.

 

I saw my primary care physician about this issue back in January, and he put me on Naproxin (Aleve) for four weeks (two tablets twice a day, and more in case of excess pain). The pain subsided when I was on the medication (and doing normal things including climbing and typing), but came back as soon as I stopped taking the pills. I did not want to take too much of the pills -- the pain was not unbearable, and I did not feel it when not putting stress or strain on my wrist. Hence I stopped taking Aleve. The doctor told me that I might have to rest my wrist fot a long time (may be up to a year) before the pain goes away. I do not remember falling on my wrist any time. My doctor's diagnosis was that I was short on the lubricating fluid in the cavity that connects the bone in my forehand (ulna) and the carpal bones. This condition typically happens due to over-use (from typing and/or climbing?). I was thinking carpal tunnel, but I do not have some of the typical symptoms associated with it (like tingling sensations). I also do not have any pain in any other bones or joints. In extreme cases, one could inject some fluid (or a steroid?) in this cavity, and that is supposed to relieve the pain; but since mine was not that extreme a case, he suggested not to do it. As an alternative, he referred me to physical therapy. I've had seven or eight visits to my PT since then, and she has suggested putty squeezes to inclease blood flow to my wrist/palm, and other exercises to strengthen surrounding muscle groups (forearm, wrist etc.). Things have not improved much though. I've not been climbing hard on my right hand/wrist for the last month or more (heck, I've not been climbing much at all), but have been doing the usual load of typing. I'm starting to lose faith in PT.. :cry:

 

Has any one had the same/similar condition/symptom? What was your experience? Are there any supplements that I could take to help with the recovery?

 

Sorry for the longish post and TIA.

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I'd get a second medical opinion. I had a good experience down at the UW orthopedics and sports med. clinic. There is a surgeon there named Thomas Trumble, and he's basically the best hand dude you can find in the country. They've also got several top not hand therapists - I know because my mom works with some of them and also Dr. Trumble.

 

I'm not qualified to diagnose what your problem is, but I've had my fare share of wrist carnage. ITS NOT FUN. If you've got the time and insurance coverage, I'd get in to that clinic.

 

A year of rest is too much if theres something else you can do about it.

 

http://www.orthop.washington.edu/uw/tabID__3349/Default.aspx

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Do you have any numbness or weakness?

 

hold your arms out in front of you and press the back of your wrists together. Hold it for 1 minute. Does the same pain come back?

 

Edited by tlinn

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Not to sound like an anatomy snob but just to clarify, the distal radius articulates with the carpal bones, not the ulna. It forms a synovial joint so it would have synovial fluid but I don't think a lack of fluid is the problem.

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Do you have any numbness or weakness?

No.

hold your arms out in front of you and press the back of your wrists together. Hold it for 1 minute. Does the same pain come back?

No.

he distal radius articulates with the carpal bones, not the ulna. It forms a synovial joint so it would have synovial fluid but I don't think a lack of fluid is the problem.

If I remember correctly, the doc (and my PT) talked about the place where the ulna meets or rubs against pisiform and triquetrum. My PT showed a picture (from some Anatomy picture book if I remember correctly) that is quite similar to the one below. As far as I understood, she was talking about the fluid in the cavity between the articular disc and ulna; but I might be wrong.

 

xsection.gif

 

 

The pain is pretty much concentrated on the bony projection of the ulna and a surrounding area of 1/2 inch radius.

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Thanks for the suggestion ils.. being in Pullman, seeing an ortho in Seattle might not be all that feasible. In any case, I'll go see an othro nearby (Pullman-Moscow or Spokane).

 

A year is indeed a long time.. and I simply cannot afford not to type for a year (unless I want to get deported back to India :noway: ).

But the doc was probably describing a single case in which it took a year to heal.

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i've had similar symptoms: years ago from too much line cooking, and currently from too many Indian creek fist cracks.

 

are you icing your wrist?

 

what do you do with your hands when you sleep?

 

whenever i fuck up my wrists i start doing weird protective things in my sleep, like bending them under the pillow or under my chin and it becomes this chronic issue because they are never able to recover. eventually i have to start sleeping with wrist guards on and about 3 weeks later the pain is usually gone. like your doc said there is proabaly not enought lubrication down there, the ice will help flush out scar tissue and bring in blood, and the wrist guards will allow your wrist a chance to recover. also: bromelain and arnica as supplements to aid with the inflammation, aleve is only slowing down the healing, that shit is toxic.

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Pup, I'm still not clear if it hurts on the pink (ulnar) side or your thumb (radial) side of your wrist?

 

Assuming these questions are no: You didn't fall on an outstretched hand. You don't have point tenderness over your scaphoid. There is no excessive popping and clunking in your wrist. Then these are my two major diagnosis (re:guesses over the internet) depending on where it hurts.

 

If it's your ulnar side then it sounds like you've injured your Triangular Fibrocartilage between your distal ulnar, and your triquetrum. Think of it as your "wrist menisus" With no direct blood supply, and injury to that can take a long time to heal without the right treatment approach.

 

If it is on your radial side, do this: Make a fist with your thumb tucked inside. Hold your arm straight out with the thumb side up (Still tucked in). Now ulnar deviate your wrist to the floor (flex your wrist sideways toward your pinky finger). Does that cause severe pain? If so, then it could be de Quervain's Disease...which is basically a tendinopathy of your thumb muscles...also a bitch to heal without proper Tx.

 

So...which is it? Thumb or pinky side pain?

 

 

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Layton, its the ulnar side (pinky side). I do not feel any pain on the thumb side. The answers to the three questions you listed are indeed NO (I can't recall falling on my hand, no pain over scaphoid, and no popping).

 

So, if indeed I've injured my "wrist meniscus", what do you recommend is the right treatment?

 

Frosty, I do ice my wrist - may be I'll make it more frequent. I don't think I'm sleeping with my wrist/hand in a weird position. I tried (as suggested by PT) ace bandage to get some support for my wrist, but it seemed to hurt more. So, I do no use any wrist guards. What kind of wrist guard do you use?

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i use standard sports wristguards with the plastic stiffener's taken out so that my wrist remains straight. ace bandage seems counterproductive cuz of the decrease in blood flow.

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i've had wrist pain like yours, pup. like frosty, i use wristguards at night, which helps a lot. climbing hard (not that I climb that hard) tends to aggravate it.

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Pup, ditto on the wrist guards at night and during wrist intensive activities :) -like driving, typing, and climbing for 4 weeks. Get the kind that go up over your hand, but find the most low profile one you can...I forget the brand but there's a flesh colored (for yellow people) brand that's soft and comfy.

 

Ditto on the bromelain for the inflammation, and ice massages. Maybe chondoitin or glucosamine SULFATE (not HCL) for the synovium and cartilage.

 

Work your wrist with weights or tubing and rubber bands for the fingers in PAIN FREE directions focusing on very high reps, low weight. You probably don't need to focus on the flexors. I'd adjust the carpal bones and the radius and ulna, but I'm a chiropractor. It helps a lot in tough cases.

 

Have someone work on the soft tissues around the area-in your hand, wrist and forearm.

 

If bugger all doesn't work, then get it x-rayed (which will probably show nothing). Then they're gonna want to MRI it, which will be excruciatingly painful. Or maybe they'll give you a cortisone injection which could help, but the wrist is not a place you want to make unstable! Then if that doesn't work, surgery. So yeah, you have to do those things if nothing else fixes it, but it'd suggest trying to fix it before it gets to the MRI/Injection/Surgery stage.

 

 

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Sorry pup,

 

I think Layton has mentioned the most likely things.

 

If you don't have pain on the radial (thumb) side then it's not De Quervain's.

 

If the pain is only with extension of the wrist I was thinking possibly tennis elbow (a problem that originates in the wrist but the pain occurs on the outside side of the elbow). You don't have any pain there so that sounds unlikely.

 

It is most likely an injury to the articular disc or a sprained ligament on the ulnar side (pinkie side).

 

Layton is 3 years ahead of me in school though so listen to him. Or better yet, go see him in Seattle!

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Thanks a bunch for the suggestions Layton!! I'll try the wrist guard. I'm doing exercises (high-rep, low weight) using a thera-band, and also using a light-weight cooking pan (don't have a dumbell rod at home).

 

Have someone work on the soft tissues around the area-in your hand, wrist and forearm.

 

What exactly do you mean by "work on"? Massage? And by "someone" you mean a PT or a Chiro?

 

The doc already took an x-ray early on -- everything looked normal on it.

 

 

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Yeah, massage. Have someone dig around for trigger points, tightness, or sore spots and rub and press on them real good (advanced massage therapists can roll your eyes...now).

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Thanks for asking, but its more or less the same as what it was before :anger:.

 

I have gotten a new chair to position me better in front of my computer at work, and started using a wrist guard with a splint.

The wrist guard is not perfect though - the split goes from inside my palm over to my forearm. It might be better if I can splint the

side of my hand instead. I couldn't find a wrist guard that immobilizes that sideways movement (think about moving your mouse

left to right on the mousepad while keeping your elbow more or less fixed).

 

I'm doing high-rep exercises to strengthen related muscle groups. May be it'll get better in a few weeks.

Technical climbing is out for a while I suppose :cry: .

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