[Fiend]

Did "something" to my wrist at the wall yesterday. Have booked in to see a physio tomorrow but am after ideas and advice in the meantime.

Cause...
Not quite sure. I was well warmed up nearing the end of a easy-mid grade circuit, and doing a few juggy problems on steep terrain. At some point during the last few problems it started hurting when I moved my arm/wrist position on jugs. There was no clear tweaking point and no particularly outrageous movement I was doing.

Previous history...
None. Never had any problems with my right wrist - it gets regular exercise.

Symptoms...
Area of pain is on the little finger side of the wrist, from the dip left of the base of the thumb muscle leftwards (palm up). AOP extends a few inches down into forearm depending on movement, on the inside of the wrist. On the outside of the wrist, AOP is just around the wrist bones and does not extend downwards. No pain upwards into palm on either side.

No pain when fully at rest / immobile, but noticable pain with a few different movements:
- Moving hand in complex rotations produces the most pain, throughout the area. Sudden movements are the worst. I was struggling to move the wok around doing a stir-fry last night.
- Rotating inwards / outwards produces noticable pain, inwards being worse.
- Moving palm sideways inwards / outwards (i.e. parallel to fingers) produces mild pain. Moving palm inwards / outwards produces no pain.
- Clenching fist / crimping / pulling with fingers produces little / no pain, but wrist movement in that position produces pain.
- Stretching the wrist back in the classic forearm stretch produces mild pain. Stretching the opposite way produces no pain.
- Pressing and massaging the area produces mild pain in the area, but no pain when pressing hard on bones.

The pain tends to be sharp-ish but not extreme. It feels reminiscent of an impingment pain (as per shoulders).

Any ideas

[mikejones]

Hey there!
Your symptoms sound very similar to my own, is it a sharp pain you experience similar to an electric shock or pin prick (but very minor pain levels)? Further symptoms which I have which may/may not be related are very tight muscles in the forearm and currently inflamed golfers elbow.

I have seen two physiotherapists about this, the first didn't seem to have much of a clue. The second physio reckons that I have damaged the flexor retinaculum on the medial side. This piece of tissue I believe plays a similar role to that of the pulleys in the fingers. I believe my diagnosis was based on three things, firstly the site of the pain, very similar to what you described. It was also based on the fact that I experienced pain when my fingers were extended or in open hand position, less pain experienced when fist clenched or in a crimp position. My climbing history also fitted the injury, I had recently changed from crimping to open handing everything and increased the intensity of my climbing and the injury most likely occurred due to overuse as the retinaculum was not used to the loads I suddenly started to place on it.

I am currently in the stage of healing the injury but have had a number of relapses. My physio recommended complete immobilization for 7-10 days to allow scar tissue to form, light bumb bell exercises were suggested to combat the golfers elbow, help stretch the forearm muscles and encourage blood flow.
After the immobilization stage, very SLOWLY introduce strengthening/ re-educating exercises for the tendon to be able to properly function under load and to avoid re injury. These exercises involve regaining full range of motion in the wrist, firstly without weight and then with very small amounts of weight. He also suggested slowly introducing gripping exercises, starting off with gently squeezing a ball to stimulate blood flow. After 3 weeks (and a check up) I will be allowed to slowly start climbing again.

The pain I am experiencing is only minor and the course of action, which involves no climbing for 3 weeks and only a re-introduction to bouldering after 6 weeks seemed at first a bit extreme to me but I believe it will help nip this injury in the bud as I have been on and off (mostly off) for the last 3 months due to the injury. One piece of advice which I strongly recommend, if we share the same type of injury, and that i have been using as a mantra is "no pain does not equal no injury". When I first injured the wrist I took a week off and the pain disappeared so I quite quickly (after a week of climbing) returned to full intensity which involved 2 days on and one day off. This resulted in badly re-injuring the wrist and my current 3 months of fun.

Apologies for this essay! I would be very interested to hear what your experience is and what feedback you get from your physio. There doesn't seem to be too much literature on the web about this injury.

All the best,
Mike

[rginns]

My pain sounds very much like yours Fiend., except on the left. The cause seems to differ as I did get a noticeable twang., as if something went suddenly. However., its just painful when I load it., nothing otherwise. How long did it take before yours cleared up or is it still dodgy.? Are you doing any specific exercises to help.?

[Duncan Disorderly]

Overuse? 

 

[Fiend]

Not enough, that's the problem, it needed more regular gentle exercise and stability obviously.

TWAT.

[Fiend]

rginns, sorry to lazy to think about it now, this is what I wrote on my blog:

I have somehow picked up a tendinopathy on the inside of my wrist on the little finger side. This "appeared" without any obvious cause sometime during the latter stages of the easy-ish green circuit at TCA. I'd warmed up well with a hobbling micro-run, felt fine on the circuit, and somehow during the last few problems my wrist started hurting, especially on any occasions where I was moving it relative to my hand. I stopped after a couple more problems, went home and iced it, but found I couldn't even slide a wok around whilst cooking a stir-fry. The next day it was hurting more so I went to the New Victoria MIU in case it was broken. Swift service there and some prodding, pressing and pulling gave a diagnosis of tendonitis. Wrist injuries are outside my "comfort zone" of A2 pulley tweaks, golfer's elbow and shoulder impingements, so I booked a physio appointment too - well justified as it is still hurting today in quite a few minor movements, rotation especially. The more indepth physio diagnosis was the same, some form of tendonitis / tendinopathy, as was the treatment: Rest, ice, anti-inflammatories (which I'm not supposed to take being on Warfarin, i.e. I'll sure as hell take them and hope it all calms down before my next INR reading), reduced mobility, massaging forearm muscles, then gently stretching the wrist. Once every day stir-frying / general motions are pain-free, ease back into climbing with shorter sessions, and combine this with general wrist exercises. Continue with CV / any exercise that doesn't aggravate it in the meantime.
 

Then:

And what is going on is that my wrist seems to be healing okay....really really fucking slowly.
 
I rested it completely for one week, then tried some gentle wrist curls as the physio suggested. I used 7 kg instead of my default 12kg which I regularly use for pain-free anti-golfer's-elbow eccentric wrist curls. I did a few sets of those and it bloody hurt.
 
So I rested it completely for another week. It still a bit hurt to do wok-shaking during stir-frying, brushing cups during washing up, even turning keys in locks.
 
So I rested it completely for another week, then went for a gentle session at the wall. Well, sort of gentle session. I met a friend there and got encouraged onto some slightly harder problems than I should be on....maybe even V2 or V3, bletch. I managed to drop off most problems that felt at all tweaky, but even some easier ones on side-pull pockets and jugs felt bad....anything that started my wrist moving or rotating on holds. Small holds, tiny crimps, and straight pulling felt okay. To that end, I had a hunch and went on the Beastmaker for a bit....I could hang the 30' slopers and smallest crimps very comfortably - i.e. NO pain at all. I couldn't do the slightest pull-up on the slopers as my wrist started moving, but could do pull-ups including an equal PB of 4 on the smallest crimps. Hmmm. Maybe this was not the best plan? It was a bit tender for a couple of days after and is slightly better now but still feels stiff and prone to random tweaking. I can do the washing up mostly pain-free, woooot fuck my life.
 

[mindfull]

I'm not an expert, but if you are looking for a taping that restricts the inward movement of the wrist you can PM me. The same goes for outwards movement but that's a lot of tape. Resting sounds like the winner but I cannot do that myself. 

[user deactivated]

Hi Fiend, having recently done something similar I'd be keen to know how this injury played out for ya? Currently living in fear it means 3 months off! Cheers

[Mark Lloyd]

Hi Fiend, having recently done something similar I'd be keen to know how this injury played out for ya? Currently living in fear it means 3 months off! Cheers

Shouldn't you be giving the advice as you are/were a physiotherapist ?

[duncan]

Ulnar side (little finger) wrist pain, worse on rotation as Fiend describes, is often a TFCC issue. This is one of those diagnoses that don't mean much in isolation, outlook depends more on the severity than the name.

Compression through the joint is often problematic, pulling down straight with a neutral wrist is often not too bad. This means as well as the relative rest - as for any soft-tissue injury - specifically avoid jamming, guppying, palming, mantel-shelves and other wrist-awkwardness until it settles.

Usual disclaimers about internet diagnosis apply.

[user deactivated]

Cheers Duncan, much appreciated. Weirdly I think it’s involving structures around the carpal tunnel, with some referral back up the arm. Sort of double crush if such a thing exists, and some sort of flexor sheath tear. I think the ulnar sided pain is a red herring from my days of pisiform mobs.

Hey lloydy! Just doing a bit of healthy reassurance seeking. On a different note I hear they’re demolishing mason lees quarry. You must be gutted mate

[Mark Lloyd]

Not so Fast young Jedi its only a resculpting of the access track, anyway i don't get out much these days last time i was there was probably with you.