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Wrist Injury - would an MRI be useful? (Read 2874 times)

James Malloch

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Wrist Injury - would an MRI be useful?
August 04, 2020, 11:14:50 am
I’ve had a wrist injury which comes and goes depending on what I’m doing. It’s manageable and seems to be fine when warmed up, but can constantly hurt in the days/weeks after climbing.

It’s on the outside of my right wrist and causes pain when I rotate my hand (from a palm facing down position):

1) 90 degrees Clockwise - So my thumb is facing up (and gets worse as it goes past this towards palm facing up)
2) 45 degrees anti-clock wise - (i.e. thumb is halfway towards facing down).

It’s been really good during lockdown when I’ve been traversing at a local quarry 2-3 times a week but that’s all basically pulling downwards. I went out Sport Climbing for the first time since Christmas this weekend & after the second route it was painful again & it’s been pretty bad since then. The route I tried was a bit harder than the traversing I’ve been doing but I think it was the fact it involved undercuts & sidepulls which caused it to flare up.

Anyway...

I’ve seen a hand specialist for it a few times in the past and the exercises I was given never really helped that much. I wondered if something like an MRI might help to identify the issue more accurately, but I’ve no idea what they really entail.

Has anyone got much experience of this kind of thing? It is a very specific pain in one location.

Any advice would be much appreciated!

sheavi

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Can you specify the location of pain in your wrist - little finger or thumb side of wrist, palm or back (dorsal) wrist? Can you push without pain - pushing up from a chair/bath or press-ups?  What exercises were you previously given?

A MRI might or might not help in a diagnosis and treatment.


James Malloch

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It is the little finger side. The location is kind of where the Ulna bone joins the wrist - though the pain is slightly more towards the palm side of the joint. The closest thing I can find on the web is somewhere in the triangular fibrocartilage complex. The pain feels like it’s about 5mm or so into the wrist.

Exercises I have done in the past are a mix of:

1) Trying to press hand in the direction of the pinky (no rotation) whilst resisting with my other hand.
2) standing on a theraband and doing wrist curls (hand in fist but Palm facing down)
3) Putting finger tips together into a theraband and then extending fingers outwards from each other.
4) A bit of using a powerball.

I feel like there was a fifth but I can’t remember what it was...

I originally hurt it after a big day (for me) of climbing about 5 years ago. After a lot of board climbing I had an awesome day bouldering at stoney and climbed about 10 new problems which were all relatively hard for me. Ever since then I’ve often seemed to injure it when using sidepulls and undercuts (or at least they are the positions which hurt to go into once the pain starts up again. There was a reasonable period of a few years where it was fine but in the last 2 years it seems to keep coming back.

sheavi

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It could be the TFCC.  An MRI scan may help but would have to be evaluated by a radiologist who has TFCC experience in these injuries. Gold standard diagnosis would be arthroscopy.

From the little I know about your injury could it be a case of insufficient loading during rehabilitation phase? The exercises you describe are ok for lower level loading.  However if you then jump from some rest, gentle rehab to fully loading the structures while climbing with undercuts etc it wouldn't be surprising if you get recurrent issues.

Have you tried gradually loading the tissues in a specific way i.e climbing with undercuts and sidepulls, and building this progressingly up over time? Enough to overload the area without causing a recurrence?

 

Coops_13

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I’ve been having wrist issues over the past four years and the two MRIs I’ve had have shown nothing. You may be more lucky though. The recommendation was either to rest and rehab it better or an arthroscopy to get a diagnosis. The progressive loading route is what I’m trying now, with focus on exercises that oppose the pain (I.e. strengthening the things that support the tissue causing discomfort)

Paul B

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It’s on the outside of my right wrist and causes pain when I rotate my hand (from a palm facing down position):

My issue which sounds similar (and which I thought was TFCC; see other posts/thread) was diagnosed as Flexor carpi ulnaris (I had to Google the spelling). Mine would be absolutely fine boning down on crimps but as soon as I opened my fingers, used a side-pull etc. I'd get an incredibly sharp pain (enough to make me drop off and wince for a good few seconds).

I'm not my physio (or a physio) but what convinced him it wasn't TFCC was me doing a press-up in front of him without too much discomfort.

The test he used was to have my arm at 90deg with a karate chop shaped hand (thumb up) and using my un-injured hand tilt my hand upwards (thumb still up). The goal was to be able to then straighten my injured arm whilst holding this position without pain. I'm just about there (7 months post injury).

The first exercise I was given was to take a rolling pin gripped in your injured hand with your arm straight out in front of you. With the rolling pin extending upwards and lent away from the body, to pull back on the rolling pin with my uninjured arm and resist it with the injured one. Holds were 30s repeated 5 times.

James Malloch

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Can you push without pain - pushing up from a chair/bath or press-ups?

I missed this earlier. I can feel some pain when doing a push up but nothing significant (i.e. way less than just rotating my hand). It felt better doing dips on rings when there’s no rotation or bending in the wrist.

James Malloch

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It could be the TFCC.  An MRI scan may help but would have to be evaluated by a radiologist who has TFCC experience in these injuries. Gold standard diagnosis would be arthroscopy.

From the little I know about your injury could it be a case of insufficient loading during rehabilitation phase? The exercises you describe are ok for lower level loading.  However if you then jump from some rest, gentle rehab to fully loading the structures while climbing with undercuts etc it wouldn't be surprising if you get recurrent issues.

Have you tried gradually loading the tissues in a specific way i.e climbing with undercuts and sidepulls, and building this progressingly up over time? Enough to overload the area without causing a recurrence?

I didn’t do any specific loading during the re-hab phase. Though I did continue to carefully climb (albeit much less) and reign in my grades a lot. Though perhaps I didn’t keep at that for long enough to make enough of a difference / build up enough strength.

Maybe my lockdown did it a lot of good but the lack of sidepulls and undercuts didn’t do anything to help either...

James Malloch

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It’s on the outside of my right wrist and causes pain when I rotate my hand (from a palm facing down position):

My issue which sounds similar (and which I thought was TFCC; see other posts/thread) was diagnosed as Flexor carpi ulnaris (I had to Google the spelling). Mine would be absolutely fine boning down on crimps but as soon as I opened my fingers, used a side-pull etc. I'd get an incredibly sharp pain (enough to make me drop off and wince for a good few seconds).

I'm not my physio (or a physio) but what convinced him it wasn't TFCC was me doing a press-up in front of him without too much discomfort.

The test he used was to have my arm at 90deg with a karate chop shaped hand (thumb up) and using my un-injured hand tilt my hand upwards (thumb still up). The goal was to be able to then straighten my injured arm whilst holding this position without pain. I'm just about there (7 months post injury).

The first exercise I was given was to take a rolling pin gripped in your injured hand with your arm straight out in front of you. With the rolling pin extending upwards and lent away from the body, to pull back on the rolling pin with my uninjured arm and resist it with the injured one. Holds were 30s repeated 5 times.

Assuming I did the test correctly, I didn’t get any pain doing that one just now. I did:

Elbow of injured arm into the body with 90 degree bend (so forearm parallel to the ground, thumb facing up).
Lift injured hand upwards with the other hand (lifting from little finger side & pushing up)
Then straighten whilst keeping that position.

I did get pain though if I push the hand, in the same position, towards the ground.
I’ll have a look over your other thread though as well, thank you.

James Malloch

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Thanks for all the replies so far. They’re much appreciated.

I’d welcome any recommendations for people to see about it whether it be for Physio or MRI (if it could be useful). I’m based in the south lakes but regularly travel to Leeds/Sheffield areas as well.

I’m assuming that the gold standard mentioned, Arthroscopy, is likey to be fairly expensive to get done privately?

Paul B

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Sounds right but it's so hard to tell online!

I did get pain though if I push the hand, in the same position, towards the ground.
I’ll have a look over your other thread though as well, thank you.

Can't remember which but there were a few other directions that we tested, just that's the one that hurt and was to be used as a measure of rehab/success in my instance.  :worms:

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I’m assuming that the gold standard mentioned, Arthroscopy, is likey to be fairly expensive to get done privately?
It's also invasive so I'd avoid at all costs

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Hi,

To echo what others have said certainly sounds like extensor carpi ulnaris problem. Likely chronic tendinopathy +/- sheath rupture. Do you feel a click when turning hand from palm facing down to palm facing up? ECU does form part of the triangular fibrocartilage complex but this type of injury not usually considered as a TFCC injury.

MRI unlikely to be particularly useful as essentially picks up fluid in acute injury and would certainly need to be reported by someone who looks at lots and lots of wrist MRI (rare breed!)

Agree arthroscopy is gold standard diagnostic (it’s also very low risk to be honest, despite being “invasive”) but probably a bit pointless as unlikely to be able to do much about it. ECU sheath reconstruction has been described but I don’t know anyone who does it.

Anyway long way of saying physio and self experimentation likely your best bet (sorry!). I have actually had this injury some time ago and it is possible to manage it. Dropping the little finger off tweaks moves certainly helps.

James Malloch

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#13 Re: Wrist Injury - would an MRI be useful?
September 02, 2020, 09:51:01 am
As an update I saw a physio yesterday at Kendal Wall who did a bunch of tests. He diagnosed it as some kind of tendon issue (I forget the technical terms) with the Flexor carpi ulnaris, which has been mentioned by a few people above. Good beta, thank you!

Similar to Paul B, a TFCC issue was rejected following some tests. I'm getting a bit of a write up and a rehab regime to follow in the coming days. Good news is that climbing on it is okay at the moment as long as I'm careful - had my first session for a while after my consultation which was a nice change.

Hopefully I can get in under control over the Autumn/Winter and have some kind of sport season next year!

Thanks for all the input. I'd also recommend Andy to anyone who needs help with an injury (https://www.kendalwall.co.uk/other-activities/physio-kendal-wall/). He's a nice guy and a climber - he actually took me out sport climbing for the first time when I visited Chorro in a boiling hot September and there was no one staying at the Olive branch...

Paul B

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#14 Re: Wrist Injury - would an MRI be useful?
September 02, 2020, 11:49:04 am
Good to hear  :great:

I'd be interested to hear more about the rehab regime.

Mine's definitely improving as I managed to carry a heavy solid wood kitchen worktop which there'd have been no way I would have attempted earlier this year but it seems very easy to 'tweak' and end up setting myself back a few weeks/a month (opening whilst simultaneously lifting, with one hand, a stiff garden gate was the last trigger!).

 

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