UKBouldering.com

Wrist injury experiences (including surgery) (Read 465 times)

PeteHukb

Offline
  • *
  • newbie
  • Posts: 17
  • Karma: +1/-0
Hi all.

Have myself a nasty wrist injury which has kept me from climbing or doing any training at all for almost four months. I'm at the point where it's no better despite regular powerballing (as per physio/wrist surgeon advice) and I'm wondering about second opinions/pursuing a surgical option vs just going back to *very* limited climbing as carefully as possible and seeing what happens. Have read a few posts on here from others with wrist injuries but no long-term outcomes, which is what I'm interested in. Has anyone had successful wrist surgery or diagnostic arthroscopy, or can report longer term outcomes from a wrist injury that sounds similar to mine?

Brief description:
Probably happened dyno-ing to a horizontal pinch indoors; no pain at the time but instantly felt unstable, like my hand and my arm wanted to part company on particular holds. Not bad on crimps (or any holds with the wrist extended), although it feels like collateral ligaments (at either side of wrist) are taking strain that they shouldn't be. Pulling on any holds with the wrist in neutral or flexed (ie bent towards the direction the palm faces) is very uncomfortable in a dull unstable sort of way. Can't even half-crimp bodyweight two-handed. Slopers are basically impossible - they're much more uncomfortable.
I can also reliably cause a lot of pain by forced hyperflexion of my wrist (pushing the back of my hand so that the palm faces the elbow). Most pain feels like it's right in the middle of the wrist, but this manoeuvre makes it hurt slightly more on the ulnar (little finger) side.

More details for the keen:

- I had a partial tear of my scapholunate ligament (volar fibres) six years ago (torquing off a fist jam I think) and had an MRI arthrogram then - I was back climbing within a month or two and have climbed F8a and Font 7C since without noticing much impairment - very occasionally my wrist would feel a bit "loose" on certain holds.

- My MRI arthrogram in December was essentially unchanged from six years ago, which I interpret as either a) I've repeated the same injury, which had healed, but it's worse this time, b) I've torn whatever was holding my wrist stable after the original injury (which never healed), but it's too small to show up on a scan 8 weeks post-injury and/or radiologists don't know enough about climbing biomechanics to diagnose the new injury.

- I'm a doctor (ICU/anaesthetics), which has helped with getting a quick surgical review and imaging, but I'm still not sure I've really got a diagnosis. The literature on scapholunate injuries (and wrist biomechanics in general) is focused on axial loading (e.g. press-ups, pushing up out of a chair) and I've barely found any info which feels relevant to the sort of traction loads we exert in climbing.

Many thanks.

Stewart

Offline
  • **
  • addict
  • Posts: 145
  • Karma: +5/-0
I had succesful wrist surgery a few years back. Sounds very similar to yours I think.
The injury was sustained holding a barn door on very shallow sloper (control A at Buthiers). Heard a slight crack then pain. Was never too painful but knew I was underpowered and uncomfortable (on slopers especially) for months. Scans showed nothing, physio work didn't help. Eventually had exploratory surgery 9 months after which found one of my tendons had not snapped but stretched beyond its elasticity range like a strawberry lace. Surgeon took in the slack and tied it off round a small wrist bone. A few months in plaster them slow return to fitness. Never had any issue since apart from an occasional wrist click and a need to readjust on slopers (or let go) sometimes if I feel my wrist is just slightly unaligned. Bit of a weird feeling but less common than it used to be.
 Not sure this really helps. As you will know there are a thousand things which could be going wrong in that joint so not sure how transferable this info is to your case.

Ru

Offline
  • *****
  • Global Moderator
  • forum hero
  • Posts: 1812
  • Karma: +105/-0
I also had a partial S/L tear a few years ago. I didn't have any surgery and the recovery time was about 6 months-ish, but I irritated it again after about 3 months, similarly to you, catching a hold. It now seems to have recovered fine apart from some random mild aching on the radial side of my wrist that isn't in the same area.

After reviewing my MRI with a wrist surgeon I'm not really convinced that S/L tears show well on MRI, although mine didn't have contrast dye. Apart from MRI, the sign of S/L rupture is whether there is static and/or dynamic instability. Fluoroscopy can be used to see if there is a widening of the S/L gap on movement, but it doesn't seem very popular in the UK. Widening of the S/L gap also shows on x-ray, but the images need to be taken by some one with experience of S/L injuries as the wrist needs to be put in a position that pulls the scaphoid and lunate apart.

As I'm sure you know, untreated complete S/L rupture usually leads to SLAC wrist after a few years, quicker with heavier use, for which only some kind of fusion seems to be the treatment, so it would be worth getting a second opinion or having further investigation if complete S/L rupture is a distinct possibility. That said, repair of the ligament is only possible for about 1-2 months post injury, after which time reconstruction of the ligament is the only possible solution. S/L reconstruction is a fairly major operation, that doesn't always lead to a good outcome. It also can't be left for a few years to have at a later stage as it is contra-inidicated if there is any sclerosis. The surgeon I saw said he wouldn't consider operating if you are capable of press-ups without pain. All in all, it's a bit of shit injury, so I'd hope that you've not done that.

Gold standard diagnosis is only possible with a scope. I reckon most wrist surgeons would suggest that as a next step if you are still having problems.

I find the NHS is terrible for taking orthopaedic injuries seriously unless you can't work, although you may have more luck as a medic. I can recommend Mike Hayton in Manchester if you want to see someone privately. He has a practice that is entirely limited to wrists and hands, he specialises in sports injuries and although not a climber is interested in climbing injuries. He also has a specific interest in S/L injuries. I can't think of anyone better in the UK.

Disclaimer - not a doctor, but apart from having had a wrist injury myself, I do medico legal work, have done cases involving failure to diagnose complete S/L rupture injuries, had conferences with a number of experts, and have a good friend that is a hand surgeon in Canada that I have irritated with endless questions.
« Last Edit: March 01, 2020, 10:19:42 pm by Ru »

PeteHukb

Offline
  • *
  • newbie
  • Posts: 17
  • Karma: +1/-0
Thanks both, good to hear positive experiences of both surgery and conservative management.

Ru, I'd actually been half-planning to see Mike Hayton even before your post - I gather he did some pretty bespoke surgery on Molly Thompson-Smith's pulleys. Was it him who said he wouldn't operate if you could do press-ups? Seems beside the point (but in line with the prevailing idea that SL injuries happen from axial loads/falls onto outstretched hand), and I'd hoped to find someone who could respect the goal of getting back to climbing..

Seems fairly likely I'll just end up climbing within limits and seeing what happens - but as you've alluded to, I don't really want to risk progression to SLAC (or any kind of arthritis).

Will try to update this with outcome at some point, for the benefit of future readers.

Ru

Offline
  • *****
  • Global Moderator
  • forum hero
  • Posts: 1812
  • Karma: +105/-0
Ru, I'd actually been half-planning to see Mike Hayton even before your post - I gather he did some pretty bespoke surgery on Molly Thompson-Smith's pulleys. Was it him who said he wouldn't operate if you could do press-ups? Seems beside the point (but in line with the prevailing idea that SL injuries happen from axial loads/falls onto outstretched hand), and I'd hoped to find someone who could respect the goal of getting back to climbing..

It was Mike that said that, but he said it within the context of an SL injury caused by a fall onto an outstretched hand and in the context of a wrist that had some minor residual aching but full function and no subjective (or clinically observable) instability. The overall point is that S/L reconstruction is a fairly invasive surgery so he didn't want to do it unless there was functional deficit. Your case sounds different. He would very much respect the goal of getting back to climbing and he says he gets very good results from SL reconstruction surgery if you end up going down that route. His bread and butter seems to be rehabilitating athletes. He's easy to talk to and responds to questions after properly considering the answers.

 

SimplePortal 2.3.7 © 2008-2020, SimplePortal