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Wrist woes

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 whitlew 03 Feb 2022

So a bit of an injury saga here. I would really appreciate hearing from someone who's been in a similar situation & can recommend a consultant. Morale is a little low. 

Last February I injured both wrists while bouldering. I wasn't warmed up enough clearly and they had probably had been building in the background for a while. 

This led to a few weeks of pain when doing everyday tasks. When this stage passed I would only feel pain when poking the troubled tendon, or when bending the wrist towards the pinkie. 

I took some time off and saw a respected climber physio for advice. They prescribed a series of extensor side strengthening excersises, and recommended light climbing with tape. 

I took this onboard and slowly started climbing once the pain had gone down, continuing with the rehab excersises. 

This would work to a degree but I would keep having setbacks. I'd often feel fine when climbing but the next day my wrists would be noticeably painful and weak. I tried to maintain a balance through the summer but got tired of having to drop my grade to avoid making the tendonitis worse. 

I've essentially stopped all climbing since October and have re-visted the same physio twice since, both times with the advice to unload and rehab.

I went for my first indoor climb since last autumn this week. Keeping it very light and keeping well within my pre-injury grades resulted in next day pain and weakness. 

Total nightmare basically, current physio advice is that there may be issues with my fascia and that I should look into approaching my GP for further advice.. which I really don't see working out. 

For context, I'm in my 20s and healthy in general. I don't have a family history of high cholesterol, which I know sometimes can be a contributing factor to recurring tendon issues. 

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 nniff 03 Feb 2022
In reply to whitlew:

TFCC tear?

https://www.assh.org/handcare/condition/tfcc-tear

Post edited at 14:06
 Paul Sagar 03 Feb 2022
In reply to whitlew:

Sounds like a TFCC tear. My girlfriend has been battling with one for the past year. 
 

You need to see a physio who understands climbing. That basically means Cristiano Costa. 
 

In the meantime there is a thing called a “wrist widget” that you can wear that may help reduce pain and stop you making it immediately worse. But see a physio ASAP. It won’t heal by itself. 

 daWalt 03 Feb 2022
In reply to whitlew:

sounds a bit familiar

A good few years ago I hut my wrist. not particularly badly either, and not a sudden impact injury, just over-strained it trying to crank too hard while too cold and unconditioned. It took over a year to get back to being better - and a good while after to get near where-it-was...I suspect it'll just take a good while.

do lots of light exercise & stretching,

work on forearms too,  

be very mindful of computer, mouse etc, if you drive a desk during the week,

get a 2nd physio for a (potentially) different view (but if two people tell you the same thing....)

I'd suggest GP only if you think surgical or medical treatment is need. 

good luck, be patent but persistent.

 Paul Sagar 03 Feb 2022
In reply to Paul Sagar:

If the physio isn’t working you may need surgery and so seeing a GP - or even better, getting a physio to refer you direct to a consultant - May in fact be necessary. TFCC injuries are notorious for being very long-lasting and not good at healing by themselves I’m afraid. I’d also recommend investing in an MRI to find out exactly what is wrong. 

 Jackspratt 03 Feb 2022
In reply to whitlew:

I've been as hard as before my wrist injury using a wrist widget, you do have to tighten them up a lot but this is perfect for bouldering, alternatively I've had success using Andy Mcvittie out of BUK as a remote physio, he's sorted my pulley and TFCC is on the mend (it's a notoriously long road to recovery with TFCC). I'd highly recommend buying the widget for all of about £15 (their policy allows returns if it doesn't work) just to see.

For context I blew mine big style the day before a 10 day holiday where I was going to be doing a lot of bouldering, when this arrived I managed to climb all day every day at the same level as planned.

 dwisniewski 03 Feb 2022
In reply to whitlew:

Like you I've also suffered with ulnar sided wrist pain, going on for about 4 years now. It really peaked around October/November 2019 when I had to stop climbing because of the pain. It had started with slow onset mild pain, roughly around the ulnar styloid process of my left wrist, and steadily worsened. There wasn't any trauma to the wrist at any point. For me the pain was typically worse post-climb and the following days, where I would struggle to lift a cup of tea. It progressed to the point where I was getting pretty severe ulnar neuropathy in my wrist and up and down my arm, and pins and needles in pinky, ring finger and ulnar palm. During this time I saw two separate physiotherapists and did similar to you i.e. eccentric wrist strengthening exercises. These didn't seem to help.

In December 2019 I went to the GP and laid out my symptom history and the physiotherapy I'd done and requested that he refer me for a surgical consultation as I felt that was the only thing really left to do. Got the consultation on the basis of the ulnar neuropathy, we thought that there was perhaps ulnar nerve entrapment somewhere, either wrist or in the elbow (more common). Long story short, I pushed back a bit against initial diagnosis, got an x-ray, found a potential cyst in my lunate bone, got an MRI (about 5 months after stopping climbing) confirming intraosseous ganglion cyst in the lunate, TFCC appeared normal, some inflammation in pisotriquetral joint, ligaments all looked good and only mild expansion of the ECU tendon and mild inflammation of its tendon sheath. So it seems as if the lunate cyst is causing the problem, but it's not really clear why that would be the case. I'm now waiting on surgery to confirm there's no damage to the TFCC and if that's the case will have the cyst removed and the remaining hole filled with some bone cement. 

So I guess based on my experience go to the GP and push for a referral to a specialist consultant, ask them lots of questions, and try to get an MRI ASAP. I saw about getting the surgery done privately due to the NHS wait times but unfortunately in August 2020 messed up my knee and had to pay to get that fixed instead. I think the quote for my wrist surgery was something like £3200, and MRIs from the same provider were about £300-500 + consultation fees of ~£180. For additional reference I'm based in Edinburgh and got referred to the Hooper Hand unit at St John's hospital in Livingston, initially saw Luca Lancerotto and then Clair Simpson (specialist wrist surgeon), I then also went for a second opinion privately and saw Phillipa Rust at The Edinburgh Clinic.

Whilst I was out of climbing I took up mountain biking instead which didn't seem to aggravate my wrist. Unfortunately, that's what resulted in my knee injury. However, after my knee surgery December 2020, I'm now back biking (April 2021) and climbing (November 2021). Still not got my wrist fixed but I couldn't keep away from climbing and I'm managing the pain better this time round. This basically involves using anti-inflammatory gel (e.g. diclofenac or ibuprofen based gel) before climbing, immediately after climbing and the day after climbing. Not the most healthy and sustainable option but it does allow me to climb and the resulting pain is manageable. Also, when I'm climbing I try my best not to overdo positions that's unduly aggravate my left wrist, which for me is typically undercuts. For me personally this is an acceptable trade off whilst waiting for surgery. 

I think going to GP and requesting a referral would be a good first option, and maybe look into a private MRI as a back up. Don't be shy about asking firmly for a specialist referral at the GP, as these injuries can have a massive impact on your quality of life. 

Hope this is of some help. I know from the past couple of years injury woes how difficult it can be mentally to deal with the chronic injury and pain, and I'm not really sure there is a way to fix that, but for me getting outdoors and doing what I physically could was massively beneficial for my mental health. 

Take care.

 CantClimbTom 03 Feb 2022
In reply to whitlew:

Doesn't Dave MacLeod have a book about this kind of thing https://www.amazon.co.uk/Make-Break-Climbing-Injuries-Dictate/dp/0956428134

Post edited at 16:24
OP whitlew 03 Feb 2022
In reply to whitlew:

Och, thanks very much for everyone's responses. Really helpful stuff. 

I will start down the NHS consultant path and maybe get another physio's advice as well. I have heard of wrist widgets but have been slightly sceptical that they would work in my case, worth trying out though. 

May come back to some of you once I've taken on the info. 

 von_donsburg 03 Feb 2022
In reply to whitlew:

I had a similar sounding issue a few years ago (Flexor Carpi Ulnaris, apparently). Here are a few nuggets that helped me (after a lot of searching and not getting better!):

1) Tendons don't like a big change in use, whether that's a decrease or increase. Therefore best to continue climbing as much as possible, whilst fulfilling the following rules: no pain the next morning, no sharp pain while climbing, low ache is ok. Increase frequency or intensity SLOWLY.

2) I had a specific exercise from a climbing physio (who I believe has moved abroad, sorry). Might not be relevant for your case but I think it was something along the lines of: forearm supported and horizontal (e.g. on your knee) and make your hand/wrist do a "throwing a dart at the floor" motion, using a resistance band to increase difficulty.

3) I religiously rubbed the area with a cream which supposedly improved bloodflow, no idea if it helped but it smelled nice.

4) Dave MacLeod has a video about elbows but I think it has some useful general tendon tips:  youtube.com/watch?v=_iMueqiCsVI&

Hope that helps. After many months of suffering, I did this protocol for a few months and it just got better. It's super annoying and I hope you are able to get on top of it soon.

 jack_44 03 Feb 2022
In reply to whitlew:

Wrist pain can be slow to improve, frustrating and quite complex to pin down, don't necessarily jump to "it's TFCC because my friend/relative had a TFCC injury". 

My advice would be to speak to your GP about it. A common pathway would be a referral to MSK physio, but ask to be seen by the hand service. In most cases, the hand physio team will work closely with orthopaedics. You'll be seen quicker than sitting on an ortho waiting list, assessed and started with advice/rehab and ideally monitored, then depending on progress, there would be a case for discussion with ortho for further investigation. 

Imaging should rarely be the first port of call and the evidence will always point to a conservative approach first. 

 DenzelLN 03 Feb 2022
In reply to whitlew:

I had the double wrist pain like yourself, slowly built over time due to an inherent weakness. Very strong in crimp but could not hold body weight open handed on a pull-up bar. A tendonopathy was the cause.

My physio had me weight the beast maker 2000 slopers, the 30 degree ones. I had to offset the weight at first to the tune of around 30kg but slowly got back to bodyweight without pain. It is creeping back at present so I intend to repeat the same protocol.

He told me to not stop climbing but to try and stop wild slappy open handed moves etc

Physio's name is Andy McVittie, based in the Northwest - he also makes tendon pulley splints which also was of great help for a pulley sprain!

Post edited at 20:22
 icarus82 04 Feb 2022
In reply to whitlew:

+ Find the absolute best physio/doctor/consultant and do whatever it takes to see them. 

+ Do plenty of reading around wrist injuries and get well informed.

+ Take it easy on the climbing but strengthen the wrist and forearm sensibly.

+ Be patient. You have years and years to climb better to take a bit of time away and get it sorted than be plagued with wrist injuries or make it a lot worse.

OP whitlew 04 Feb 2022
In reply to dwisniewski:

Thank you for the info there. I'm in Perth so maybe St Johns would be the place to get referred to. 

I'll look into waiting times etc. before splashing out on a private scan, but an MRI definitely seems the way to go and keep up the rehab work in the meantime.

Interesting about your cyst - I've been having trouble with both of my wrists although left is slightly worse. This would make a lunate cyst unlikely for me perhaps? Not too sure.

Thanks again for your advice and best of luck getting healthy yourself! 

OP whitlew 04 Feb 2022
In reply to von_donsburg:

Yes it's the SLOWLY part that I'm not too good at! I suppose the important thing to remember is that it's just a blip. Will be much easier once spring comes around and I can blow off steam on scrambley mountain routes. 

Thanks for your excersise advice - I almost feel like my wrist is folding in on itself so maybe strengthening in this direction will help.

Fingers crossed it's not a surgical thing and I can nurse it back with some more training.  

OP whitlew 04 Feb 2022
In reply to CantClimbTom:

Great for general advice but not too much background on specifically wrists.

 dwisniewski 04 Feb 2022
In reply to whitlew:

Yeah absolutley go via the NHS in the first instance, but be clear that you've stuck at different treatment options with your physio to no avail for a while, hopefully they listen and could potentially get you onto an MRI straightaway - dependent on your GP.

Aye, I would think it highly unlikely for your issue to be similar to mine. One, intraosseous cysts in the carpal bones are rare, most are discovered incidentally. It's then even less common for those cysts to be related to wrist pain, and so to have two wrists presenting with this would be even less likely again.

The frustration with these things is that it could be so many different issues, but it sounds like that for you considering the physiotherapy hasn't worked thus far, the next stage would be to progress to orthopaedic consultation and imaging.

 DDDD 04 Feb 2022
In reply to whitlew:

My experience with most injuries I've had is that initially I always thought I that they were due to climbing. Yours may be. However, it took a visit to a good physio to persuade me that my double ulnaris tendon problem was due to keyboard use. All it took to cure it was a silicon wrist rest. It's worth keeping an open mind.


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