wrist pain

[Owen Harris]

I would like some advice about a patient.
The patient presents with a >1yr Hx of wrist pain, with an incidious onset and increase in sx.
Pmh of 2x wrist # many years ago but nil else of note.
Her pain follows a mechanical pattern, and her symptoms are focused on the wrist joint area with ocaisional radiaion 3" up the arm on the palmar aspect.
She has full ROM, with P @ EOR on all mvts and no creps.
She has pain on muscle contraction which limits acurate Ax of true strength. PAMs are painful but not stiff, and on palpation she is acutely tender over the dorsal aspect of the wrist.

I am suprised there seems from the history and ax to be no inflam component.

Any ideas

Sorry for all the abreviations

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[Physiobase]

Hmm, not uncommon for old wrist injuries to become painful years on. Especially if it was an old Colles facture that resulted in a shortening of the radius and therefore upsetting of the whole carpus. She could have slept on it in an end of range position and irritated something there. On that does she have any metal work in the wrist?

Go back to basics as a first step. If she has pain at passive end of range (EOR) and also on resisted movements, I assume isometric not through range isokinetic/isotonic mvts? and also point tenderness then it sounds more joint related.

How are her upper limb tension tests for the brachial plexus? This might be a factor and would be worth testing. If you wish to treat her conservatively in the first instance why not provide her with a wrist support to wear for a week or so and treat the joint issues as you chose. Mulligans MWM's might assist if it is a join tracking issue.

Any more info would be great 8o

[binmath]

hello,
have you ruled out deQuervens disease.is the patient has pain with active finger extension,especially individual finger extension.check the x ray for any hair line fracture

[arkesh_physio]

hi,
chk out for a neural component with ULTTs which is most imp.
the radiatn could be due to compression in carpal tunnel or at the tunnel of guyon.
find out the occupation of the patient bcz handling vibrating tools & reptd movts can also cause various injuries.
Regards,
ark..