Wrist-neck conundrum

[Hotsocks]

This is a bit of a re-frame of a problem I asked about a few years ago that I've now thought more about...

Starting in a neutral position (I believe it's called) for clarity's sake.. if I flex my right elbow to 90 degrees, when I then extend or abduct my right wrist, my right shoulder flexes i.e. the elbow moves forwards about an inch or two towards the hand. It feels a bit like the elbow is being pulled by the wrist motion towards the hand (wherever it is). When I release the wrist from abduction or extension, the elbow wants go back to where it was e.g. by my side when starting from a neutral position. To move the wrist in this way without the upper arm moving I have to tense the wrist or the elbow. If I concentrate really hard on not tensing either of those when making these wrist movements, then the muscles at the right rear side of my neck will kick in to prevent the arm moving. There is no difficulty in adducting or flexing the wrist normally. However, if I've allow the arm to move during abduction or extension, and then try to return the wrist to a straight position or further adduct or flex it without allowing the elbow to return to its normal position, then I have to tense the hand/elbow in a similar way and suffer the same (or possibly even greater) tension at the neck. None of this happens on the left side.

I believe this neck involvement is the cause of the severe neck tension I feel after performing tasks that need precise wrist movement e.g. mousing in games or playing guitar. I have to massage the neck area to prevent debilitating headaches afterwards.

A physio gave me some exercises for the wrist (rotations with arms straight in front) and neck and shoulder posture, but it's not helped. Also a median nerve (I think) exercise (right palm on wall to my right and rotate down).

My question at this point is this: is there any reason other than neural that could explain the upper arm, shoulder and neck getting involved in a wrist movement? The muscles moving the wrist don't go up there do they? So they shouldn't be pulling the upper arm about (if that's what they're doing)?

I've already spent a fair bit on the physio and an osteopath before that, so any ideas would be welcome.

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[violablue]

Think of the body like a knit sweater. When the sweater is in good shape it moves and flows and drapes properly. Catch a snag in it, and the sweater distorts and no longer moves properly. Same with the body. Sure, the wrist muscles don't connect into the neck, but you have have muscle chains or trains (book Anatomy Trains). You also have nerves that run through, which can get adhered in tissue, so not flowing properly as you move. And there is the myofascial tissue, which can also get adhesed.

I'm not quite clear on your positioning...your elbow is bent (flexed) and when you extend your wrist (top of hand pressing towards your arm) or when you abduct (thumb moving towards your arm) you have issues that don't allow you to smoothly complete the movements. It's not typical problem positioning, so just wanting to make sure I've got you right...

[Hotsocks]

Thanks for the reply.

Yes, you've understood the movements correctly. The starting point with elbow bent at 90 degrees was just intended to make it easier for me to describe. Actually, with the elbow bent at any angle and even the humorous rotated outwards, the elbow is still pulled towards the hand when the wrist makes these movements.

One other fact: If I hold the hand with the fingers gently curved and then while trying to abduct the wrist I flex the thumb and 'first finger' (especially) towards the palm/base of thumb - rather as you would if clenching the fist - then the wrist can abduct much more freely and with a lot less upper arm involvement. In fact, if I squeeze the thumb and first finger together in just the right way, the the upper arm doesn't move at all when I abduct.

[Hotsocks]

I was rather hoping for something more specific as to where any such adhesion might be in view of the pattern described. Or at least what kind of therapist might help? For example would one of these 'active release' ART practioners I've read about be worth a go? Trouble with therapies is the longer it takes to (possibly) fix you, the more money they get. Pity you can't get a quote for the job like fixing a toilet.

Err...Energy crystals?

[violablue]

Hey, sorry, I've been on course.

It's seems fairly likely it's a nerve adhesion issue.

Have you done any nerve flossing exercises? If you're PT assessed you and figured on median nerve, you can floss the nerve:

Of course, if the median nerve exercises don't really help, then it could be the ulnar or radial nerve binding in some way.

You can also do what you've been doing yourself, massage and loosen up muscular tissue. The nerve can get stuck in tight muscles especially, so just picking up the tissue and giving it a nice loose oscillating rhythmic shaking can be very helpful. You can try this in various areas of your arm and pec. That's not going to work at the neck so gentle press and release, press and release can be helpful.

To track it down to your problem area, do the movement that bothers you, note the range. Work with the glide or the loosening. Then re-assess to see if any gains or losses have occurred.

Don't continue on a course of action that causes worse pain or reduced motion. And be very gentle. When nerves get "wound up" they don't have the stretch muscles have. Instead they can snap! Caution is best.

There is a good DVD on neurodynamics that I need to track down the name of.

Have you checked back in with your physio to say the exercises aren't helping? The PT can re-assess and try something that may be more appropriate.

You might also try massage to see if loosening up your chronically tight muscles may be helpful. Or try a new PT that has more extensive knowledge of neurodynamics...

Of course, it may be something else altogether! Hard to tell without assessing you!

[violablue]

Hmm, that YouTube link button didn't seem to work: ‪Median Nerve Flossing‬‏ - YouTube

[violablue]

Okay, this is the David Butler’s, excellent but expensive: NOI | Neuro Orthopaedic Institute

These Nerve Mobilization DVDs are awesome too: Real Bodywork: Nerve Mobilization Set

You can buy them as a set or separately and they are quite well-priced. Here’s a YouTube example of the DVD: ‪Nerve Mobilization for the Arm by Real Bodywork‬‏ - YouTube

Good luck, and please keep us posted as to what’s happening!

[Hotsocks]

OK, thanks for the suggestions. I have seen some of those nerve gliding Youtubes and dabbled a bit, but to be honest not sure they're really showing up anything in particular.

Will try massaging the whole arm a bit more. Up to now the neck massaging has just been to counter the tension build up (I believe) as a consequence of unconsciously trying to stop the arm moving in an unhelpful way when making precise wrist movements.