wrist injury - lack of weight bearing and tendonitis

[bluetabu]

Hi,
I have a long history of getting tendonitis in my right wrist. 2 years ago i was in a car accident with my hand on the gear shift, a month later my wrist started hurting which I thought was tendonitis, so it was treated as such. The swelling kept going down and then flare up. When the swelling was down I couldn't put my wrist into extension/hyper extension when putting weight on it (ie a push up). The tendonitis is gone (at least I think so, I pretty sure i know what it feels like). But it's been 2 years of this off and on tendonitis with lack of weight bearing. I was in a brace for several months and lost some muscle tone and flexibility which is pretty much back to normal now. All my x-rays have come back normal. My physio is doing deep muscle massages to release the tension in my forearm, which helps a bit.

Does anyone have any advise on what exercises I should do? Or any idea what could be causing the lack of extension? Could this have been caused by the car accident? I think the tendonitis is just coming back due to the weakness in the wrist. Thanks for any help.

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[Canuck Physio]

Hi,
I have a long history of getting tendonitis in my wright wrist. 2 years ago i was in a car accident with my hand on the gear shift, a month later my wrist started hurting which I thought was tendonitis, so it was treated as such. The swelling kept going down and then flare up. When the swelling was down I couldn't put my wrist into extension/hyper extension when putting weight on it (ie a push up). The tendonitis is gone (at least I think so, I pretty sure i know what it feels like). But it's been 2 years of this off and on tendonitis with lack of weight bearing. I was in a brace for several months and lost some muscle tone and flexibility which is pretty much back to normal now. All my x-rays have come back normal. My physio is doing deep muscle massages to release the tension in my forearm, which helps a bit.

Does anyone have any advise on what exercises I should do? Or any idea what could be causing the lack of extension? Could this have been caused by the car accident? I think the tendonitis is just coming back due to the weakness in the wrist. Thanks for any help.

Personally I would like to know your hand grip strength compared to the other side, and compare the position of your joints compared to the other side, and compare your pincer grip to the other side, and overall finger spacing via adduction/abduction, and joint mobility overall... The reasons being that to return normal movement to that hand it will be important to consider such factors.

[willeseden]

The lack of weight bearing tolerance and lack of extension lead me to wonder if there is an instability between the scaphiod and lunate bones. An x-ray would not show ligament damage between these bones. The Watson's test would reveal this. It would explain the chronicity of your symptoms.

Willeseden

[mira_16]

Hi,
I've had similar issues for almost a year now with little to no pain relief. I don't think it was tendonitis though i think it is instability. I would try find a physio that is a good hand therapist and see one. I've been seeing one steady for a month or so now and he is working at mob'ing my carpals to break down some scar tissue that is between the carpals and part of a ligament.
I also have a small ganglion cyst somewhere in there that was revealed on MRI (the MRI showed a TFCC tear but that is not the issue i am experiencing).

I would suggest and MRI and a good hand therapist.
Good luck!

[wendy howard]

Hello,

I am an Occupational Therapist and Certified Hand Therapist in Hawaii and have been studying ulnar sided wrist pain and TFCC tears for 5 years and treating just hands for 16 years.

Ulnar sided wrist pain is quite a difficult injury to diagnose and treat. I have a few questions for you. If you take a bathroom scale and place the hand flat with the elbow straight (push up position) what amount of weight can you bear without pain and what is the other wrist tolerance. Also- do you have pain with rotation and grip? If so, does the pain go away when you squeeze your wrist?

I have researched a splint WristWidget TM Orthopedic Brace - Clinically proven to reduce wrist pain. on over 2000 patients and can tell you that it is worth reading about. There is some great research out of Japan on the effectiveness of this splint if you have a TFCC tear.

Best of luck to you and please let me know if you have any further questions. I would be happy to assist you in any way I can.

Warmly,

Wendy Howard, OTR, CHT, Clinical Research Coordinator

[Canuck Physio]

I am an Occupational Therapist and Certified Hand Therapist in Hawaii and have been studying ulnar sided wrist pain and TFCC tears for 5 years and treating just hands for 16 years.

Ulnar sided wrist pain is quite a difficult injury to diagnose and treat. I have a few questions for you. If you take a bathroom scale and place the hand flat with the elbow straight (push up position) what amount of weight can you bear without pain and what is the other wrist tolerance. Also- do you have pain with rotation and grip? If so, does the pain go away when you squeeze your wrist?

I have researched a splint WristWidget TM Orthopedic Brace - Clinically proven to reduce wrist pain. on over 2000 patients and can tell you that it is worth reading about. There is some great research out of Japan on the effectiveness of this splint if you have a TFCC tear.

Wendy Howard, OTR, CHT, Clinical Research Coordinator

That is quite useful to know, thanks for the input

[oscar]

I'm a physio with a TFCC tear (very minor)...I might be purchasing one of those for myself! Thanks for the info

[wendy howard]

Hello,

There is one thing common amongst people with TFCC tears, cysts related to TFCC pathology, distal radius fractures with TFCC involvement: pain with weight bearing. The lack of weight bearing comes in many different levels of dysfunction.
Most people dont test it objectively with a scale and this can be a great tool to define where you are so you can determine progress and change over the course of treatment.

Extensor Carpi Ulnaris tendonitis looks and behaves just like a TFCC tear as it also creates ulnar sided wrist pain. People with ECU tendonitis have normal weight bearing tolerance.

There is a division of the ECU which attaches onto the TFCC which can be torn and cause clicking with rotation and ulnar sided wrist pain as well.

Scaphoid Lunate dysfunction is more difficult to see patterns of symptoms but ulnar sided wrist pain from this injury is not predictable.

If you do have a TFCC tear- both peripheral and central- rotation places a stretch on this ligament. This is important because if rotation stretches it than rotation must be avoided for full recovery. Easier said than done!!! The time frame for recovery when immobilized is clearly 8-12 weeks. It is well known that casting of the elbow is required to fully immobilize the wrist from rotation. Nobody does this because of the great risk of contractures of the elbow..so a compromise is taken at 4-6 weeks.

About 50% of all wrist fractures involve the TFCC. 30% of golfers and tennis players get this injury.

I have found that if you take the wrist which has a TFCC tear, and squeeze the DRUJ without involving the hand, and without compression of the ulnar head, that there is an immediate increase of grip strength, decrease of pain, increase of weight bearing tolerance, and on 2000 patients so far, complete healing of the TFCC tear- both central and peripheral tears.

The splint WristWidget TM Orthopedic Brace - Clinically proven to reduce wrist pain. is designed to treat TFCC tears. It must be worn for 8-10 weeks continuously. It allows you to function while wearing it and is quite effective in managing strain to the TFCC during rotation, grip and weight bearing.

It has yet to be shown that any intervention including ultrasound, iontophoresis, estim, massage etc do not get down to the debth of the TFCC- through all of the extensor tendons of the wrist. This is a mechanical injury similiar to the meniscus of the knee which is slow to respond to most treatments.

It is also clear that the longer people have this injury, the more common it is to have ECU tendonitis which makes seeing through the woods more challenging.

You can try taping the wrist similiar to the wristwidget and see the change in grip and weight bearing. Careful not to compress the ulnar head. taping works but is quite difficult to get perfectly tight to prevent compression of the nerves of the wrist for the course of 8 weeks.

Research is going on and slowly coming out to support what I have learned over the past 5 years of study. Google Japan wrist splint and TFCC to see an independent publication of these reports.

It is a pleasure to share my work and I look forward to hearing from you all.

Warm Aloha,

Wendy Howard, OTR, CHT, Clinical Research Coordinator

[mira_16]

Wow Wendy that is all great info and very interesting.

Just wanted to share my experience. I have mentioned in this thread and others that I have experienced left wrist pain with lack of weight bearing for almost a year. I had an MRI that showed a TFCC tear and ganglion cyst. The odd thing was most of my pain was located central and dorsal and not ulnar. I waited about 8 months to finally get treatment (i know...) and it was slow recovery at first. I started to see another physio about 1 month ago on a regular basis and he's been working on mobilizing my carpals and cross friction to the ligaments (mainly the one between the radius and capitate..i think). I have experienced such a decrease in pain and am definetly more functional.
Right now I tried to weight bear and it's not painful. Sometimes this happens and pain develops later in the day but so far I've had great relief.

While I'm working I wear a wrist support. So I do recommend that to prevent reinjury and pain. Taping works well for temp relief but I would get the wrist widget or something similar to help with support. But ultimately you want to get the source of the problem fixed.

So once again I recommend to see someone that is a hand therapist or someone that is well experienced with hands and can located and actually feel the scar tissue in the hand ligaments.

Best of luck!

[1toddy38]

Hi,

I am new to this forum and found you by accident when looking for some answers about ECU tendonitis.
I have recently undergone wrist replacement surgery and have now been diagnosed as having the above. It is like having a continuous chinese burn and I would like to know what the treatments are for this. I already have a splint but this irritates it more.
Will I need further surgery?

Thank you

[wendy howard]

Hello,

Thank you for writing. If you have ECU tendonitis you should have the following symptoms:

Pain at the insertion of the tendon at the base of the pinky on the back of the hand... to touch.

Pain in the morning - stiffness and ache.

Sometimes clicking with rotation.

Pain with mousing, writing or typing.

Pain free weight bearing and grip.

Treatment: no stretch to the wrist into flexion (common night time position)

Wrist cock-up splint at night for the time it takes to become pain free at rest, pain free to touch and pain free with motion.

NO strengthening.

Direct ice 2 minutes throughout the day as much as you can tolerate.

I wonder how you developed this as there is a high correlation of TFCC involvement with ECU tendonitis.

The weight bearing test will tell the story. What are your numbers?
Extensor carpi ulnaris - Ganfyd


I hope that helps. Please let me know if I can answer any further questions.

[1toddy38]

what is tfcc?

I cannot weight bare at present as I am only 3 weeks after the operation. It is very tender to touch at slightly hotter that the rest of the hand/wrist.
I have slight rotation but not alot as yet. It began to hurt when I was in the back slab and bandages and I put it down to chaffing but this continued after they were removed and the gp said it was infection. After taking anti-biotics this did not get better so the specialist said it was ECU.

He advised that as the bones were missing it was rubbing and causing the inflamation and he may need to remove the tip of the ulna.

[wendy howard]

Sorry-

Wrist replacement surgery has a completely different protocol post operatively. You have at least 12 weeks of rehab and recovery. I would recommend that you find a CHT certified hand therapist in your area. You can find this at the International Hand Therapy website.

The ECU tendon can be treated for you with lots of ice and splinting to prevent end range motion. I would suggest that you are careful with early strengthening. Find out what your grip strength is.. if it under 45 lbs. then you cant really function without hurting it. You will see a great improvement in your function after 45 lbs. of grip. It is too early post operatively to do much except protect it.

I hope that helps.

Wendy

[1toddy38]

Thats a great help, thank you.

I haven't had a grip test but put it this way I cannot even squeeze a stress ball.

[wendy howard]

This is typical post wrist replacement. Strengthening is not started until 6-8 weeks. The goal initially is to maintain your tendon gliding and finger mobility.

Good luck!

Wendy

[Glenda24]

Just a question...has anyone expeeienced pain NOT only with weight bearing (normal and equal right and left when tested on a
Scale) but with weight bearing combined with finger extension. For example when doing the weight bearing on a scale test there is pain only when i lift the fingers up off the scale. Or another example is in a prayer position pushing the heels of the hands together and then sharp Pain when i lift the right finger aways from the left fingers. Forced passive wrist extension there is no
pain. No pain with
Resisted finger extension. No pain really any other time. Started acutely around 2 months ago after getting up off the bed using arms with hand fully extended. Pain has not changed. Any suggestions would be great. Tried the wrist widget briefly but there
was no immediate relief and no problem with only weight bearing to begin with so i did not continue with that.

[WristWIdget]

This could be a bunch of things-- It likely is the extensor retinaculum problem. In the extensor retinaculum cases, the weight bearing is oddly affected but only at the higher ranges of weight bearing. For instance-- if your age is 21, male, 6'1, normal weight bearing should be 100 lbs. You will not see the extensor retinaculum issue until you are at the 80-100 lb range. You can also test this by making a fist with the long finger tightly flexed. Then flex the wrist into wrist flexion and while the hand is flexed, lift the long finger against resistance.
Give it a try and let me know what you find.

- - - Updated - - -

Get some tape on the wrist or the wristwidget and see if your pain goes away. You cant do the weight bearing test this soon after surgery but it should be a part of your post op care. The TFCC is related to the ECU and often if you have a primary TFCC injury, the ECU takes on a load and becomes irritated. Make sure your post op brace does not compress the ulna as this is a common problem that impairs the healing of the tfcc and causes a ton of pain.