Wrist pain, TFCC injury and other issues

Hey, I have got ongoing wrist problems that I hope someone may be able to give me some advice on, id like to say ill keep this brief, but I want to give as much background info as poss.

BACKGROUND

Im 28 and in reasonable physical shape, im pretty muscular but not too fit, dont smoke or drink tooo excessively. I work as a window cleaner using the pole system (this is relevant) and I used to play golf and guitar, however my guitar and clubs have been collecting dust for ovre 6 months now, and it doesnt look like this will change soon.

It started when I broke my scaffoid mountain biking about 7 years ago when I was 21. I dropped about 4ft and didnt absorb the landing correctly, all the impact went through (primarily) my left wrist, the scaffoid cracked laterally. After a couple of months in a cast (which I cut off, I know stupid) I was told all fixed and went back to normal routine. However I often got incredibly painful stabs of pain in my scaffoid, and after a few more months, another set of Xrays and finally a CT scan, they found the scaffoid had never healed......

I then had a bone graft from my hip which was inserted in the middle of my scaffoid bone and pinned together. So for the next 7-8 years Ive had slightly limited movement and strength in that wrist, the odd bout of pain which usually subsides quite well with rest. I was quite happy with this really.

About a year ago I took up golf (this may not have been 'cause' of pain, I was working as a mechanic at the time so lots of strain on my arms in general), and after a few months my wrist started to act up a bit, general pain through the joint, so I did what I usually did, strapped it up when it hurt, rested a little, but primarily ignored it.

PROBLEM

I have seen a docter or two, and get the usual 'yeah.... you may get pain, we cant wave a magic wand' response, I eventually got sent to a physio, and she was all but useless, basically told me there was 'something' wrong in my wrist, probably a ligament injury, I could try gentle exercises but thats it.

I since have done a lot of my own research and concluded that its a TFCC injury, I get sharp pain that area particularly when I rotate my wrist inwards pushing my pinky up towards the sky, I found the wrist widget website and did the load test. So I got a Wrist widget, which has helped most the time. But not always, it sometimes slips down my arm a little, and sometimes causes me discomfort and pain because, and heres the odd bit, the pain and problems are sometimes elsewhere.....

I get tingling in my pinky and half of next finger, so as far as I can gather this is an ulner nerve issue. Could this be caused by TFCC injury?
But I often get pain on what feels like the tendons reaching up my arm from my wrist, this is exasperated by wearing the widget.

Occasionally I get pain similar to the TFCC side pain, but this is just at the base of my thumb.

I am kind of alternating between the Wrist Widget, a McAdams brace (helps with the tendon pain) and wearing no brace to let my wrist move naturally when it isnt giving me trouble.

Its causing me a lot of trouble with work at the moment, particularly if I have an akward house to do and im holding the pole more horizontal than usual, by the end of the day I can barely move my wrist or even fingers.

Any ideas, advice or anything really??? I am planning to go back to docters but I feel I need some more ammo to tell THEM what I think is wrong and needed.

Many thanks



Andrew

Only an orthopedic doctor specialized in hand and wrist injury can suggest you the best. I would advice you to visit one asap.

Hi There,

I cant say whether or not you have a TFCC injury as a scan will be able to confirm/deny. What I can say is that from your symptoms i.e forearm pain and ulnar nerve like sensations is that you have some involvement of your forearm muscles. The key issue with this is that the muscles that control your wrist start at the bony bits of the inside and outside elbow. Have a poke around there and have a feel and you will notice it is quite tender.

http://teachmeanatomy.info/wp-conten...labelled21.jpg
If you overload these muscle you can appreciate that it will cause some strain on the origin at the bony bit and all the 4 long muscles attached to ONE tendon so tendon is unhappy and starts to thicken and tighten. This can then cause weakness and restriction at your wrist. It is like doing 100 bicep curls and then your bicep is obviously tight and weakened as it has been overloaded. I suspect this is what has happened and resulting in some of your symptoms (not all) but can amount for a lot of it.

Treatment:
- Suggest seeing phyiso/ acupuncturist or massage thereapist or any one that can get stuck into the muscle to release the forearm muscles.
- Stretching forearm muscles like so:
http://4.bp.blogspot.com/_P5DPLYwwqO...00/forearm.jpg
Keeping elbow straight.

From your history it is likely to have a structural issue whether it be scaphoid, degenerative/overuse TFCC injury or wrist instability. Addressing the muscle issues should (i hope!) reduce some of your symtpoms. Give it 4 or 5 sessions of some deep tissue work to release it and the remaining symptoms will dictate how to go about it although obtaining an MRI is useful and consulting with an orthopod.

Hope that helps :D

Thanks very much for replys. I have just booked another appt with doctor to see if I can be refered back to NHS physio again, but I think I will also look at a private physio.

That makes alot of sense about the muscle strain, i tend to get that problem mainly after a long dayu at work, cleaning windows gripping the pole for a long time. The difficulty is that since my scaffoid op I have had limited movement of that wrist, I cannot bend it any where near as far back or forward as in the picture there. I guess this may contribute to the tightness if my movement has been limited for so long?

I think I may try and push for a scan if I can. As I understand it wrist injuries are very difficult to diagnose properly. I know from last time the consultants thought my wrist was healed, only with the scan months later did they immediately see that my scaffoid was split down the middle.....

Thanks again

No problem. Glad to have helped. Again it sometimes is process of elimination. So work on the muscles and hopefully the physio will also address the joint stiffness with some hands on manual therapy. Give it a good 3-4 weeks of treatment and see how you go before you jump to any dire conclusions. After about a month of treatment and if your symptoms continue then further investigation may be warranted. An MRI will show a TFCC issue if that helps. :) All the best!

Ok, am now waiting appointment from orthopedic dept at hospital. However I would just like to mention latest problems, as I seem to have developed other problems with the wrist. The TFCC pain hasnt been too bad the last few weeks, I got a 3Point wrist wrap which feels really good. However I am getting pain and aching in the centre of the wrist, and sharp pain at the base of the thumb, from what I can gather the area is the first dorsal compartment tendon. Is it usual ofor one problem to lead to another like this? Because honestly I can describe 3 or 4 DIFFERENT pains and problems now over the last 11 months or so, as one problem feels like its getting better, another problem surfaces, when I factor in the popping and cracking, it just kind of feels like my wrist is giving up on me! I'm trying to rest it as much as I can until I get to the hospital, but that could be a few months and i got to work.....

You can try the following:

• Do flexibility and strengthening exercises every day. Work with a physical therapist to learn the best and safest exercises for your wrist.
• Try the exercises after a hot bath or shower so that your wrist is warmed up and less stiff.
• DO NOT perform exercises when your wrist is actively inflamed.
• Make sure that you also rest the joint adequately. Both rest and exercise are important when you have arthritis.

Ok so thought id just keep posting here for reference, may be useful to someone sometime. After an examination which showed up no problem (suprise suprise) I had another Xray (gonna grow another arm soon). They are concerned that the pin in my scaphoid is protruding a little from the bone, could be causing problems. Is this common? I actually remember when I had the op that I was told it was protruding a little and it WOULDNT cause problems, but either way, the next step is a CT scan but this cant be done with the pin in my wrist anyway. So in 3 months or so ill be having the pin removed and will go from there.