problem wrist injury!

[helenabelle]

I'm a student physio currently working with a men's hockey team and I have a bit of a problem case.
I'm currently treating one of the guys for just general wrist pain and stiffness. He says his arm is fine at rest but during matches, training, etc. it becomes quite painful.
He has pain on the dorsal side of the forearm on resisted flexion and a pain "inside the wrist." He also has pain on radial/ulnar deviation and supination.
For the past few weeks, I've been doing some deep forearm massage and frictions around the wrist post training and matches. Pre matches and training, I've been taping around the wrist. I tried taping to prevent excessive flexion/extension, but he says he feels more comfortable with just the tape around the wirst to stabilise it. I've also given him stretches and some light strengthening. After treatment he says his wrist feels better and does so for a number of days until the next time he has a match/training.
He has no prior trauma to the wrist.

At the minute, I feel that this patient has plateaued with his treatment slightly and any ideas you have would be greatly appreciated!

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[pudding_bowl]

Having dorsal pain with resisted wrist flexion doesn't make huge sense. It sounds like you've tried alot of things... except removing him from sport and doing a higher level of strengthening... How viable is that? - e.g. how close are u to end of season etc. With having no injury to bring on the problem we assume it's come on from his sport - removing the sport and undertaking a much harder strengthening program may be what he needs to return pain free to sport.

You can look at some mobilisations of the wrist if he has pain inside the wrist and assess that, check for neural tension issues as well... and if possible get a second opinion with one of your supervisors if they are nice like that.

If it is still plateauing and the pain is significant enough get some further investigations done in terms of xray and US.

[helenabelle]

I have suggested a complete break from sport, including training, weight lifting and matches, even if it's only for a week or ten days, but that didn't go down so well! It's only a month into the season so he's pretty keen to keep playing.
At our last session I did try some physiological mobs around the wrist but he thought they were too painful so I think I'll try some accessorys at the next session.
Thanks for you advice!

[pudding_bowl]

How plausible is it for you to get him r/v'd by another physio or sent for some scans?