Chronic Wrist pain...help!!

[mira_16]

So the patient is myself!
I am a recent grad and experiencing left wrist pain since Sept.
I was stretching a patients heel chords and noticed the pain shortly after and since the pain has been pretty much constant. I cannot seem to find the cause of the pain. There has been no swelling and no paresthesia.
Pain present with passive flexion and extension, moderate pain with resisted flexion and extension. Grasping large objects such as a melon are difficult and carrying heavy objects such as grocery bags etc. Pain with palpation on dorsal surface of the wrist predominately around the capitate region.
I don't find much relief with ice either.
This problem has become quite troubling as I am starting work soon and need both my hands! I have consulted other PTs and no one seems to have an answer for me.

Any advice is much appreciated!
Thank you

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[physiomitch]

2 things you mention there could be caused by the same thing, ie poor circulation control. I have successfully treated both Reynaud's and chronically painful wrists. In both cases, the sympathetic nervous syetem is at fault, as it is in a state of fatigue. This system controls the tone of your blood vessels, hence the rate of blood flow. If the rate is poor, usually due to lax arteries, then the supply to the periphery of the body, ie hands and feet (in your case hands), is sluggish and symptoms related to poor circulation occur, eg, Reynaud's, pain, stiffness, weakness, etc. I would definately see if you can find someone who treats the sympathetic nervous system, and someone who will assess your biomechanics from the shoulder to the wrist. Wrist pain, esp of a non-traumatic nature, is usually a result of ongoing mechanical dysfunction usually as high up as the shoulder. If these 2 systems can be treated, then you will most likely solve your problem. Good luck

[jenlemoine]

Yes, I suffer from Raynaud's phenomenon and the test was indeed an EMG. I followed up with my primary today. She asked if I was wearing my wrist brace still. I told her I do but the metal in it makes my wrist go numb (pins & needle) feeling. My wrist goes numb exactly where my wrist sits against the metal in the brace. My doctor really feels strongly that it is a sign of carpal tunnel so she's sending me for a second opinion as my problem is still here and it just might have progressed where it can be detected. Hopefully I can get this under control or fixed...1 year is too long.

[jenlemoine]

I am finding this to be very interesting because Raynaud's affects both my hands & feet. I suffer no pain or issues with my feet (currently). When you mentioned the shoulder. I am currently suffering from some type of lump under my arm pit *can only be felt not seen (I'm still under going testing to find out what it is...suspected to be scar tissue so far but I don't know of any injuries to this area) My shoulders also pops (like when you crack your knuckle) often just by extending past my ears. I also suffer from a lot of neck pain & sometimes pinches in my neck at times. My doc is sending me out for a second opinion as she feels strong that I am indeed suffering from carpal tunnel, but I will also bring this info with me as well.

[physiomitch]

To get one thing straight, carpal tunnel syndrome ONLY affects the thumb, index, middle and half (thumb side) of the ring finger. It is very specific, and will not affect the little finger. It is often mis-diagnosed, and symptoms in the hand are often given the diagnosis of carpal tunnel syndrome when they are merely soft tissue tigfhtness in the forearm, and can easily be relieved with soft tissue release massage techniques. It also includes numbness in the above mentioned areas, and does not go above the wrist, as the trapped nerve is in the wrist, not in the forearm. It is worth doing some research on the net, and if you are unsure, get a 2nd, or 3rd opinion. It is your body, take charge of it...

Scar tissue is another overrated diagnosis, even if scar tisue is evident, it is a normal part of repair. Only if it repairs abnormally is it an issue, but this is rarely the case. Find someone who knows about myofascial release massage, or at least understands the nature of fascia (the soft tissue of the body).

[Denver Chiropractor]

Good call on the carpal tunnel affecting half the ring finger PhysioMitch!
Denver Chiropractor

[jenlemoine]

I never knew that the pain in my fingers was connected with my wrist. I have constant pain in my thumb, index and middle. (I haven't experienced any problems yet with ring finger) I find myself massaging my hand often mostly at the base of the thumb all the way to my index and middle. Sometimes it makes it feel a little bit better sometimes I think I aggravate it more. I am hoping my second opinion appointment comes soon. Because I'm currently a student going to graphic design and multi media and I use my hands/computers a lot. Even more now that finals are due in three weeks and I'm not sure if I can make all my deadlines for all my work without ending up crying every night from pain.

[alophysio]

Hi Jenlemoine,

Your problem doesn't sound like the OP's (Mira's).

It really sounds like a referred neck problem, possibly affecting the radial nerve...

The lump in your armpit can be many things but assuming it isn't a fatty tissue lump, quite often it might be a tender rib from the Serratus Anterior (which goes all the way to rib 1)...

If EMG has ruled out carpal tunnel then it is unlikely to be carpal tunnel syndrome where the carpal tunnel is too narrow...more likely that pressing on the carpal tunnel irritates the symptoms (like from your brace etc).

From listening to your story, i am going to put my money on a neck problem or a thoracic spine (in particular a thoracic ring) problem.

Let us know how you get on

Cheers!

[jenlemoine]

I had to google where the thoracic spine actually sits because I didn't know if it was high or low. Once I seen where it is located my mouth dropped. I have constant pain exactly in the same area everyday. Standing for too long hurts this area and same with sitting unless I have one leg resting on something higher it feels like it almost takes the pressure/pain off. I have been in at least 2 pretty good car accidents over the last 8 years (both not my fault) One was someone cutting in front of me so I ended up hitting them going about 40 MPH. The other I was stopped at a red light and a Mac truck rear ended me since that accident I can tell you I've never been the same. I've only had xrays and no MRI's on my back but will bring this to the attention to my doctor as soon as they get the referral let's see if they want to do a full MRI of my spine it would make seance tho.
As for the arm pit...I've had Mamo & Ultrasound they think its some type of scar tissue but now that I noticed its disgustingly noticeable I'm wondering if it could be a lymph node. I've been noticing by the time 2 in the afternoon hits everyday I feel like I could literally take a nap and Im young, but feel at least 20 years older than what I am! I don't know all I know is I do have the pain in my wrist/hand, back, neck and shoulders but the pain that bothers me the most right now is the wrist/hand probably because its the most used thing being a graphic designer/photographer. Thank you everyone for advice, if I find out anything I will post.

Hi Jenlemoine,

Your problem doesn't sound like the OP's (Mira's).

It really sounds like a referred neck problem, possibly affecting the radial nerve...

The lump in your armpit can be many things but assuming it isn't a fatty tissue lump, quite often it might be a tender rib from the Serratus Anterior (which goes all the way to rib 1)...

If EMG has ruled out carpal tunnel then it is unlikely to be carpal tunnel syndrome where the carpal tunnel is too narrow...more likely that pressing on the carpal tunnel irritates the symptoms (like from your brace etc).

From listening to your story, i am going to put my money on a neck problem or a thoracic spine (in particular a thoracic ring) problem.

Let us know how you get on

Cheers!

[alophysio]

hi,

I am glad that the symptoms and the "story" fit each other.

I would take an educated guess and say that you have some pretty clear signs of thoracic spine trouble and you need to find someone who can help you improve the way that it all coordinates.

if you email [email protected], they might know of someone in your area who can help - they are in my opinion the world's experts in thoracic spine care and treatment. Otherwise keep us posted.

Cheers

[jenlemoine]

Finally almost 1 year and I have an answer! Had my second opinion appointment today and am really lucky to have a doctor that sat down and listened to me & my symptoms. I failed a test miserably where my hands were up like a football style goal post, head looking at ceiling & while opening & closing hands. Within 15 seconds my right hand was ghost white & my wrist didn't have a pulse. My arm also felt almost fully tingly & felt like 3 lbs. heavier. (Yup that's the blood that's stuck there) Thoracic outlet syndrome is my official d/x. Now I have at least 6 months physical therapy ahead of me, praying that it solves the issue. You nailed it...

In a way this brings tears to my eyes to finally know what is wrong with me & that I can finally start to get better because my case isn't pretty and it hurts more than ever.

[alophysio]

That's great news jenlemoine! Thanks for letting us know Glad to have helped


A diagnosis is so important to moving forwards.

Glad you found someone who listened to you - that is important as well.

Now you have to find someone who can treat it well...have fun

Let us know how you go and what treatment they are giving you.

Again,. i am so happy you have a diagnosis

Cheers!

[jenlemoine]

So I'm back again. After confirming my TOS shortly after the diagnosis I was also involved in a MVA which someone hit me & totaled my car. In that accident my right forearm was just resting on the center console until the force of her car hit mine where my arm snapped back then forward hitting the steering wheel.

After going through my full treatment of PT I thought I was on the road to recovery. I was doing semi well for a month or two but I also wasn't doing much of anything at the same time.

In October I found a new job and on my 4th shift I got stuck folding clothing for 7hrs!! I was in so much pain I wanted to cry. I know pain is not normal so I decided to go see my orthopedic Dr. again. Now this is very similar pain I had way back in 2010 but also hurt on the outer side of my forearm now too. Well my orthopedic Dr. basically says he wants me to see a specialist in Boston to rule out a TFCC tear.

First I have a normal MRI of my forearm since I still have a lump that hurts and still looks bruised (MVA happened on 6/23/11) MRI showed a 4mm focus of heterogeneous signal in the subcutaneous soft tissue adjacent to the marker I had placed on my arm. Says it can be a small resolving hematoma, or a tiny lymph node. But then says something about correlation with physical exam for whether this is the site of a recent trauma...guess the guy didn't read the notes on why I was having the MRI. But also mentions within the differential would be a tiny subcutaneous hemangioma.

Well I don't understand any of that...other than if you touch it....it hurts really bad still.

The specialist in Boston then orders a 2nd MRI an arthrogram of the wrist and this is what my results are...I don't understand any of it...can someone put it in English for me? I don't go back to see the specialist until 12/19 and I want to understand a little more about what's wrong before I see him.


It says that my radiocarpal joint & distal radioulnar joints are distended with contrast.
I have a full-thickness tear of the proximal radioulnar ligament on its palmar aspect with dorsal subluxation of the distal ulna.
Also a tear of the lunatoriquetral and/or pisiform attachment of the triangular fibrocartlidge. Scapholunate ligaments are intact with mild fraying on the palmar aspect.

[alophysio]

Thanks jenlemoine,

English translation...

It says that my radiocarpal joint & distal radioulnar joints are distended with contrast.
I have a full-thickness tear of the proximal radioulnar ligament on its palmar aspect with dorsal subluxation of the distal ulna.
Also a tear of the lunatoriquetral and/or pisiform attachment of the triangular fibrocartlidge. Scapholunate ligaments are intact with mild fraying on the palmar aspect.

Looks like a wrist sprain. The "distended" joints are basically seen to be wider than what would be considered "normal" (but i am guessing)
You have a tear of the ligament that holds your "chicken wing" bones together. Also a TFCC tear.

Did the PT look at your thorax during the MVA treatment? What has your physical therapy been?

Thanks

[jenlemoine]

PT did not look at my thorax during the MVA treatment. They did notice my right shoulder blade was a little off but they said that could be because of the TOS. Anyway during my PT my physical therapist said I probably have an underlying wrist problem as well because when I had to do progress evaluations she had my hand in hers and had me try to resist her turning my hand outward (almost like arm wrestling...without my elbow being down) I told her that it hurt. But she didn't mention to me or pressure me to go see my ortho again. I was in PT from July to mid August and we really only focused on my TOS and neck from MRI.

October 2011- is when I had pain again while working and was like ok that's not right and I followed up with my ortho Dr. again that's when he mentioned I could have a possible TFCC tear. When I read about a TFCC tear I knew right away that's what I had.

Now back in July 2010 I complained of right wrist pain after photographing a portrait session at work. I was laying on my belly taking photographs & when I was done I pushed myself up off the floor using my palms of my hands. I'm assuming that's exactly where/when I injured myself because right after is when I had pain. This pain was closer to the thumb side on the palmer side but after the car accident I noticed pain closer to the pinky finger palmer side. I have also been complaining of popping/clicking for 19 months!!!...I still suffer from Raynolds and my hand/wrist sometimes feels like its burning (also gets red...but I'm assuming its just from inflamation)

Where can I find wrist pictures/diagrams online of where my MRI says what's wrong with me? I tried googling but haven't found exact wording to match up with what the MRI says.

[alophysio]

Hi,

The wording refers to little bones in the hand...try:
1. Scaphoid,
2. Lunate,
3. Triquetral
4. Pisiform
5. Trapezium
6. Trapezoid
7. Capitate
8. Hamate

Together they are referred to as the carpal bones

The bottom row articulates to the radius (radmainly and the ulna. The radius and ulna also shar a joint proximally and distally called the radio-ulnar joint.

Joints are named by the bones that form them - scapholunate is scaphoid and lunate etc.

As for not treating your thorax during rehab for MVA - they should have a look at it because you no doubt had a seat belt on...

Look up Reynaud's as the red is not likely inflammation ;-P

Cheers!