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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[lexi]

I have had what sounds like similar problem and it was subluxed carpal bone I got it reduced and hasn't been a problem. since...good luck

[sureshbpt]

Dear Patient,
Chronic wrist pain might be intra-articular or extra-articular origin.
Like soft tissue injury, Osteoarthritis, Carpal instability, Space occupying lesion...

We should differentiate the root cause of pain.

Can u tell me, did you had any history of injury, swelling, rise in temp, loss appetite,
your job nature, intensity of pain, is pain radiating or localized?, any numbness down to hand, neck pain?, when does u r pain aggravates and which position of u r wrist relives pain.


Suresh Mani

[physiomitch]

Hi Mira

The majority of pains like this are soft tissue related, but not necessarily soft tissue where the pain is! If you have pain on flexion/extension resistance, this may mean the muscles of the forearm are unable to perform fully as their fascial sheathing may be tight around them. This has the effect of 'strangling' the muscle and as a muscle needs all it natural space to work in, it will become weak to a degree if not. What you feel in the wrist is often the compensation for this weakness, ie overuse of local intrinsic muscles and muscles not normall used for flexion/extension. This overuse stresses these muscles and related fascia thus pain occurs. If you have limited ROM in flexion/extension this will be further proof of fascial tightening. You will need some myofascial release done to the forearm fascia to release this, thus allowing muscles to work correctly, which then reduces the need for compensation, thus no pain. It will be very unusual for a joint to be the cause in something so acute...remember joint movement depends on soft tissues giving them the space in which to work.

Try that

Hope it helps

Pete

[oscar]

could be a torn tfcc (triangular fibro cartilidge complex), I tore mine several years ago falling into my wrist. I had a MRI scan to confirm it....the pain has pretty much gone now and I decided not to go down the sugery route as the tear was very small..I also got pain on extension/ulnar deviation type movements

[mira_16]

Thanks for the input guys. I am going to see someone about this tomorrow..hopefully i'll find some answers...or have to wait 4 months for an MRI...
I'll keep you updated!

[mira_16]

Okay, so we discovered the lunate doesn't sit properly, it seem to keep subluxing. Also my wrist extensors are tight and there is a slight thickening and area of tenderness on the dorsal wrist primarily around the lunate.

I am splinting my wrist for the next two weeks. I am taking it off at night doing gentle AROM. I find when I flex after extending, my wrist clicks (centrally and slightly ulnarly). I think it's a tendon clicking..perhaps the extensor dig. communis.

Do you think the extensor retinaculum or an extensor tendon is tights and therefore pulling on the lunate causing this subluxing?

Any thoughts?

Thanks!

[Dr Damien]

having ur pain on both resistance flexion and extension suggests a muscular component however u did not mention anything about ulna and radial deviation resistance.I think you have a classic capitate subluxation but you have not reported any abvious deformity. having pain on both passive flexion and extension and equal pain on resistance takes my mind of muscle and focuses it on joints. so I think its a capitate subluxation may be what u have is sparin of the ligaments surrounding the capitate bone. You may require some manipulation to reset it, and possibly frictions around it, but the history resembles the diagnosis justy mentioned.

[Dr Damien]

sorry dint read ur follow up texts so it was a subluxation afterall but not the capitate,look at the ligaments holding the two carpal bones ok.

[mira_16]

Hi,
Thanks for the reply. Regarding the painful movements, it seems to be all directions hurt with passive and active movements, it varies through the day and depends with what i am doing. The main area of pain is the scapholunate interval with extension. I seem to get some clicking (seems tendon-like) with movements such as flexion following extension.
My PT tried to manipulate the lunate back into place, but he says it's not staying put. I have no obvious deformity, but he mentioned it was "sitting high" when he palpated it.
I had a simple wrist xray done and they said everything looks normal.

I have been splinting for almost a week now. Yesterday I experienced a lot of discomfort with the splint and removed it. I was having pain with opposition and any movements. It seemed as through the extensor tendons were very irritated. I was also having some knee swelling (separate issue) so i took an Ibuprophen and massaged the extensors and did some ROM and the pain seems to have diminished.
I have pain with palpation around the scapholunate interval. I'm not sure what this might imply other than an instability of the carpals.
If I have no obvious deformity could it still be a torn carpal ligament?
I am getting very stressed out and concerned that I am going to require surgery of develop arthritis. It's very concerning as I"m just starting my career and my body seems to already be falling apart!
Thanks for all the advice!

[mira_16]

Oh, and regarding some of the other questions..

I had no specific injury. I have no neck pain, no numbess or shooting pains through the arm. Pain is absent if my wrist is static. No night pain. No swelling. No loss of appetite. And no appearance of a ganglion cyst.


Thanks

[Dr Damien]

how old are you madam?

[mira_16]

haha..sorry forgot to mention..
i'm 25

[Dr Damien]

First of all, I think we need to be sure that the knee problem and wrist problem are two seperate issues.Which I think they must be since you are laughing happily...anyways if you are not getting any freedom from any treatment, consider getting an injection dose.But I would really like you to reassure me that the knee and wrist are not the same thing, maybe you want to tell me about the knee etc. and possibly if anyone in ur family has had a similar case.

[mira_16]

Hi Dr. Damien,
Well i'm not certain they are separate issues..the onset was around the same time. They are both mystery cases as well, so i shouldn't be so sure to dismiss them as being related..but I'm not sure how they would be.

I noticed both around September of 07. I have no incident to pin point either to. I think the knee pain started after a game of tennis (or this is just what i'm thinking it's related to..not sure). It is my right knee. I have pain with extension (ie terminal extension in walking) as well as with straightening it after prolonged flexion (ie coming out of cross legged sitting etc). I tend to cross my legs a lot and sit with them crossed under me while sitting at my desk or on the couch etc. The pain and swelling was mostly localized to the posterior lateral aspect of my knee. This past weekend however I noticed some anterior lateral and medial swelling around the patella. I iced and took an ibuprophen and the swelling has gone.
I find all the muscles in my right leg seem to be weak and unsteady. In sept a friend tested the ligaments, and we didn't find any major findings. I did however notice my popliteus is quite thick and tender. As well, when I strengthen my gastrocs (heel raises) I get quite a bit of posterior lateral knee pain.
I notice discomfort with closed chain internal tibial rotation as well as placing my right heel on my left knee and allowing the right knee to hang freely. Recently I've also noticed the pain around the lateral joint line. Again things tend to appear vague and they come and go so it's hard to pin point the problem.

I haven't been doing anything particularly irritating lately. In fact I haven't been exercising much at all..so that might be the issue..but I've been trying to let this issues rest and resolve, but it doesn't seem to be helping..

Is there any other info you'd like about the knee or wrist? Do you think they could be related?
(just to clarify, it's the left wrist, and right knee. I am right handed)


Thanks again!

[Dr Damien]

Well I do not want to say anything that might scare you so take my thoughts with a pinch of salt, ok? your symptoms may very well be coincidental however joint problems starting with small joints then large joints suggest systemic inflammatory problems e.g rhematoid arthritis I'm sure you know that. but since you are in good health I do not think thath is a problem anyway, just good to have it at the back of the mind.If I was to disregard that, and I look at your knee pain exclusively, I would say its possibly almost not abnormal for a woman to have these symptoms.YOu need to check your abductor strength and any iliotibial tightness on that side. you could easily do dat by standing on one leg.You are presenting with symptoms that are more joint related than muscular. Do a quick blood test to rule out subtle rhematoid problems just to be sure...I am not saying there is so do not be alarmed.All these need to be clear before before you consider the injection dose. like I said since nothing appears to be helping its the last option but I think injection will help immensely.

[mira_16]

By Injection, do you mean corticosteroids?

Thanks for the info..i will look into the blood test.
If it was RA, wouldn't there be redness/swelling present pretty consistently?

[Dr Damien]

yes, dats why I wouldnt give it too much thought and ur case may just be purely coincidental.
yeah corticosteroid injections, a few shots around the area nothing fancy, sample other opinions if you wish and let me know ok?

[mira_16]

Thanks for the advice..i think i'll pop by the doctors tomorrow.
I"ll keep you updated!

[mira_16]

MRI Results:
High grade partial tear of the ulnar attachment of the TFCC with adjacent ganglion/synovial cyst. 3mm ulnar negative variance with no edema identified in the lunate.

So my question is..now what...
My GP is referring me to a surgeon but he said it will be a while. Any suggestions on how to be more functional (esp at work) without irritating this further. At this point it's been 7 months and little things such as putting on a seat belt, carrying groceries, twisting open the gas tank etc are all aggravating.

Anyone with experience treating these injuries, what do you suggest? Do you recommend surgery or not? From googling I read a lot of people had increased pain and decreased function post surgical intervention. Any treatment ideas?
Seeing as how this injury has occurred over 7 months ago, are there chances pain will decrease with further time without surgical intervention?

Thanks!!

[oscar]

Yep, sounded a lot like my TFCC tear so good to hear the MRI confirmed it

I can only really go on my own personal experience, my tear is smaller I think which may be why mine hasn't been so problematic and the pain which was as bad as you seem to be having did die down after 3 or 4 months....though recentley it has been flaring up every now and again

It's been nearly 7 years since I tore mine and its certainly got a lot better, but it's obviously something thats never totally going to go away, the main aggs are holding a book with my wrist in extension/ulnar deviation for a minute or so and pushing down through the wrist (which does make mobs difficult!). I decided against the surgery a year ago as its really not that bad now, I've sort of adapted... I wear a wrist support (a band that goes around the wrist) for exercise/heavy lifting and if its been bothering me during the day I'll sleep with a wrist splint on at night (not the most glamorous of things for night wear but never mind!). I would suggest you try and get a second opinion on the surgery though, specifically a hand specialist rather than an ortho consultant before making any decisions. I'd also try wearing a wrist splint at night to rest and immobilise it and a wrist strap/support for lifitng etc...

Sorry I can't be more helpful but from personal experience it does get a little easier with time (talking years rather than months), but may never really be 100% given the tear- saying that though the surgery could result in even less use out of it! It's probably going to be a case of getting around it and adapting what you do which ever route you go down....

[mira_16]

Thanks for the advice Oscar, I will try to learn how to adapt to it. I haven't tried the wrist strap, I'll try taping it and see if that helps.
Was your pain mostly on the ulnar aspect? Mine is more dorsal and central around the scapholunate area. The tear on my MRI says its ulnarly located but I dont' have ulnar pain. I don't have any experience with TFCC tears so I'm basically clueless...
Thanks!

[oscar]

my pain is also dorsal, but more ulnar and when its really aggrivated the pain can spread up the ulna on the dorsal side

[jenlemoine]

I've been googling to find out what is wrong with my wrist and this seems similar. I injured it July 2010, I don't know how I injured myself as well. I was placed in an orthopedic wrist brace for 2 months. I've seen an ortho, had MRI and had some type of shock test to rule out carpal tunnel and doctor says everything is fine.
But almost 1 year later I'm still in pain! The only other thing I suffer from is reynolds phenomenon in both hands. Wrist clicks as well and randomly likes to get real red/hot with extreme pain.

[Denver Chiropractor]

Sounds like the test you had was needle electromyography (EMG). Also sounds like the Raynaud's phenomenon may be your culprit. Sorry couldn't be of more help.
Denver Chiropractor