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skibum14
Jun 3, 2009, 12:20 AM
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Hello all. I've been reading alot of the wrist injury threads on here, but I didn't find anything quite like my injury. (Perhaps there's one out there, but I didn't find it.) I'll try to be as accurate as possible, with the limited about of medical knowledge that I have. If anything I say doesn't seem correct, please let me know.
So here's the deal: I injured the flexor tendons in my left wrist about three years ago. The injury wasn't acute; it seems to be simply from overuse. I was a dumb teenager who simply wanted to climb all the time (in a gym). I first started feeling pain about six months after I started climbing. I was climbing 3-5 days a week for 2-5 hours each time. Stupid, I know. I'd rest for a while, start climbing, and then it'd hurt. Take ibuprofen and repeat cycle. This went on for a year and a half or so. So last spring I did four months of PT. Very little improvement. I had an MRI over the summer that showed mild flexor tendonitis, so I did four more months of PT in the fall. Not too much improvement. I had a quite a bit of pain over the winter while doing an internship on a ship. The PT consisted of ultrasound, manual work, and light exercise. A different physical therapist (who I started seeing this spring after having hip arthroscopy in March) told me to start sleeping in a cock-up splint. But he wouldn't treat the wrist until I saw a hand specialist (orthopedic surgeon). So I did that last week, and he basically said it wasn't carpal tunnel, so he couldn't do anything. He prescribed NSAIDs and sent me on my way.
So I guess I'm wondering what to do next. It seems like it is a fairly minor injury, but it's just not getting better. I didn't realize it was NSAIDs that he was prescribing (stupid me for not asking more questions), and from what I've read, NSAIDs hinder tendon recovery. Should I just not take them and keep doing PT? Call him and ask him about it? Any suggestions would be very helpful. I've never been to a doctor who was a climber as well, and I'm not sure they really understand my injury. Any amount of help is very appreciated.
Zak
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onceahardman
Jun 3, 2009, 2:33 AM
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Registered: Aug 3, 2007
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skibum, there are really two wrist flexors, one on thumb side:
flexor carpi radialis http://www.wheelessonline.com/...lexor_carpi_radialis
and one on the pinky side:
flexor carpi ulnaris: http://www.wheelessonline.com/...flexor_carpi_ulnaris
In addition, the finger flexors (flexor digitorum profundus and f.d. superficialis) assist in wrist flexion.
So, "wrist flexor tendinitis" could be any of several things.
In general, improving an old case of tendinitis can be difficult. It's probably really a tendinosis at this point.
Picture this: An overworked, under rested tendon develops small tears in living tissue. Living cells are damaged, spilling their contents into interstitial spaces. This causes an inflammatory response. The body responds by sending repair cells, called fibroblasts, which build scar tissue to stabilize the situation.
UNLESS: you take NSAIDs, decreasing the inflammatory response, and subsequent formation of scar tissue...OR...you continue to overexercise, causing larger, weaker scar tissue formation.
Now you have this old, poor quality scar tissue that really isn't getting better. My personal clinical approach would be some pretty unpleasant deep friction massage 2-3 times weekly for 2-5 minutes, right on the most affected areas, followed by fairly aggressive strengthening of the affected muscle/tendon(s).
The theory is, you now need to re-inflame in a controlled manner, break down the old scar tissue, then load the tendon in the desired direction, in order to remodel the scar to make it more like the original tissue.
It usually works, but takes time and patience. Having a patient with high cognition is helpful.
I'd expect more than slight improvement in 4 months. Maybe 50% improvement over that time.
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skibum14
Jun 3, 2009, 3:23 AM
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Registered: Apr 16, 2008
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OAHM,
Thank you very, very much for your help.
I'm not sure if it is the radialis or the ulnaris because I have had pain on both sides. Is there an easy way to tell this? My current PT has the MRI report, so I assume it says there; though I was simply told it was "flexor tendonitis".
I think it was a problem of both taking NSAIDs and continuing exercise...
Now, as to the question of treatment. Would you recommend I simply tell my current physical therapist (the one I'm seeing for my hip) to attempt the treatment you described? He has done a good job helping me recover from hip arthroscopy, but doesn't seem to know the hand all that well. (And of course he doesn't climb.)
Or should I consider going to a certified hand therapist? A quick search yielded quite a few locally (I'm on Long Island). If I should see a CHT, how do a determine which one is best?
Thanks again.
Zak
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onceahardman
Jun 3, 2009, 10:43 PM
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In reply to: Now, as to the question of treatment. Would you recommend I simply tell my current physical therapist (the one I'm seeing for my hip) to attempt the treatment you described?
No, I wouldn't. Just because my treatment plan would be different does not mean I'm right.
But I would consider a different PT if I wasn't 50% better over 4 months. I'd express my displeasure, politely but firmly, and if he doesn't change the plan, I'd look elsewhere.
something like," You know, I've been coming here for four months, and my symptoms are pretty much the same. Is there any reason to expect this to improve anytime soon? Is there something more aggressive, or different, that we could try that might bring a chance of success?"
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skibum14
Jun 5, 2009, 10:28 PM
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Registered: Apr 16, 2008
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Okay, that's fair. Though my current PT hasn't worked on my hand, just my hip. I switched PTs after having hip surgery.
I'm going home for the summer in two weeks, so I'll just find a CHT there.
Thanks again for all your help. It's very nice to have an experienced PT answering all these questions.
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