Extensor Digitorum tenosynovitis

A guitarist came with complaints of left wrist pain and swelling a few days ago. She had been training vigourously and held the 'chords' with the fingers (left hand) and subsequently did her biceps and triceps curls using dumbbells. Soon after the episode she started having pain and noticed 'fullness' in the back (dorsum) of her wrist.

She was advised to do RICE treatment and apply the anti-inflammatory gel. She was also treated with Ultrasound therapy and isometric wrist exercises. After a few days, the symptoms subsided and she was given a step-by-step exercise program to prevent recurrence.

Read up more here.

Flexor Carpi Ulnaris tendinopathy in Goalkeeper

Lance (not his real name) is a badminton and futsal athlete who deflected a fast soccer ball during play 10 months ago. He was given a physiotherapy and wrist brace for several months but he could not resume competitive play due to Ulnar-sided wrist pain. He could not palm-off the ball (hyperextended wrist) and do forceful wrist skills (e.g. lob, flick, repetitive jabbing and smashing) with the badminton racquet.

He had tenderness over the Triangular Fibrocartilage Complex (TFCC) and along the Flexor Carpi Ulnaris tendon, pain with wrist hyperextension and resisted flexion of the hyperextended wrist joint. He also had laxity of the Distal Radio-ulna Joint.



He did not want to do further investigations (plain X-rays, Ultrasound scan and possibly an MRI) despite being advised so. We proceeded to teach him how to tape his wrist and forearm to give him a pain-free range of motion while allowing explosive powerful smashes (badminton) and some goalkeeping. He was given some Theraband exercises and proprioceptive exercises using a soccer ball for balance.

I expect him to take at least 6 - 8 weeks to return to normal play. However, if he is keen on competitive soccer, he would require further investigations and possibly, surgery to rectify the TFCC and DRUJ injury.

Interesting links:
TFCC Injuries
Ulnar-sided wrist pain

Distal Radioulnar Joint Subluxation

A video of the wrist of a martial arts exponent who had a fall on his right hand 2 years ago during competition. He sustained an injury to his wrist causing him to have pain during punching. He also had painful full flexion of his wrist and resisted extension.

I have demonstrated the dorsal movement of the ulna with a fixed radius in the video. Although he would maintain some form of wrist stability with taping, he should be seen by a Hand surgeon to correct the instability.

Interesting links:
Radioulnar Joint Instability

Wrist (Radiocarpal ) Impingement and mild arthritis

Mr White (not his real name) is a 120kg weightlifter in his 20s who suffered from right wrist pain since 2 weeks duration. Prior to his competition he came to see me as the pain was preventing him from lifting beyond maximal capacity during 'clean and jerk'. His earlier X-ray did not show any fracture or osteophytes.

I examined his wrist yesterday morning only to find tenderness and slight fullness (synovitis) over the lunate bone in his right wrist. Forceful wrist hyperextension ellicits the same pain he experiences doing 'cleans'. Resisted extension was unaffected (ruling out extensor digitorum communis tendon involvement) He would need to rule out a lunate stress fracture (Radioisotope Bone Scans would be useful). He did not have any scaphoid bone tenderness although it is more common amongst weightlifters.

While awaiting his Radioisotope Bone Scan to rule out a stress fracture or Kienbock's Disease he would need to avoid doing 'cleans' and reduce the load of lifts. An ultrasound scan would be able to determine the extent of joint and tendon involvement with a musculoskeletal radiologist. Meanwhile, he should not participate in competition as it could worsen his condition. He would benefit from daily low frequency ultrasound (Exogen) for another 2 - 4 weeks. If symptoms persists he would need to be reviewed. MRI Scan could be an option then.

Interesting links:-
Wrist arthritis
A possible complication: Kienbock Disease

Wrist injury in Badminton player (Scapho-lunate Subluxation)

Chris is a 16 years old club badminton player who fell on his right palm 6 weeks ago while playing singles competition. He tried to play in the doubles soon after but couldn't as the wrist started to swell and the pain was unbearable. He was seen by a doctor and his pain was on the ulna styloid. He could not do any lobs and smashing after that as he had pain on the back of the wrist (dorsum).

He did not have any problems with wrist range of movement. "Ouch!", he squealled when I palpated the lunate bone. There seemed to be more mobility of the bone adjacent to the scaphoid bone (see picture). After discussing with him, we decided to do an X-ray to rule out fracture of the lunate bone followed by an Ultrasound or MRI of the Right wrist to rule out scapholunate ligament tear.

Meanwhile, I told him to start pain-free strengthening exercises for his wrist and suggested he tape his wrist during play. He was not to do any 'lobs' and 'smashing' until we obtained the results from his X-rays and MRI.

Ulna Neuritis in Cyclist

Mark is a 45 years old road cyclist with a mileage of 200 km per week. He came to see me 2 months ago with complaints of numbness and tingling sensation of his little finger and adjacent side of the hand. He mentioned that he was 'riding harder' than usual and had occasional wrist pain 2 weeks earlier as he 'felt good' and wanted to do more.

He was quite happy to lay off riding for 2 weeks and was given some isometric and resistance exercises with theraband. Subsequently, when I reviewed him again last month, he was slightly better. I gave him some neurotonics (vitamin B12) and allowed him to ride but advised against putting excessive pressure on the handlebars.

He came back last week without any symptoms and he said that he was riding better now that his wrists were stronger.