Wrist Pain, Solved

Chapters

• 0:01 Welcome And Scope Of Topic
• 0:48 Not Medical Advice Disclaimer
• 1:02 Wrist Anatomy Made Simple
• 1:24 Push-Ups And Hyperextension Pain
• 3:01 Self-Check For Dorsal Wrist Tenderness
• 3:21 Lifting Form And Bar Position
• 4:06 Knuckle Push-Ups And Stability
• 5:00 Push-Up Bars And Yoga Modifications
• 5:47 Fast Cold Therapy Protocol
• 6:20 Fixing Root Cause And Timeline
• 6:58 Clinic Tools And Joint Mobilization
• 7:26 Closing And Resources

Transcript

SPEAKER_00: 0:01

Welcome back to the Hand to Shoulder Solution, Giving Pain the Middle Finger. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist. I specialize in the rehabilitation of orthopedic conditions affecting the fingertips through the shoulder. Today I want to talk about another cause of mystery wrist pain. And it happens about probably three or four times a year when I get someone in the clinic who has been having wrist pain on the back of their wrist for sometimes six months, a year, sometimes on and off for a couple of years, and they've been to you know a lot of different offices, and it's quite the mechanical issue. And I also I always want to stress to folks that on the podcast, this isn't medical advice or treatment. There really isn't anything that can replace a physical in-person exam. There's a lot going on in the wrist. The wrist is made up of 15 bones, the two forearm bones, eight carpal bones, and five metacarpals, and they all connect here. There's a group of 24 ligaments that connects all the bones together. There's 24 contact surfaces where the surfaces meet and they move on each other. One of the activities that really provokes the symptoms and causes wrist pain in this instance, in this situation, is doing push-ups or weightlifting on a hyperextended wrist. So if, for example, when doing push-ups, the hand comes back too far and makes the wrist bend too far, that impacts the end of these forearm bones into the carpal bones. And I want to show you a little better detail here. If you look at the end of the radius, it's angled down like this. So there's an edge right there on the top. We're looking at the back of the wrist. When this comes back, it presses in, that edge is pressing into the bones, causing a lot of inflammation, a lot of tenderness, a lot of pain. So if you might be experiencing a mysterious discomfort on the back of your wrist, and you you can feel these bones. So this big bone right here is on the thumb side. So if you follow this down, and you just kind of bend your wrist a little bit, and you see where that steps off, and you press in there, and that's really sore. And you're a weightlifter, or you do a lot of push-ups, or you're doing anything where there's weight bearing on an outstretched hand like that, and that's sore. Pay attention to their ergonomics or the body positioning, the use of your body during these activities. Usually, my first question to these patients is do you lift weights? Or do you exercise? What do you do for exercise? When you're lifting weights, what kind of pushing exercises are you doing? And occasional, occasionally, real flexible people demonstrate, and I have them push, I have a stick in the office that'll say, Let's pretend this is you know, you're doing a sitting, you're you're doing a bench press, put your wrist on it, and they'll put their wrist on the bar like that. And the bar is you know toward the back, toward the fingers more, and the wrist is severely hyperextended. Now, doing bench press or on your back or doing a seated press, the wrist should be a little more straight like that. You would still you still have enough palm to rest on. The carpal tunnel is right here, so you're not jamming that carpal tunnel, you're still on the palm, but you're not in a hyperextended position. The wrist is straighter. Also, if you're conditioned for it, and we could talk about this in another episode, knuckle push-ups are really good. And you would bear weight or lean through the first two knuckles. It's those first two knuckles that are in line and most stable because this side on the peaky side, there's a big space, but the first two knuckles are in line, and this is most congruent, and that requires co-contraction of all the muscles so your wrist doesn't buckle, and that strengthens your forearm at the same time. If you're not comfortable with doing knuckle push-ups, do them on an outstretched hand, that's fine. But don't do it so far back, go out a little bit further so this is not impacting or jamming in. Another nice technique to use is push-up bars. So you can get, I just had a patient about three weeks ago, and my instruction to her was she was doing some uh yoga poses and Pilates and other things, and she was very frequently leaning on a very hard outstretched hand. I said, During those poses, just get some push-up bars that it's a it's a literal bar wrapped in foam, and you can hold that, grip it, and lean on it in this type of fashion with a wrist pretty straight but still above the heel of the palm, and that will prevent the hyperextension motion will prevent that impaction. Now, when you're having the pain and you're having that impaction syndrome, inflation inflammation is increased, your pain is increased. So, what shrinks all that down? Cold. And the best technique, instead of using a cold pack for 10 minutes, what's better, easier, and quicker is cold running water right around the wrist, right under the fossa, only until deeply cold, 10 to 20 seconds. And that's really all it takes. Right when it feels deeply cold, that's good. And I would do that after the exercise. If you're having the pain in the wrist, I have patients you know do that three or four times a day, lunchtime, dinner time, and before bed, until the discomfort goes away and they're changing their position, like we like I just demonstrated, and you have to get to the root cause. When you fix the root cause of the mechanical problem, then the inflammation, the pain, the muscle bruising, that all goes away. And it's quite remarkable, even though patients have been experiencing these symptoms for a year or more, after about three or four weeks, it typically fully goes away. There's other techniques we can do inside the clinic, cold laser, extremely bright red light therapy to reduce inflammation, increase blood flow, also ultrasound. I also like to do traction to separate the joints, restore the uh in some joint mobilization to restore normal biomechanics of everything that's going on here. Because as you see today, it's a quite complicated area. And a lot of the times, within this complicated area, it's a simple solution. So thank you for tuning in to the hand-to-shoulder solution, giving pain the middle finger. Check me out at CarlPetito.com and thank you for sharing the channel with other folks who you think might benefit. And thank you very much for subscribing and for liking. Thank you.