Nov 28, 2012

Clinical Pearl(?): Wrist Reset


I aggravated my wrist that I blogged about previously while I was on vacation in Disneyworld carrying strollers on and off buses..

This eventually calmed down, then was re-aggravated by trying to do light KB snatches and then again when my basement flooded during the recent Irene rains. I had to carry a lot of stuff out of my basement.

My Sx were slightly different this time around, I still had pain but less swelling in my snuffbox, more pain on my distal radius posterior side, pain/difficulty with P/A (wrist extension), and right sided recurrent cervical/upper trap pain.

After trying

  • STM
  • neurodynamics
  • cervical thrust
  • cervical and thoracic MDT
  • thoracic thrust
  • treating any DN I could find
I was either no better and sometimes slightly worse. I was able to alleviate the cervical discomfort, but it returned often. A very helpful NKT skype session with David Weinstock helped get about 50% of my pain from my EPB tendon in my snuffbox right to the muscle belly itself. Through some careful MMT done by myself and my wife, David assessed that my brachioradialis on the same side was inhibited, causing facilitation of my EPB. Light release of the EPB reduced the pain dramatically in the snuffbox tendon to palpation. However, that was only one session and further releases made no change. However, I was pleased that after a few releases to my EPB, the cervical pain never returned (possible upper trap facilitation?)

When I reviewed the anatomy of the EPB, it turns out that where I thought I had a possible radial fracture was right where the muscle belly was. So then I tried


  • IASTM to the tendon sheaths (which in the morning had very painful clicking 1-2 times, but did not return the rest of the day)
  • functional release to the EPB and EPL
  • more radial neurodynamics
  • light eccentric loading
None of this helped and a few times, even though I was very light, I inflamed the tendons so much I had to take ibuprofen for 4 days to calm it down. Over the weekend, I tried to counterstrain the EPB to release some tone, so I tried passive wrist, thumb, and IP extension. This flared up my wrist so much (not the snuffbox) I could barely move in any direction. It was like this most of the day.

For some reason, later that night, I thought, maybe I chose the wrong direction, despite me rapidly giving up hope there was a directional preference. I did repeated end range loading into wrist flexion, which immediately relieved the pain about 95%. I also did some distal RU A/P glides which further reduced point tenderness in the EPB muscle belly. 

When I thought about the mechanism of injury originally, my lack of wrist control (most likely due to DNs in my shoulder, thoracic spine, right hip and ankle) during KB snatches caused the KB to hit my radius, possibly causing a minor anterior positional fault of the distal RU. This would also place the EBP on tension, further increasing tension on the tendons. 

I was able to work out finally for the first time in 3 months yesterday lightly on the Jungle Gym and with KB swings (no more snatches for me until I get my DNs taken care of). I do not see enough DeQuervain's like presentations to see if this is a real clinical pearl, and may be unique to me because of the original mechanism of injury. Please go out and try this on your wrist patients to see if it works well as an MDT reset and report back!

Here's the vid as the embed wasn't working for me!

 

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