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Jan 10th, 2014
Tom asked The Guru for the following Physiotherapy Advice:
15 months ago I was diagnosed with FCU tendonitis of both my wrists as a result of overtraining (I am a rock climber). Following a year’s rest and rehab I have begun to gradually build back into my sport (rock climbing). Whilst the problem in my left hand wrist has settled and almost disappeared, the problem in my right still persists. Last night when training I experienced the all to familiar popping sensation on the ulnar side of my wrist when under strain and at an angle. Is this a sign of being back to square one and needing to return to a long period of rest or with a few weeks rest am I able to return to my rehab programme? This problem whilst never serious enough to consider surgery is really starting to feel like a never ending battle, what is the chance of full recovery without surgery or is this something I should perhaps be considering? Thank you very much in advance for your help.
The Guru Responded:
I think surgery should be the last thing on your mind, and only considered when you’ve failed at good rehab – and when you’ve got a true structural issue (like an unstable wrist) rather than a functional (because of something else) issue.
Let’s assume that you’ve got stable wrists (an MRI/stress Xray would have confirmed this), we need to know why you’re overusing your FCU, if you haven’t got a structural issue. This scenario is pretty common and mostly it’s because of an functional issue somewhere up your arm – shoulders are at the top of the list (and your arm!)
If your shoulder “sits” in the wrong position (not necessarily painful) then everything else down the chain has to compensate because of this. The greater the force and further away it is the greater the potential breakdown. Shoulders often sit in the wrong position because of having a stiff thoracic spine.
To climb you’ll need good thoracic mobility, control of your shoulder blade and the ability to keep your shoulder/arm in the correct place whilst delivering power through your wrist. Your rehab should not have just concentrated around the wrist and elbow. It must be more global and functional and most likely less specific…
Also has anyone had a look at you ulnar nerve as it whizzes through your forearm and into your wrist? I think this is worth a prod and poke as you’ve had your symptoms for quite a while, and can mimic lots of stuff….
Let me know how you go….
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