Wrist Pain

Your wrist is a complex joint, and its many moving parts mean a lot can go wrong. Diagnosis is often not straightforward. Illustration Samantha Zimmerman

Q:

I have had nagging wrist pain for two years. I bouldered for eight months with occasional aches, and then I started climbing indoors. After a few days of longer, sustained crimping my wrist hurt so badly I ended up sidelined for a year. I returned to climbing, and again my wrist flared up. It can also hurt when I hold a pan or play guitar. I did take a bad fall on an extended wrist while skateboarding three years ago. I’ve had active release technique (ART) therapy, rested and used an arm massager, to no avail.

—Matthew Vanatta, Australia

A:

The skateboarding injury is almost certainly the catalyst of your current situation—falling onto an extended wrist, as most of us are apt to do bouldering, is a recipe for disaster. Trying to guess what is injured sans examination would be laughable. Some educated speculation, however, will at least give you a bit of direction.

One thing is for sure. This is not something that ART or any form of massage is going to fix, though for a small fee I could try some distance reiki. Just send me your credit-card details, and then forget about it.

A multitude of things can go wrong, but the big three are fractures (that may not be as obvious as you think), Triangular Fibrocartilage Complex (TFCC) damage, and carpal-ligament rupture. Any one of these can instigate painful and long-lasting downstream problems.

For the most part, the wrist is a mass of bones, cartilage (synovial cartilage on joint surfaces and the TFCC) and ligaments. Tendons, nerves and blood vessels pass through the area, but given your injury mechanism and subsequent presentation, these are probably not contributing.

Most likely you have a combination of TFCC and ligament damage resulting in mechanical mayhem, plus or minus ganglion-cyst formation. Let me again stress that my diagnosis is guess-based. Next stop: MRI!


This article appeared in Rock and Ice 245


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