Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physiotherapy in Vancouver. They're sports physiotherapy experts. And we're gonna talk today about wrist pain and cartilage injuries in your wrist. How you doing Wil? 

Wil: Hey, I'm doing good, thanks Mark. 

Mark: What's going on with this kind of stuff in your wrist? I got such a sore wrist, man. 

Wil: Yeah. I wanted to actually touch base on this because it seems to be something that's also more prevalent with a lot of rock climbers. And we treat a lot of rock climbers in our clinic and myself being a rock climber. And I have a lot of friends at rock climb that quite often you know, end up injuring this part of the wrist and they'll have the wrist pain and then it goes away and it's sometimes undiagnosed.

But the recovery of the type of injury is quite good. So basically, what we're talking about specifically is the cartilage portion on this side of the wrist and the cartilage, it's actually more accurately called the triangular fibrocartilage complex. So in the abbreviated form, we call it the TFCC or EFCC injuries, the triangular fibrocartilage injuries, or cartilage complex injury.

And the reason why we call it that is because it's made up of the cartilage, the ligaments and the capital, and then there's also the bony structures in there that houses it that actually impact it quite a bit as well.

And so quite often with rock climbing, it totally fits that presentation in terms of the mechanisms of injury. But like, I'll talk about a little bit about the presentation of the type of injury as well. And mostly like I was saying, the complaint of the symptoms are usually on this side and it gets worse when you're moving it or going back into climbing and trying to stress it.

There may also may be like weakness in that whole hand, in the grip strength and it'll click maybe. And there might even be some instability in the wrist. Some actual instability and perceived instability. It's usually directly related to some kind of trauma. So like with rock climbing, you know, it's that hyper extension sort of like if they're like mantling and pushing off in a really, really extended wrist position and trying to push off, they might injure that part of the cartilage.

Or if they're doing a hand jam or you're doing like jamming into a crack, but then you're like, not just jamming like this, but then you're like this, and now you're putting all your weight on that wrist now. So that's another way of injuring it. Give you some other examples from like you know, baseball or whatever.

Like you're trying to throw the ball and you end up cocking it or you're doing like a certain throw and then you flick it or whatever, and you hyper extend and put too much compression on the side of the joint that can cause it to basically compress. If you injure the ligament in there too, because then it's infinitely connected with that cartilage area. 

The other thing that actually is interesting is on a sort of more structural level so you have two bones that make up the forearm. And the inside bone is called the ulna, and that ulna bone, basically what the ulna and the other bone here called the radius.

They both connect to your wrist bones, you have eight muscles that make up wrist bones, and they kind of basically go in two rows. Like the first row is four and then another row four on top kind of thing. And so typically, if there is a change in the anatomical length of your ulna bone, then that can also add more compression, it'll put a little change, how your wrist can move physiologically. And so that's another thing to look for too. So they call that in a physiological term, like a positive ulna variance. 

And stuff like gymnastics, you know, a lot of impact, you know, you're doing all these flips and stuff like that where you land and you're compressing. So that's another way of injuring it. So usually you feel like it gets inflamed. You know, it feels really inflamed in there. And some people can experience it like, oh, maybe I got tendonitis. So anything that's involved in gymnastics, you're on those bars. 

Or you're doing anything where you're like repetitively, like say you're carpenter. It's that competitive where, oh, you start to feel pain in there and they think it's a tendonitis and you could often misdiagnose it as just a wrist overuse or a wrist, like a ligament sprain. But you know, it's usually a little bit more involved. 

Mark: So diagnosing this, what are the steps to kind of narrow it down to what exactly is going on?

Wil: Yeah. So there's a couple of really specific tests that you can do for the TFCC. You can do what's called a compression test. Where you have the arm in a certain position and then you try and move basically the ulna, like basically relative to the little wrist bone in here called the pisiform to see if it actually produces any symptoms. So that's like a compressions test and we can do other stress testing on that TFCC. The triangular fibrocartilage complex. By applying that force through that ulna bone. 

You can do other rotational tests. We call the supination test and whatnot, and basically grabbing the underneath side of the table. You can do a little home test where you rotate, that's called supination, and then grab the under side of the table and that load of just doing that, if that causes pain in there, then that may be an indication that you have some kind of tear or pathology in that TFCC. 

There's also another test where you look at, so this is kind of like a more growth instability, which is called a piano key test where you try to press the hands on the table. And then as you're pressing the hands, if that ulna bone that I talked about on this side, if it pops up, then like, oh, there's something going on there. And then if there's instability plus positive symptoms, then that's another indication of a positive test. 

And then there's like other tech where you're just compressing, grinding the radial portion and the ulna portion where you're just trying to really reproduce the symptoms of that TFCC. So if there's a tear in there and you're grinding and may indicate that yeah, there's something going on, but maybe degenerative process or something like. 

Mark: So what's the typical course of treatment once you've narrowed down to what's going on? 

Wil: Yeah, so it's it's something that's really rehabitable. So it's really good with rehabilitation. Prognosis is usually really good. Especially with minor ones. We've seen some success with definitely more mild ones. And then where, you know, you get into for more of the extreme ones where people can't even like, it's really swollen and an acute injury. And it's looking you know, probability of it being really high that it's TFCC injury. Then as we get the swelling down, then you know, on some of these more rare cases, or I guess on the lower percentages where it's more serious than maybe getting medical intervention where surgery may be an option. To repair it, to debride it or to do something if it's like a physiological thing, then doing something with the bone. It is a very good success in terms of the actual surgical procedure as well. 

The rehab is also very, very successful. It is a bit length when you're looking at considerative treatment because of it being a cartilage tear and the fact that you're using your hands all the time and also the nature of the injury. And especially if it's something that's causing a lot of swelling in there. Because usually if there's swelling and especially if there's any kind of bruising and bleeding from the trauma, then it usually indicates that there's a little bit more soft tissue injury involved. 

So really let me just sum up. Basically, number one, you really wanna look at being able to immobilize it for the first week, if it's any kind of injury that has swelling and is more than just mild because you need to really give it a chance to heal and let the swelling settle down.

Getting a brace for it would be really helpful to not use it because you really wanna just let that settle right down. That's super important. So no using it. No playing sports with it. And once it's settled down for maybe even two weeks or three weeks, then you can start to you know, do a functional splint where you're now able to do some stuff. And then maybe at this point you start to actually work on the range, start to work on the strength. 

If it's more mild, then you might not even need a splint or a brace at all from the get go. And we want to address the mobility right away. We wanna address the strength issue right away. We do a lot of things to activate the core of wrist. Just like in the neck and your lower back, you have core stability muscles of your wrist. So you wanna work on these muscles that help rotate your arm and stabilize the wrist. 

Now here's been a really interesting thing that a lot of people don't really realize when you have an injury in there because there's tendon attachments down into that wrist area. And this is why people quite often think that it may be a tendonitis or an overuse injury, or it gets misdiagnosed as an overuse injury, because what happens is that we get really tight too. But then if we actually accurately diagnose it and look at well, what is the true cause of your wrist pain? And we figure it's that, you can still have this adjacent or this combined tightness into your forearms because of its intimate connection with that wrist joint and TFCC. 

So what can happen is that you may not actually have a dysfunction in this forearm muscle or the forearm muscles, there's more than one here. Like your flexor carpi ulnaris muscle, for example, or your flexor digitorum superficialis or the flexor digitorum profundus. So these are just some of the muscles I'm naming here that are getting more specific here, that can be involving it really tight. Now why I'm mentioning this is because if that gets really tight, especially that one that's connected to the wrist, then it can cause more compression.

Then it can actually impact the healing and the rehab of that wrist injury of the TFCC. So then what that means is that we have to address the tightness here, to allow this to decompress, give it more space, more of a chance to work on that mobility because when things start to compress, then it's just gonna irritate that a little bit more. So that's another thing to consider. 

Another thing to consider too, is what caused all that to begin with? Why did you have to start to hyper extend like with whatever sport, activity that you're doing. If you're a carpenter, are you getting issues in your neck and shoulder that is causing you to really get into the hyper ulnar deviation, is the motion right? That then you can't bring your shoulder right up because maybe there's an existing shoulder issue that was never really addressed by yourself or by even acknowledging that there's something there going on maybe. So those kind of things, to really take into consideration. 

Mark: How's your wrist really? If it's hurting, get into Insync Physio. They can help you. You can reach them at their website insyncphysio.com. They have two offices to serve you .One in Vancouver, one in North Burnaby. You can call them the Cambie office is at (604) 566-9716 to book or in North Burnaby, (604) 298-4878. Get expert help for your wrist pain. It can heal. So get in there and get some help. Thanks Wil. 

Wil: You bet, Mark. Thank you.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. And we're going to talk about wrist injuries from rock climbing. How you doing Wil?  

Wil: Hey, Mark. I'm doing well. Thanks. How about you? 

Mark: Good. So what kind of symptoms would someone have other than just pain? Like how do you hurt your wrist? I can see fingers, all kinds of things, but your wrist, rock climbing. 

Wil: Yeah. So, so the symptoms would be other than pain, would be like some swelling, obviously like you're saying, and then some loss in range, but also with this kind of injury, you can get some clicking in the wrist. So what I'm thinking more specifically is when you have the type of injury where you say, if you're rock climbing and bouldering, and you basically fall down and then you land with your hand outstretched and wrist extended kind of thing, to try and soften the blow of the fall. Then that can cause a strain into your cartilage and this side of your wrist, which is called the ulnar side.

And so that cartilage, that whole area is called the triangular fibrocartilage complex, TFCC for short. And so basically the reason why it's called that is because there's the cartilage and then you also have ligaments in your capsule in through there. And so it's a complex in the fact that they all work together to stabilize that area of the wrist.

And so in rope climbing or league climbing, or more specifically like what's called traditional climbing, you're doing a lot of crack climbing and hand jamming. You basically have over rotated wrists. So you can either basically over-pronate is what it's called, where you turn it that way and you jam it in a rock. And then you're like basically trying to hang all your weight off the wrist. So you can now imagine all the forces that are basically being put on the wrist in that motion. And then also the twisting where we may try and just do anything to hang on. So you can see how the wrist can also be injured in that area.

So those are very common ways of doing. And the other way is also when you're climbing, whether it's on a rope or bouldering or whatnot, and you're trying to like push up to a really hard move. And you're now once again, you're kind of pushing off and extending your wrist and putting pressure through that palm and that's called a mantling move. So you're just essentially trying to like push off this way and now you're super extended. 

Mark: Sort of like if you're climbing up onto a ledge and you're trying to mantle yourself up over that with all that pressure being right on your wrist. So one of those things, we don't really necessarily understand that the wrist is incredibly complex with all the bones, ligaments, tendons.

There's eight bones in there, plus all your metacarpals that make up your wrist. So we think of our shoulder as being complex, but you know, our wrists are actually possibly more complex. So putting all that pressure on there without training for it can be a really interesting situation. So how do you go about diagnosing what's actually going on and then what the course of treatment's going to be? What are the steps. 

Wil: Yeah. So with these type of injuries, these type of cartilage injuries in your wrist, there are a few specific tests. That will either rule it in or rule it out. And you don't want to just do one of them because you want to do a few of them to just sort of, you know, get sort of a battery of them. And then that'll give you a good idea. And also, you got to hear out what's the, okay yeah, I did this or I did that or I landed like this. And then you add that with a test and then you can sort of figure that out. 

And so the other important component that's missing here is that especially with so once again, I talked about this in previous podcasts or different videos where competition climbers tend to have less of those injuries versus climbers here are just more, you know, beginners or just avid, but don't really take care of their bodies or really look at trying to balance things out and be strong overall. And so why I bring that up as an important point is because if you climb a lot and you don't look at recovery, and you're really imbalanced and you're just always training, climb, training, climb, training, climb training. You're not doing other things. Then you can get really tight in your flexors and so those flexors, especially certain flexors that attach from your elbow, forearm all the way down to that wrist area. By that cartilage, that complex area, it can cause a lot more sort of compression strain already.

So even pre-loading before you even start climbing, you're already at a disadvantage. Now, because of that, then you go to like, you know, all of a sudden you have to like catch yourself, because you're going to fall or you have to do one of these maneuvers where you mantle or you have to like hyper pronate and hang and really tension that joint. Then you're already at a disadvantage because everything's more compressed. And now you're going to torque that cartilage complex area even more. 

And I see this quite a lot. And the other thing I found too, you know, you look at stuff that's going on in the neck and all the way down. Usually related. Usually there's stuff related to that. So that's why I say that with competition climbers, there tends to be less wrist type of stuff like that, you know? Beginner climbers, you go hard at it, and they fall a lot or they do those maneuvers and without a lot of muscle balance and recovery and looking at okay, you know, I got to train this part of my body a little bit more and having more balance in that way. 

Mark: So once I guess, get the swelling down, but then what's the typical course of treatment. Once you get the swelling down for somebody with this kind of injury?

Wil: Yeah. So you also want to consider, okay, what's the healing timeframe for something like this. Because that's important to look at, how well is this doing? So typically, these things can be minor and you can function and you can still keep climbing and it's not like, oh man, I can't climb ever again. Yeah you can. So four to six weeks, you should start to see some good improvement and it takes about that length of time for it to heal.

And so during those four to six weeks, what are we working on? Working on making sure that you increase your mobility. So you want to make sure that you get the mobility back in your wrist in all directions and also strength. So strength, you want to work on many different aspects of strength.

So there's three types of strength. So there's what's called isometric, concentric and eccentric. So isometric is when you develop strength, tensile strength in your muscle where that force of that muscle, it is tensioning up, but there is no lengthening of the muscle. There's no movement in the joint. A concentric force is basically when you're tensioning that muscle and then you're shortening the muscle and shortening the joint or flexing the joint or extending the joint. So the key is the shortening of the muscle versus isometric, there is no change in the length of muscle. Eccentric strength is the constant tension strength of the muscle while it's lengthening, whether it's inflection or extension in whatever movement. So you want to focus on all those different aspects of strength. And the last thing then is really focusing on your functional movement.

So for climbing, it's very functional for like these different types of holds that you start to need to be able to grasp again, you know, from crimper hold to pincher holds and to even like lock offs, and there's another term called gaston, where basically it's putting your wrist in a specific position.

So there's all these different type of positions in different holds in different ways that you want to start to build that functional strength. And here's the other key thing too. You want to do that building your core, building your, not just like your AB core strength, but also your lower extremity strength. Because research showed that when you start to work on your lower core, then you start to get more core strengthening in your upper extremities.

And you have more core strength in your scapular muscles, which is your shoulder blades. Then you're going to be relying less on your forearms all the time. And this is important in the rehab process. We don't really think about that in climbing, you know in volleyball it's a given because you got to run and jump and then hit. You get a wrist injury or shoulder injury yeah, you got to work on core. Seems more obvious. But in climbing, we don't really think about that as much. So we got to also focus on that. 

Mark: If you've had a wrist problem from climbing, the guys to see are Insync Physio. You can book online at insyncphysio.com. They have two locations to serve you. One in Vancouver on Cambie Street and King Edward, you can call them (604) 566-9716. Or in North Burnaby on Willingdon and Hastings (604) 298-4878. Get expert help from expert climbers so that you can get back doing the sport you love. Thanks Wil 

Wil: Thanks Mark.

A common problem after spraining your wrist is a restricted pinching pain on the top of the wrist. Pain and loss in full extension can persist when trying to put weight through the hand with the wrist extended, like pushing yourself up from sitting or doing a push up. This can continue to occur even months after it’s fully healed because the movement dysfunction in the wrist has not been normalized. Here’s an exercise that can help restore this.

Start by identifying your scaphoid bone located between your two thumb tendons and the second bone called your lunate which is right beside it. You will also be using the webspace of your opposite hand. Roll up a hand towel and can grab it comfortably with your knuckles down.

Then wrap the webspace of your other hand nice and snug around the those two bones of your wrist with some downward pressure while pressing down with your affected wrist at the same time. Extend your elbow to provide weighted extension into your wrist, then release.

To add more functional weight resistance, bring one leg on the couch and go onto one foot on the ground to get a little higher. You can also stand up to add more weight resistance. Repeat this for 15 reps doing 3 sets 3 times per day.

This exercise should not cause any pain or discomfort. If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing.