55 year old Man Training for 10k Swim – Wrist Pain is Slowing him Down
HISTORY
Pain in the right wrist that radiates into the hand. Pain is felt when he twists wrist for swim strokes, when using a mouse at his computer for work and when cycling (weight through wrist while holding handle bar is uncomfortable) Wrist – right side. He also feels some weakness in the arm with right shoulder tightness. The initial injury was probably from swimming. He has been using a brace, but has seen little improvement.
Pain Scale 1-10 Client reports 6
Life Affected 1-10 Client reports 6
ASSESSMENT
First Visit
Resisted shoulder and wrist flexion, abduction, external and internal rotation. Pain reactions in shoulder and wrist with manipulation.
Medial clavicle compression with pectoralis major tightness Shoulder in flexion loses centering. Active wrist is painful in ulnar deviation.
Swollen, tender bump at ulnar aspect – tendons of Flexor Carpi Ulnaris, Extensor Digitalis Longus tendons to 2nd and 3rd fingers.
Tender Scaphoid-Lunate ligaments and Supraspinatus tendon – pain with wrist movements and weight bearing through limb.
Second Visit
Medial wrist ligaments and tendons are still tender and scarred. Pain with weight bearing and ulnar deviation. Shoulder loss of centering, tightness in pectoralis minor and major, rotator cuff tendons, and posterior shoulder capsule. Weak rotator cuff muscles.
Third Visit and 4th Visit Rehabilitation Session
Pain in the wrist is improved, alignment and centering in the shoulder is held. Client is learning self-care stretching and strengthening exercises to continue to improve and to avoid future pain and injury while at work and in leisure sports.
TREATMENT
First Visit
Soft Tissue Mobilization and Deep Tissue Massage to the muscle groups listed in Assessment.
Joint mobilization with traction to wrist and shoulder.
Shoulder centering with arm elevation.
Posture and ergonomic education.
2nd visit and 3rd visit
Soft Tissue Mobilization, Deep Tissue Massage to the ulnar wrist, pectoralis minor, Rotator Cuff tendons in the shoulder.
Stretch posterior shoulder capsule.
Release and stretch hip vectors for posture alignment correction.
Rotator cuff strengthening using a resistance band external and internal rotation resistance.
4th Visit with Rehabilitation Assistant
Client works with RA to perform exercises and review posture, alignment and lifestyle changes for as long as he needs support. Only one was required and then the client felt confident on his own.
OUTCOME
After three Physiotherapy Sessions for deep tissue massage and manual traction to align back, shoulder and wrist and one Rehabilitation Session for review of his regular self-treatment routine, the Client is improved. He is better able to bear weight through his wrist, his shoulder stays centered through normal range of motion and he is building stronger rotator cuff muscles to support the strain of swimming strokes. Wrist pain is down to Pain Scale 1-2 with regular stretching before and after swimming and cycling and he no longer wears a brace. The Client is swimming regularly again and is in training for a 10k open water swim race.