Ulnar Sided Wrist Pain - Undiagnosed

[RyW]

I have had extreme pain for almost two years when hitting a golf ball to the point where couldn't play in any club competitions in 2017 and have only attempted a few this year.

The pain is on the ulnar side of the wrist around the pisiform and PT joint.  I have had an X-ray, MRI scan and two CT scans which have all come back 'fine' and therefore the two consultants I have seen have been unable to diagnose what the problem is.

Day to day activities are not affected, there isn't any pain when pressing around the affected areas (making the consultants job even harder) but the pain when trying to play golf is unbearable.

I have recently been given an ultrasound guided steroid injection but 10 days later it doesn't feel any different.

As you can appreciate this is so frustrating given the length of time I have had the injury and the fact nobody seems to be able to diagnose it.

Has anyone else had something similar??? I have spent hours and hours over the past 18 months trying to self-diagnose from the internet but given the complexity of the wrist and hand it is impossible.

Any help or advice would be greatly appreciated.

Ps. TFCC has been ruled out.

Thanks

[cipher]

If the doctors are having a tough time figuring this out it may be tough for any of us to help you too much.  However, I had the same type pain in the same area, for two years as well.  Eventually they figured out it was the ECU.  Have they ruled that out?  The type of pain, when you have it, and where it is all consistent with that.  They could not really see the problem and even "guessed" incorrectly after my MRI.  They eventually did a surgery, with a scope fist to actually verify the problem.  I was pretty convinced myself that it was the ECU and the scope finally verified the problem the day of the surgery.  The surgery did mostly fix the problem for me and I can play again, but I still always have some pain and don't play much anymore myself.   Was there a one time event in which you did something that resulted in the wrist having the extreme pain?

[RyW]

Thank you for your response.  They have commented that ECU tendon was 'pain free and stable' and the recent ultrasound suggested that the tendons were o.k. (they said if they weren't then they wouldn't be giving me the steroid injection).  The first consultant I saw thought it may be a fracture in the hook of hamate bone but the radiographer and second consultant did not agree.  I cannot remember a particular incident as it initially came on gradually during a round.  It was winter at the time so it could have been the result of hitting the ground or mat but I can also remember the area being irritated whilst doing light deadlifts in the gym a week or so before (but not extreme pain).

 

[Vinsk]

1 hour ago, RyW said:

Thank you for your response.  They have commented that ECU tendon was 'pain free and stable' and the recent ultrasound suggested that the tendons were o.k. (they said if they weren't then they wouldn't be giving me the steroid injection).  The first consultant I saw thought it may be a fracture in the hook of hamate bone but the radiographer and second consultant did not agree.  I cannot remember a particular incident as it initially came on gradually during a round.  It was winter at the time so it could have been the result of hitting the ground or mat but I can also remember the area being irritated whilst doing light deadlifts in the gym a week or so before (but not extreme pain).

 

Have nerve conduction studies been mentioned? I wound suggest a visit to a neurologist. An EMG may provide better insight to your issue. Often MRI & US will show no ‘injury’ when it’s a nerve component causing your pain. 

[iacas]

30 minutes ago, Vinsk said:

Have nerve conduction studies been mentioned? I wound suggest a visit to a neurologist. An EMG may provide better insight to your issue. Often MRI & US will show no ‘injury’ when it’s a nerve component causing your pain. 

FWIW @RyW, @Vinsk is an actual doctor of some sort, so… listen to him more than almost anyone else here.

[Valleygolfer]

Do push ups hurt? Or anything you do with a flat extended wrist? 

Edited October 18, 2018 by Valleygolfer

[Vinsk]

57 minutes ago, iacas said:

FWIW @RyW, @Vinsk is an actual doctor of some sort, so… listen to him more than almost anyone else here.

@RyW I should’ve mentioned that, thanks Erik. But yes, I’m a Board Certified Family Medicine (general practicioner) doctor and I’ve worked in ER and currently do Urgent Care. 

[cipher]

6 hours ago, RyW said:

I cannot remember a particular incident as it initially came on gradually during a round.  

Almost certainly not the ECU then.  Best of luck, I know how frustrating the wait can be!

[MarvChamp]

9 hours ago, Vinsk said:

Have nerve conduction studies been mentioned? I wound suggest a visit to a neurologist. An EM may provide better insight to your issue. Often MRI & US will show no ‘injury’ when it’s a nerve component causing your pain. 

@Vinsk  and @RyW a recent MRI on my right wrist was interpreted as a POSSIBLE scapholunate ligament tear but hand surgeon, a really good diagnostician, thinks other things are going on due to rheum arthritis and the contractures in my palm (one of which has been clipped). I had EMG's on both wrists and carpal tunnel on the right wrist last November plus various x-rays. So, yeah, best to proceed with all diagnostic tests before deciding on a "cure". Good luck with this painful problem, -Marv

[RyW]

15 hours ago, Valleygolfer said:

Do push ups hurt? Or anything you do with a flat extended wrist? 

@ValleygolferYes, push ups hurt to the point where I haven't done any for a long long time.  When I have aggravated the wrist by trying to hit a few balls I have pain for a few days after when turning door handles, pouring/lifting a kettle, lifting pan off the oven etc. - anything that compresses the hand towards the ulnar side of my arm.

 

16 hours ago, Vinsk said:

Have nerve conduction studies been mentioned? I wound suggest a visit to a neurologist. An EMG may provide better insight to your issue. Often MRI & US will show no ‘injury’ when it’s a nerve component causing your pain. 

hi @Vinsk nerve conduction studies haven't been mentioned.  I explained that the pain was so bad I thought it might be something to do with a nerve but the consultants seem to have ruled this out because I haven't had any numbness or 'pins & needles' sensation in my hand.

I am due to see the consultant in 4 weeks so I will ask the question with regards to an EMG.

[Moxley]

I can't help with the medical side, but I have the exact same pain (and same after symptoms), and in my case it's related to a bad injury from a motorbike crash 10 years back. 

I hope you find and are able to deal with the cause. I generally find that I'm able to play, but I have to manage the issue. Range is no/no (yes, it's not good for the long game) , but playing can be OK. I then use a combination of strategies to get by : 

- Lessen bad impacts - thicker grips, softer balls, hybrids > long irons. I haven't got graphite in my irons, but have considered it. 

- Use ibroprofen gel on the wrist before/after golf. I apply right the way up the ulna side about half way to the elbow.

- Always pick the kettle & other similar objects up with my left hand 

- I haven't yet started using a trolley (I much prefer to carry) , but I think it's inevitable that I will.

- Live with a little pain, but ease off golf if it's too much. If I have an important game, I try not to play too much in the lead up.

 

Sadly it also affects the golf a little too, with the main issue being pitching. 

 

Best of luck in either sorting out. or adapting to it.

[Valleygolfer]

4 hours ago, RyW said:

Yes, push ups hurt to the point where I haven't done any for a long long time.  When I have aggravated the wrist by trying to hit a few balls I have pain for a few days after when turning door handles, pouring/lifting a kettle, lifting pan off the oven etc. - anything that compresses the hand towards the ulnar side of my arm.

It sounds similar to my injuries. I would say it is TFCC damage, (I know it has been ruled out) only it has healed enough to not show up on the MRI. I have injured both wrists myself. They have healed as much as they are going to but they will never be the same. I can play golf and have found work arounds to stabilize them for all other activities. I would be wary of surgeries because the outcomes may not be much better than just letting them heal in the first place, but if you are having a lot of pain, you may not have a choice.

The few things I did was to wear a brace for awhile until they stabilized, especially at night because I sometime had my wrists in positions that re-aggravated the condition. I also noticed that I could do activities more comfortably with a closed fist verses a open flat hand. Obviously there are different degrees of possible damage and I think your best option is to have the area "scoped" to see if the TFCC is damaged if you haven't already.

[RyW]

3 hours ago, Valleygolfer said:

It sounds similar to my injuries. I would say it is TFCC damage, (I know it has been ruled out) only it has healed enough to not show up on the MRI. I have injured both wrists myself. They have healed as much as they are going to but they will never be the same. I can play golf and have found work arounds to stabilize them for all other activities. I would be wary of surgeries because the outcomes may not be much better than just letting them heal in the first place, but if you are having a lot of pain, you may not have a choice.

The few things I did was to wear a brace for awhile until they stabilized, especially at night because I sometime had my wrists in positions that re-aggravated the condition. I also noticed that I could do activities more comfortably with a closed fist verses a open flat hand. Obviously there are different degrees of possible damage and I think your best option is to have the area "scoped" to see if the TFCC is damaged if you haven't already.

@Valleygolfer thanks for your response. I initially thought it was TFCC as all the symptoms I have are the same as what I have read about TFCC injuries. I will ask the question again when I next see the consultant. I have got a ‘wrist-widget’ which I wear on and off but I will wear it more often and also through the night from now on.

Has anyone tried acupuncture? It’s probably a long shot but I’d try anything at the minute.

[RyW]

Just to update everyone who was kind enough to respond I am due to go for a wrist arthroscopy on 19th Dec.  There is a chance they still won't find anything to diagnose the problem but I am trying not to think about that as that would mean no more golf!

 

ps. I had 10 sessions of acupuncture and while it helped ease the pain after I aggravated it when last trying to hit a ball it didn't help with the recovery of the main problem (I went to the range after 9 sessions and it took only 6 PW/7Iron shots for the pain to return).

[boogielicious]

3 hours ago, RyW said:

Just to update everyone who was kind enough to respond I am due to go for a wrist arthroscopy on 19th Dec.  There is a chance they still won't find anything to diagnose the problem but I am trying not to think about that as that would mean no more golf!

 

ps. I had 10 sessions of acupuncture and while it helped ease the pain after I aggravated it when last trying to hit a ball it didn't help with the recovery of the main problem (I went to the range after 9 sessions and it took only 6 PW/7Iron shots for the pain to return).

Good luck.

[RyW]

Hi, I am 6 weeks post hook of hamate excision. This is following 5 years of rest, mid-diagnosis, wrist arthroscopy etc. so extremely frustrating when you enjoyed playing golf at least once a week. The surgery was a success and I know it is only 6 weeks but I can’t help think I still have a similar pain when pressing the 5th knuckle (pain in knuckle and ulnar side of wrist). Appreciate this may be linked to surgery/scar tissue but was wondering if anyone else had similar?

[iacas]

44 minutes ago, RyW said:

Hi, I am 6 weeks post hook of hamate excision. This is following 5 years of rest, mid-diagnosis, wrist arthroscopy etc. so extremely frustrating when you enjoyed playing golf at least once a week. The surgery was a success and I know it is only 6 weeks but I can’t help think I still have a similar pain when pressing the 5th knuckle (pain in knuckle and ulnar side of wrist). Appreciate this may be linked to surgery/scar tissue but was wondering if anyone else had similar?

What have your doctors said about it?

A student/friend of mine just had a cyst removed from the bone in his wrist and he still gets inflammation and tenderness/pain, and it was December 21 that his was removed via arthroscopy. He's just started hitting balls again (off tees). It can take awhile to recover and feel good (I am not a doctor).

@Vinsk is though I don't know that this is his area of expertise of course.

[Vinsk]

54 minutes ago, RyW said:

Hi, I am 6 weeks post hook of hamate excision. This is following 5 years of rest, mid-diagnosis, wrist arthroscopy etc. so extremely frustrating when you enjoyed playing golf at least once a week. The surgery was a success and I know it is only 6 weeks but I can’t help think I still have a similar pain when pressing the 5th knuckle (pain in knuckle and ulnar side of wrist). Appreciate this may be linked to surgery/scar tissue but was wondering if anyone else had similar?

Hello there! So don’t press on the 5th knuckle. 😁Just kidding. I’m a Family Medicine doc but I can tell you 6 weeks is about the average recovery time. You may need some therapy if not done already. But give it some more time before deciding If any complications exist. Cheers.