A few years ago a 50-ish year old female came to my office complaining of wrist and thumb pain. It was so severe, she had a very difficuly time turning the keys in the ignition of her car. Turning door knobs caused shots of pain into the area, and forget about opening a pickle jar.
What she tried:
She started with the family doctor and was prescribed pain meds and an anti-inflammatory. After several weeks with no improvement, she was sent to an orthopedic surgeon. The orthopedic surgeon evaluated the wrist/thumb and ordered an MRI. His diagnosis was chronic tendonitis. He referred the patient for physical therapy (4 weeks).
The physical therapy center used ultrasound, exercises and stretching, and massaging the wrist and thumb. After 4 weeks, no relief, so she returned to the orthopedist. Upon her return, he gave her a cortisone injection at the wrist. It aggravated the problem and did not help. Upon the next visit, he decided to cast the wrist and thumb for 6 weeks. The cast came off at 6 weeks and the problem was even worse. The next step was to perform surgery, but the woman refused.
What we did:
After being in pain for several months at this point, the woman came to our office based on a recommendation from a friend. She didn’t think a chiropractor treated anything but back problems, but she was willing to try anything. I evaluated the area, along with the surrounding region (forearm, elbow, arm) and found extremely tight muscles in the forearm.
Having the benefit of realizing that treating the area of pain was ineffective, I focused my efforts further up the forearm to the elbow. The brachioradialis muscle starts near the elbow and eventually connects to the thumb area of the wrist. If you give a strong “thumbs up”, you’ll see it contract. We used muscle therapy to this region, and within the matter of 4-5 visits over a week and a half, the pain was improving.
Ultimately it took around 14-16 visits over 2 months, but the patients wrist/thumb returned to normal.
I share this case because it is not uncommon that people fail to get better by only addressing the area of pain. It’s important for health care providers to look at all related areas of the body. In this case the wrist/thumb hurt, but it was due to increase tension found at the other end of the muscle. Wiggle your fingers back and forth. You’ll see that the forearm near the elbow contracts. These muscle bellies pull on tendons causing the fingers to move. In the case above, the muscle belly was too tight, putting increased tension on the tendons as it crossed the wrist into the thumb.
In this case, the orthopedist needs to remember back to the childhood jingle, “The foot bone’s connected to the, ankle bone. The ankle bone’s connected to the, leg bone…” : ) It’s all connected.
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