Grip pain in thumb and wrist

Discussion in 'Health & Fitness' started by Power Player, Apr 1, 2011.

  1. Power Player

    Power Player Talk Tennis Guru

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    Now and then I get pain in my wrist and thumb when I grip. Obviously hinders my tennis a bit and I am not sure what causes it.

    The pain starts on my wrist. If you traced a line around your hand, the pain starts 2 inches before the wrist and goes into the thumb joint as well.

    It can make it hard to hold a racquet until I get warmed up. It's really odd and I figure must be connected to an injured wrist.

    I have experienced it regardless of racquet and string selection.

    Anyone deal with this?
     
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  2. LeeD

    LeeD Bionic Poster

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    I get all sorts of old fart's hand pain, and stretching it a bit before actually hitting helps rid the cobwebs from the joint. I'll admit most is base of pinkiefinger for me, but I've had that pinch sensation between thumb and forefinger, but at the wrist.
     
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  3. Robbnc

    Robbnc Rookie

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    Radial styloid tenosynovitis aka De Quervains Syndrome ...possibly.
     
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  4. Power Player

    Power Player Talk Tennis Guru

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    I may have it..it's getting worse..it is irritated by serving. That is what gets to me the most. The first few times I serve, it can be sharp pain on contact and I can barely hit the ball over the net. Then it gradually subsides, but now it is showing up in my ground strokes as well. Really made an appearance after serving yesterday..started practicing groundstrokes and it was hurting on both back and forehand.
     
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  5. magnut

    magnut Hall of Fame

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    Whats your string and racquet combo. Do you use really small grips.

    I had some pretty major wrist issues a while back. Small grips and poly were the agitators.
     
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  6. Power Player

    Power Player Talk Tennis Guru

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    What were your wrist issues like? I know a lot of people can get them on the outside of their wrist as well.

    It seems like I have had this no matter what the string or racquet. I am going to switch to synthetic gut for a bit to be safe, since I do prefer full poly. Grip size is 3/8ths, which is the correct size for my hand.

    I currently use the Donnay Dual core with soft co poly (b5e). this happened with flexier prestiges, Dunlops..the flexier Donnay Black..just can't seem to solve it so far with a string or racquet change.
     
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  7. magnut

    magnut Hall of Fame

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    Mine was serve tendon inflimation at the wrist. and actually thought I had a cist in there.. I had a hard knot form and it was very painful. Then the pain worked its way into the elbow. Thats when I stopped and took a year off and started playing and teaching left handed. I dont use poly anymore.

    I should say that my wrists and arms are very strong so that was not the issue. My rackets are 12.5-13 ounces and very flexible. My technique is pretty much perfect and I dont arm the ball but use rotation of the body to swing the arms.

    Its a lot better now. Wrist is fine. Elbow is getting there. My left arm is 100% even though it was weaker and has stood up to rediculoussly long hitting sessions and other training. I just dont use poly anymore.

    That dang string almost took me out of the game. I thought I was going to need surgery to fix my issues and I am not one that likes to be cut.....hence the swicthing to the left hand.

    I would try takeing a little time off, maybe playing lefty if you can deal with the frustration (hey your still playing and it will help balance out your body so to speak), and stay away from Polyester strings reguardless what people tell you. They did not do anything for my game anyways. I just thought the durability was nice. Volleys are for crap with that string.
     
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  8. charliefedererer

    charliefedererer Legend

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    The only way to really get an accurate diagnosis and specific treatment plan is to be examined by a qualified hand specialist who cares of a lot of throwing athletes.

    But it does sound like you have De Quervain's tendsynovitis.

    [​IMG]

    If so, doing this motion will likely cause you pain:
    [​IMG]

    You may want to read more about it on the Mayo Clinic website: http://www.mayoclinic.com/health/de-quervains-tenosynovitis/DS00692/DSECTION=causes
    Here is their description of its cause [with some added comments by me in brackets]:
    "When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons run side by side from your forearm through the thumb side of your wrist. They normally glide unhampered through the small tunnel that connects them to the base of the thumb. In de Quervain's tenosynovitis, the tendons' slippery covering [called the synovial sheath] becomes inflamed, restricting movement of the tendons.

    Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis. For example, wringing out a cloth involves a repetitive motion, a bent wrist and the gripping of the cloth. [Similarly, ''laying the wrist back" to "aim the butt of the racquet at the ball", then rapid ulnar extension of the wrist as you snap the racquet forward as you go to hit the ball on groundstrokes or the serve, will involve a repetitive motion that moves these two tendons through the narrow tunnel at the wrist.] If you repeat an action like this day after day, this combination may be enough to irritate the sheath around the two tendons. [That synovial sheath should normally be very smooth, and even contain a "slippery fluid" to let the tendons slide, but with enough overuse, it can eventually become inflammed.]"

    Rest from tennis is required to let the inflammation subside.

    If you keep "playing through the pain" you risk the inflammation becoming more advanced, and the delicate sheath that should provide a slippery tunnel can get all scarred up, and never be normal again.

    Note that other motions, including lots of movement of a computer mouse, may also exacerbate the symptoms.

    Sometimes a cortisone injection is necessary to stop the inflammation.

    Sometimes a splint is necessary to prevent any sliding of the tendons, even while sleeping.

    Sometimes, the problem keeps recurring, and the tunnel and/or synovial sheath need to be openened in a surgical procedure to decompress the tendons.

    But really, do yourself a favor and get examined by a local expert who can make a definitive diagnosis, and guide you through until you are "all better", and even help design a physical therapy regimen to help prevent recurrence.

    Best wishes for a speedy recovery.
     
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  9. magnut

    magnut Hall of Fame

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    yup. Thats where my problems were at.

    I dunno about doctors anymore. I have been misdiagnosed a lot. One told me my back would need to be fused (It didnt). Another told me I needed knee surgery (I didnt). I was also told that my wrist needed to cut operated on (it didnt). Seems like they just always wanted to cut me and perform some procedure. I dont trust doctors anymore.

    Wait till you have a child. The doctor wanted to induce my wife when she was already in labor. I said what the hell for.......SHES IN LABOR ALREADY! I had to tell him to get the hell out and send in the midwife.

    Our bodies are complicated but they have fantastic abilities to heal on there own if the right steps are taken.
     
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  10. ab70

    ab70 New User

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    one thing that helped me tremebdously with De Quervain's is sleeping in the wirst brace. sort of gets you to neutral and puts the joint in not strained condition for a good amount of time.
     
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  11. Power Player

    Power Player Talk Tennis Guru

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    Thanks Charlie. I started sleeping in a wrist brace. It is just a wrap with a hole for my thumb that wraps around the wrist.

    Is there an even better brace I should consider..something for the thumb itself, or am I good.

    Surprisingly I can do the diagrammed exercise without pain, but everything else that is described sounds accurate.
     
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  12. ab70

    ab70 New User

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    the one I have has a support for the tumb which keep at around 30-45 degree angle relative to the rest of my palm. The one with the hole is helpful but more suitable for ulnar side issues.
     
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  13. charliefedererer

    charliefedererer Legend

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    Hmm...

    Usually it is exactly that motion of ulnar deviation that causes the discomfort.

    So here is the problem with being really sure about any diagnosis or treatment without an exam.

    In any event, if it still is De Quervain's stenosing tenosynovitis, a splint that immobilizes the thumb is usually advised to prevent this exact ulnar devation motion that causes the tendons to move back and forth through that tendon sheath.

    But the wrist is a very complex area and there a lot of tendons and nerves that have to squeeze through the relatively narrow wrist to control the larger area distally in the hand and fingers:
    [​IMG]

    So it is also possible that you have a different problem, like tendonitis of the flexor carpi radialis, in which case the pain would be less along the side of the wrist and more over the front of the wrist on the thumb side (along the path of the Flex. carp. rad. as labelled above), and which wouldn't need a wrist splint that included the thumb.
     
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  14. Power Player

    Power Player Talk Tennis Guru

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    I appreciate your help on this. Obviously I need to bite the bullet and find a doc, it just sucks because I have not used my health insurance at all, and have not touched the deductible. I have a feeling this could get costly in a hurry.

    I also think I may have the wrong brace since my thumb hurts and is part of this pain. Makes it tough to grip the racquet on groundies. The sharp inside wrist pain happens on the 2 handed backhand (conti grip on injured right hand) and serves. Serves can be almost impossible right now. Lately the pain has seemed to creep towards the middle of the wrist on the topspide of the arm towards the ulnar side, and sometimes I can feel the tendons hurting in my forehand like I need to stretch them out.

    Have had this thumb pain on and off, but I also hurt my wrist further a few months back on a serve and even with a week or 2 off it does not get much better.
     
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  15. Robbnc

    Robbnc Rookie

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    If it does turn out you have De Quervains and conservative treatments fail don't be too afraid of this operation. I had it 30 years ago on both wrists at the same. The recovery is fast, pretty much as soon as the stiches are out you are good to go. I have never had another problem with it.
     
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  16. Boricua

    Boricua Hall of Fame

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    Never had problems with my thumb but recently Ive had . No pain in the wrist though.
    I attribute the pain to full poly. When I dont hit in the sweetspot, I sense the vibration in my hand. This leads to inflamation.
    I am switching to soft copoly main, with gut or multi cross, to dampen and eliminate vibration. Also switched to Volkl Organix 8 which has a new device in the grip that helps absorb the shock and vibration.

    Use ice to prevent more inflamation and helps lessen the pain.

    Good luck!:)
     
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  17. Power Player

    Power Player Talk Tennis Guru

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    I am seeing an ortho on Monday morning..hopefully this issue will be analyzed right and i can get back on the courts. I literally can barely swing a racquet right now.
     
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  18. charliefedererer

    charliefedererer Legend

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    Smart move.

    You seem to love the sport way too much to allow destructive, permanent scarring to deprive you of many more decades of tennis enjoyment, plus risk encountering difficulties with activities of daily living.

    Best wishes for a speedy recovery.
     
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  19. Power Player

    Power Player Talk Tennis Guru

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    Thanks Charlie, appreciate your informative posts.
     
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  20. MambaT

    MambaT Rookie

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    Please... before you consent to surgery spend a few dollars on this book:

    http://www.amazon.com/Trigger-Point...3759/ref=sr_1_1?ie=UTF8&qid=1306243679&sr=8-1

    I went through a period a few months ago where I had serious neck, shoulder and arm pain. Chiro had me on a decompression table (time consuming and expensive) and was talking epidural or surgery to correct my "disc problem" that had been identified on a series of X-Rays.

    I was not willing to have back problems at my age, so I went looking for answers. I found a reference to this book, ordered it, read it, and tried it.

    Within one week I was almost pain free. What had become debilitating was almost gone for $15 and a little effort. I could sleep again and I could serve again.

    The book claims that a wide variety of issues that are blamed on misalignment, joints, and inflammation, including TE and CT are actually trigger point (muscle contraction) issues that can be resolved with self treatment. After my experience I am a firm believer.

    Worth $15 and a week to find out for yourself.

    Oh, and it will make you angry at doctors... especially chiropractors.
     
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  21. Power Player

    Power Player Talk Tennis Guru

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    When did I say I was having surgery? Or are you just spamming?
     
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  22. MambaT

    MambaT Rookie

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    Spamming??? I don't understand...

    A prior poster said this:

    "If it does turn out you have De Quervains and conservative treatments fail don't be too afraid of this operation."

    I was offering a bit of advice based on my experience and the path I was being led down when I was having pain. Surgery had been introduced into the conversation.

    Sorry, I was just trying to help...
     
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  23. Power Player

    Power Player Talk Tennis Guru

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    Well I appreciate the link, but I'm not near surgery yet so far, and from what it is looking like, I may just have to stop playing for a bit and take cortizone shots.
     
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  24. MambaT

    MambaT Rookie

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    And the book may help you avoid even that, but it is totally up to you what you try. I have absolutely no affiliation with that book and the link is a straight link to Amazon... no affiliate account or anything.

    Good luck with your treatment, whatever you choose.
     
    #24
  25. Power Player

    Power Player Talk Tennis Guru

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    Well im open minded...let me see what the diagnosis is first and i will be open to about anything..acupuncture..asian massage..etc..lol.
     
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  26. MambaT

    MambaT Rookie

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    I tried those...

    I'm just sayin'... You know what the diagnosis is... it hurts. The question is why. After my experience I have less trust in doctors to be able to answer that part... each kind is too invested in their own genre... decompression, meds, surgery.

    Heck, you can borrow my copy if you want.
     
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  27. Power Player

    Power Player Talk Tennis Guru

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    Well I appreciate that, you are pretty darn nice for a new fella..lol.

    I am afraid it could be a torn tendon. I am hoping it is micro-tears. I have been RICE ing my butt off.

    I appreciate the offer..found this book in my library, so ill walk over at lunch and grab it.
     
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  28. Power Player

    Power Player Talk Tennis Guru

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    Charlie, you were correct. I have De Quarvains sympton as diagnosed today by a sports ortho. The good news is that I can take oral anti inflammatorys and hopefully that will help me out. I stopped playing 3 weeks ago and will not resume for another 3 weeks.

    I am also switching away from full poly and will do soft hybrids now. I am wondering if there is anything else I can do in terms of gear to help prevent this in the future.
     
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  29. charliefedererer

    charliefedererer Legend

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    Thanks for the follow up.

    Good luck on a quick return.

    You may find you can play a bit longer when returning with one of your Dunlops or Prestige strung in natural gut or a multifilament. You're probably right that over the long term you'll be able to play with a "soft hybrid".

    Did the sports orthopod recommend any exercises to strengthen the muscles in the forearm once the inflammation has resolved to best prevent a recurrence? (Things like the "Tyler Twist" with a Flexbar Green or Blue, hand gripper or dumbell wrist curls, reverse curls and pronation/supination exercies. Of course the time for such recommendations may not yet have come.)


    If you have read a lot of threads here you probably have seen my posts on a lack of demonstrated efficacy of nonsteroidal antiinflamatories (ibuprofen [Motrin, Advil], and naproxen[Aleve]) for tendonitis/tenosynovitis.
    That is, although these agents can block one [cyclooxygenase or COX] of the pathways of inflammation, there are many other pathways that can "overide" the one pathway it inhibits.
    Thus, NSAIDs, while being pretty good pain relievers (in part because of its COX inhibition) are not that powerful anti-inflamatories. Probably this relative lack of efficacy is why a much broader acting anti-inflamatory like a cortisone injection, works "better" for initial or resistant cases. (Although cortisone has its own negative "anti-healing" effects, as inflammation is a stage in the "healing" process.) Hence a review of treatment of DeQuervain's yeilded the following:

    "De Quervain's Tenosynovitis: Richie et al conducted a pooled quantitative literature evaluation to determine the various reported cure rates of therapeutic modalities for treatment of de Quervain's tenosynovitis.20 The literature search resulted in the team looking at studies that reported the proportion of successful outcomes with different treatments, without a comparison to a specified control group; the study described 459 wrists subjected to one of several therapeutic modalities.20 For injection alone, the cure rate was 83%, which was much higher than any other therapeutic modality (injection and splint, 61%; splint alone, 14%; rest or NSAIDs, 0%).19 The researchers concluded that injection alone is the best therapeutic approach to de Quervain's tenosynovitis.20
    While rest, warm soaks, and NSAIDs may help in very mild cases, corticosteroid injection is the preferred and definitive treatment for de Quervain's tenosynovitis.19 Improvement occurs in 70% to 80% of cases where local corticosteroid injection and a thumb spica splint have been utilized.9 Care must be taken in the procedure so as not to rupture the tendon, a rare complication of this treatment modality.9,19 It is recommended that confining infiltration to the tendon sheath and avoiding injection of the corticosteroid into the tendon (recognized as marked resistance to injection) may prevent this complication.9 A single injection permanently relieves symptoms in approximately half of patients; a second injection, administered at least a month after the first, permanently relieves symptoms in an additional 40% to 45% of patients.13 While complications from corticosteroid injections are rare, patients should be made aware of their potential risks when counseled about their therapeutic benefits.19"
    - http://www.uspharmacist.com/content/d/senior care/c/12111/

    Anyway, I hope this isn't "information overload", and best wishes for a speedy recovery.
     
    #29
  30. Power Player

    Power Player Talk Tennis Guru

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    That is great info. I also am using the donnay now, which has reduced the vibration to about Nil from even the Prestige..hopefully that helps out as well with everything.

    Here is what the ortho said :
    first stage is to take oral antis :
    Predinsone for 6 days followed by Meloxicam.

    3 weeks rest as well.

    If that does not help, next step would be cortizone.

    Worst case is surgery where they open the sheath and clean it out then close it back with looser stitching to keep it more open.
     
    #30
  31. monomer

    monomer Rookie

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    Any update on your treatment?

    My daughter has some slight thumb pain after playing several long matches in three days (HS tennis). It sounds exactly like this. I'm going to have it looked at as soon as I can get her an appointment. She is not going to want to miss her season so I'm hoping she can get an anti-inflammatory and continue playing.
     
    #31
  32. sportsfan1

    sportsfan1 Hall of Fame

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    PP, I see you are back to a stiffer frame (Bab PDR from your sig?) if you could share any more details/thoughts on the conclusion of this treatment, what worked/didn't, how long it took, and did it go away completely would be great.


     
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  33. Power Player

    Power Player Talk Tennis Guru

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    Just saw this.

    This is a really complicated injury as it can return sometimes and I have to monitor it. It seems to come from a combo of weightlifting, tennis, using a mouse..just all kinds of factors. I find that it does not seem to be affected by racquet choice as much as I thought before, but when it was at it's worse I had to use a super flexy Prince mainly for peace of mind after taking 2 months off.

    Full poly aggravates it. I strongly prefer to use gut strings and a poly cross. It also boils down to technique on serve and groundies. If she is using too much wrist, this will aggravate it, especially on serve. I reworked my serve and have spent a ton of time on my groundstrokes to make sure I am not arming or wristing it, and am using my core to hit the ball.

    So I would suggest checking her technique before using AI's because they just mask the problem.
     
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