32 year old with wrist pain (Science : (Evidence Based Practice…
32 year old with wrist pain
Evidence Based Practice
Release of the triceps and biceps will result in decreased irritation of the ulnar nerve.
Technique correction on bench press should be observed to reduce chance of further irritation.
The ulna nerve doesn’t pass through the carpal tunnel but passes through Guyon’s canal, so the scapholunate separation shouldn’t impact the ulnar nerve
Therefore the irritation should be either in Guyon’s canal or higher up.
Ulnar nerve can be irritated under the triceps as it passes through the arm.
MRI didnt match with ulnar nerve irritation
nerve entrapment higher up
never seen anything similar - required problem solving
Hypo -thetico-deductive Reasoning
Pt tried to do bench press 3/52 ago after long absence from resistance training and felt pain on ulnar side of wrist and shoots down into finger.
: lifting, any movement
: Improves at night.
: Ulnar nerve irritation at wrist due to pain down pinky.
Scapholunate separation of 6mm
: MRI appears to be irrelevant.
: Look for places for ulnar nerve irritation
: ULTT ulna - pull from beginning then release. More pain with elbow bias
: ulna nerve is the problem. most likely entrapped at or above the elbow
3 more items...
: Flex, ext L=R - slight EOR pain
: AROM- UD - NSD RD - NSD
: Hand is not showing symptoms of damage.
1 more item...
: Scapholunate affects median nerve and not ulnar nerve
Grip strength down. Grip N - L R, Grip sup L R, Grip pro L R
: As pt was a electrical engineer he has good knowledge of electrical symptoms. This knowledge can be transferred into nerves as they are similar so the language used could be complex.
: Pt had a fear that his hand might not get better and moving his hand would make it worse. It was important to let him know that it will get better and movement will be a key part of treatment.
Narrative Based Reasoning
House work, Back to work
long term goal:
gym program loose weight
Increase grip strength. start to look at and correct UL mechanics
Increased grip streangh to functional levels. decreased Ulnar nerve irritation
: Gym (mainly cardio)
: Electrical engineer
: Wife, daughter(20 months)
: Father is GP and was interested in what was going on. It was important to call him and let him know our diagnosis and plan. This communication would also aid in reducing the fear of the pt.
: Had to read MRI report
If pain persists may need pain meds higher than neurofen? If conditioning is a goal then may need to be in contact due to medications and history of asthma.
Pt no longer needs pain medications
If pt wants to continue strength training after treatment
Seems keen to keep training