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Ulnar Sided Wrist Pain
216 Plays10 days ago
Ulnar-sided wrist pain doesn’t always need to be pain-free before discharge—Miranda and Josh explain when it’s appropriate to move on.
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Transcript
Introduction to Hosts and Hand Therapy Academy
00:00:06
josh MacDonald
Hi, I'm Josh McDonald.
00:00:07
Miranda Materi
And I'm Miranda Materi, and we are Hand Therapy Academy.
Case Study Introduction: Ulnar-sided Wrist Pain
00:00:11
josh MacDonald
We're going to do a little bit of a kind of a case study and kind of a discussion about ulnar-sided wrist pain. um I'll do a quick recap. We have a 16-year-old former gymnast who came to us with some ulnar-sided wrist pain and everything was done very conservatively. she She went through like some casting at first. She saw us for a little while. And then had some casting and then splint demobilization. And then we started the conservative stuff.
00:00:36
josh MacDonald
And now we're at this point where it's just kind of like a little bit still residual
Patient’s Inconsistent Pain Experience
00:00:42
josh MacDonald
nagging in there. When she comes into the clinic, she says, yeah, I don't have any pain. But then her mom will say, you know, she still has some like she'll do a thing at home and says it hurts.
00:00:52
josh MacDonald
And we don't want why do we still have that. She's kind of frustrated. She still has some of that discomfort. So like, what do you do? How do you know where to go with that kind of patient?
00:00:59
Miranda Materi
Yeah, I would first start by, does she have, like, what's her weight bearing? Is she able to bear weight without pain or is it less or like trying to get to the pathology or is it just more of like a centralized pain response now?
00:01:13
josh MacDonald
Yeah, and and this patient kind of presents with that centralized pain response. Like nothing in the clinic can elicit that same pain response. And it's weight bearing. i mean, we're not doing like heavy lifting stuff. We're not, you know, really pushing that threshold just because they say it still hurts at home. And so it's, but, but weight bearing on partial, uh, like, uh, map pushups and, um, some like dynamic stabilization stuff with the body blade or like light, uh, light oscillating movements, that kind of stuff. None of that duplicates the pain, but it's all during,
00:01:48
josh MacDonald
home or school-based functional tasks. And sometimes it's fatigue-based pain that she reports like, oh, it hurts because I'm tired because I did a lot. And sometimes it's doing emotion and saying, ooh, ow.
00:02:00
Miranda Materi
Yeah, that hurts.
00:02:01
josh MacDonald
Yeah, yeah.
00:02:02
Miranda Materi
Yeah. And then, yeah, it's of course like asking, is it better, worse or
The Healing Process and Pain Resolution
00:02:06
Miranda Materi
no change? You know, is it a little bit better?
00:02:07
josh MacDonald
Yeah, yeah.
00:02:08
Miranda Materi
And, and I think sometimes, you know, we want things to heal quickly, but also sometimes it just takes time, right?
00:02:16
josh MacDonald
Yeah. Yeah. And we tell patients all the time, you're not going to see us necessarily until you're 100%. You don't have to be here for the last five pounds of your 105 pound grip strength return.
00:02:29
josh MacDonald
You're going to get that when you're out there and living life, doing stuff. The same may be true of pain, but maybe we still need to kind of work through some of that. It's hard to know.
00:02:37
Miranda Materi
It is hard to know, and I think that's when you're like asking the patient, right? Or in this case, it seems like the parent is probably the one that's really concerned.
00:02:46
josh MacDonald
Yeah, yeah.
00:02:47
Miranda Materi
And then figuring out why, you know, why why is, you know, the parent concerned? Do they think something is still wrong, you know, or?
00:02:55
josh MacDonald
Yeah. And they're worried about like, why can't we get back to normal for the 16 year old girl who shouldn't have to deal with this the rest of her life? But sometimes the more questions you ask of the patient, especially with kids, the less clear the answer
Understanding Pain Descriptions Across Languages
00:03:10
josh MacDonald
becomes. You know, we want all these adjectives and modifiers to explain the pain and like a mechanic trying to find the problem with the car. And when does it hurt? And is it sharp pain or stabby pain? Or does it last? Does it go away? And sometimes kids just say, I don't know.
00:03:25
josh MacDonald
It just hurts.
00:03:26
Miranda Materi
I think that's like brilliant what you said. Sometimes the more we ask, so lest we know, right?
00:03:31
josh MacDonald
Yes. Yes.
00:03:32
Miranda Materi
With kids, that's so true. And I think that's such a good tip for our audience just thinking of it.
00:03:37
josh MacDonald
Yeah. Yeah. And, and I find, cause we, one of our offices in it is in an area that has a high population of primarily Spanish speaking patients that when we're having a conversation with the primarily Spanish speaking population, that culture does not have nearly as many adjectives and modifiers to describe pain.
00:03:57
Miranda Materi
Mm-hmm.
00:03:57
josh MacDonald
There's like, i don't know, three or four, but when I ask a patient who's English speaking and you know, that's the primary language. And I say, well, tell me about your pain. I can say, is it burning, aching, soreness, fatigue, sharp pain, stabby tat pain, dull pain? Like we have all these modifiers that maybe we just need to say like, well, how does it affect you? Like, does it keep you from doing stuff? and we need to ask the functional side, not the adjective side.
Validating Patient Pain and Managing Expectations
00:04:23
Miranda Materi
Yeah, I think, yeah, that's a great way to say it And most the times when I ask kids those questions, they're like, what do you mean?
00:04:28
josh MacDonald
Yes.
00:04:28
Miranda Materi
It's a terrible question i'm asking you because you're right.
00:04:28
josh MacDonald
Yeah.
00:04:31
josh MacDonald
Yeah.
00:04:32
Miranda Materi
Exactly. Come on.
00:04:33
josh MacDonald
Yeah, they give you that look like, i don't know, it just hurts. Like, yeah, yeah.
00:04:36
Miranda Materi
click come on And I think it's like managing the expectation of the parent too, right? So I think one thing that is I found really helpful, especially is like I've been doing this more, and you know, as a creator, it's like, is you just like validate that patient, right? Like not trying to say, oh it's not that bad or, oh, we don't worry about just say, yes, it's it does hurt and it might hurt for a long time.
00:05:02
Miranda Materi
Right? Like, and we're not saying you necessarily, we want you to live with pain, but you know, it's pretty normal to have pain as humans.
00:05:03
josh MacDonald
Yeah, yeah.
00:05:08
Miranda Materi
That's, you know, part of living, I guess.
00:05:12
josh MacDonald
Yeah, yeah. And we never want to say, deal with the pain and get over it, like move on with your life. But at the same point, we can't always take the pain away. and And maybe the answer is we can't take it away yet. It may just need more time for that structure to heal. We know the only side of the wrist is this Pandora's box of who knows what's actually causing the pain, um all these structures and soft tissues and poor vascularity and all of that, um that I do think you're you're labeling it of like a centralized pain response is maybe it's not pain, it's discomfort, or it still doesn't feel
The Role of Therapists in Pain Management
00:05:49
josh MacDonald
right.
00:05:49
josh MacDonald
And so that's the, but but that's, I label it, my central nervous system identifies that offness as pain.
00:05:50
Miranda Materi
sir
00:05:56
Miranda Materi
Right. And then saying, yes, you know, like making sure that you're saying, yes, I believe you as a patient, right? Like we want to make sure they know we believe them and we're hearing them, but also they know that like, sometimes we don't, there's sometimes we can't fix everything. Right. And sometimes the surgeon doesn't know. Sometimes we don't know, right.
00:06:14
josh MacDonald
Yeah.
00:06:14
Miranda Materi
don't know all answers and we don't, sometimes we don't always know why they have pain and neither, neither do surgeons. And It's just a feeling of suffering.
00:06:20
josh MacDonald
Yeah. Yeah. We'll, we'll do another podcast soon about pain responses and labeling pain and and how people respond to pain differently. And so we're, we're kind of like blending topics here, but it really does become a mixture of what is pain in our experience and what, what is,
00:06:40
josh MacDonald
What's normal? Like, is it okay for a 16 year old girl to still have some discomfort when she's been dealing with this for a year and a half? Like it's not just going to go away overnight, but man, if it's down to 2% of her existence, her daily activities, that's pretty darn good.
00:06:55
Miranda Materi
Right. And I think too, we don't know, like sometimes I think if we say, yeah, you're just going to have pain. That also takes away some hope too, right? From the patient that it's going to get better.
00:07:04
josh MacDonald
Yeah.
00:07:05
Miranda Materi
So I think saying we don't really know, but you may continue, you know, but we think that it'll probably go away with time because time usually does heal most things.
00:07:09
josh MacDonald
Yeah.
00:07:14
josh MacDonald
Yeah, yeah. And it may be that your body needs more time to heal and you may or may not benefit from therapy in that interim. There may be some things we can do to improve your strength below the pain threshold so that when pain does go away, you're in the best case, best position possible to move forward with life.
00:07:33
josh MacDonald
But it may be that there's a time when, you know, that, that last five degrees after a range of motion after stiffness just needs to come with you just living life, doing stuff and and kind of finding your new normal.
00:07:45
Miranda Materi
Yeah, definitely.
00:07:46
josh MacDonald
Yeah. We want to find solutions. We are problem solvers by nature as therapists, and we don't, we can't always solve every problem.
00:07:53
Miranda Materi
Yep.
00:07:53
josh MacDonald
Yeah. Yeah. Well, it's not an easy answer and we don't always have the answers, but it's good to have these kinds of conversations to just talk about like, what are some options and how would you kind of handle these patients in your clinic? So if you have any questions or have any other ideas for us, reach out to us on our platforms at Hand Therapy Academy, or you can email us at info at handtherapyacademy.com.