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Injuries and Medical Advice

Wrist: Instability

A week ago I was climbing at Arapiles when I felt my wrist twinge on a hand jam. It still feels a bit tweaky and maybe slightly swollen, and it occasionally pops. I hurt it several months ago as well, though now it feels different.

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A week ago I was climbing at Arapiles when I felt my wrist twinge on a hand jam. It still feels a bit tweaky and maybe slightly swollen, and it occasionally pops. I hurt it several months ago as well, though now it feels different.

Most of the time, it’s just the little-finger side that feels sore and hot. If I rotate my wrist around in a circle, it clicks – not a painful popping, but definitely noticeable. Playing with it loosens it up a little. If I squeeze my wrist, the whole thing pops, and I can feel the bone on the little-finger side lift up and pop back into place. Sometimes, it feels like everything’s in line, but it always goes back to that drawn-down feeling.

Climbing’s not bothering it too much, so long as I don’t do anything too hard or pull slopers.

Marisa Field, Salt Lake City, Utah

I had this condition many years ago. I saw a surgeon, and he said he could fuse my wrist for me – oh joy! – and he told me to stop climbing. Imagine that!

Sounds like you have wrist instability. It will probably be diagnosed as mid-carpal instability, but there are several different types. Few physicians understand the biomechanics of the wrist, let alone under chronic heavy loading. Virtually every case I have seen has been in a climber. The instability may appear after a single traumatic event (ligament injury or bone fractures), it may be secondary to prolonged chronic overload of supporting ligaments, or it may be consequent to an underlying disease process (e.g., rheumatoid arthritis).

The combination of these overlapping causes will result in a specific type of instability. In your case it will probably be that chronic repetitive forces of climbing combined with the previous injury have led you down the merry path of carpal mayhem.

The most commonly damaged tissue is the triangular fibro-cartilaginous complex (TFCC) that sits between the end of your ulna and the carpal bones on that side. Damage to this, or a few neighboring ligaments, allows the ulna-side carpals to drop forward, known as ulna carpal sag. If you have to pop them back into place, then they are actually partially dislocating (subluxing).

The click you hear when you rotate your wrist is either TFCC damage, which is now getting in the way, or the carpals on that side, having been caught in the wrong place, suddenly repositioning.

These almost always stabilize, so don’t rush to the surgeon just yet. Surgery can vary between the simple, the complex, and the experimental.

Routine x-rays are typically normal, though some special views, such as with a clenched fist, may be illuminating. Cinefluoroscopy (a video x-ray) will show abnormal mechanics.

Tape is your friend. Get a professional to show you the way.

The extensor exercises described in Medicine No. 156 are a good idea. Though no muscles attach to the relevant carpal bones, strength clearly plays a crucial role in stability.

Slopers will be very aggravating. Crimping should be fine, but don’t overdo it. Mix up your training.

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