wrist injury: looking for advice

In March of this year, I injured a wrist for the first time. It wasn't the result of a fall, or a chronic problem, but was an acute injury that happened while bouldering on plastic. I grabbed a hold, pulled, and it felt like something deep inside the wrist in the center tore. The pain wasn't excruciating, but I knew I'd done something bad when I couldn't even hang my weight off a pullup bar afterward.

I took two months off with no climbing, and then started climbing easy, initially only outside, but fairly soon thereafter doing routes on plastic. After 3 to 4 months, I had steadily increased the intensity of my climbing, and was starting to feel not that far away from where I was pre-injury. While I was definitely healing, things were still not 100%. I wasn't bouldering (on plastic or rock), and hadn't started weighted hangs on the fingerboard or other intensive training.

Then two weeks ago, while enjoying the delightful granite of Shuteye Ridge, I reinjured it. While cranking through the short crux of a route, I had sharp acute pain again deep in the wrist. By the time it occurred to me to let go, I was through the crux, and finished the route. I climbed several easier routes that evening, but had little strength and significant discomfort in the wrist. After nothing showed on an x-ray, I got an MRI and visited a hand surgeon. She tells me I've completely torn all ligaments between the scaphoid and lunate bones in the wrist, and this may have substantial negative impacts on my climbing.

As I'm only 50 currently, and have only been climbing for 34 years, I of course am in no way ready to quit, or even to reduce the intensity, frequency, or difficulty of my climbing. So I'm trying to figure out some next steps, and would welcome advice from any of you who might have suffered a similar injury, or those who might have helpful medical advice or thoughts.

The surgeon thought the conservative option was to simply brace the wrist, avoid all climbing or heavy use of the wrist for a few months, and thus hopefully let some scar tissue grow between the two bones. That might be enough to allow some return to function, although she was unsure if the stresses of climbing would be allowed by the joint without ligaments there. A more aggressive option would be to stick a screw from the scaphoid into the lunate bone, which she thought might allow for better odds of being able to crank aggressively with that hand.

Any thoughts from the taco? (I of course expect to hear the inevitable 'you're gonna die', but would welcome other thoughts as well.) Cheers.

Tom,

Seems like a serious injury and you seem serious about your recovery so I would seek a second opinion from a qualified specialist.

Good luck!

Jim

My advice was also to seek a second opinion -- jim beat me to it!

Hmm, I too suffered complete scaphoid-lunate dissociation ("completely torn all ligaments between the scaphoid and lunate bones in the wrist") early 1997. Luckily, it was not on my dominant hand. I got it operated on and repaired by a a superb surgeon at Mass General Hospital.

You and I are about the same age. I was climbing slabby stuff about 4 months after the operation and leading stuff a month after that.
Yes, the operation involved ligament repair and reattachment. A titanium screw was put in to keep the two bones in the correct orientation for about 3 months so that scar tissue can form. A tremendous amount of occupational theraphy was done part of the recovery process, to build up surrounding muscles to keep the 'new' joint stable.

I am not going to lie to say that I had a complete recovery. I was not able to get all the hand strength back and the range of motion after was (and still is) only adequate and no way equal to the flexibility I have in my other wrist (both wrists were very flexible prior to the injury). The type of climbing I am worse at now is left arete pinching. The strength and flexibility is just not back to what it was.

All said, it is important to know that your mileage will vary. We all respond differently to surgery. The most important thing is to get good medical advice and get it treated in a timely fashion. Hand surgery has likely improved a lot over the last 16 years so you have that in your favor (over my case).

Good luck. Send me a PM if you need more info. I am on the East Coast.

Thanks guys; I will get a second opinion. And S Neoh, I'll PM you. I'd love to get some more info on your surgery specifics. Cheers.

I tore my TFCC in my wrist last year. I had it repaired because they said that if I didn't get it fixed soon it would be much harder to repair if I continued to do more damage to it. Not sure where you are located but Dr Viola at the Steadman Clinic in Vail did my surgery, he is considered one of the best for hand/wrist injuries in athletes.

I had a complete Scapholunate dislocation in my right wrist in 2009 and had it surgically repaired (ligaments reattached) a few weeks later. After my injury it was very obvious to me that I needed to have surgery. I couldn't even carry a plate in my right hand without it opening up on me. My right hand was worthless. Turns out my schaphoid was basically just flopping around in there and banging into my other wrist bones every time I tried to use it.

I had to shop around for a doctor that understood what I wanted to do with my wrist, i.e., climb. The first doctor I went to just wanted to fuse it and call it a day. No thanks. In the end I went to Dr. Michael Gordon at CU. He told me I could either have a strong wrist or a flexible wrist, but not both. He said if I wanted to climb again I should opt for the strong wrist, so that's what I did. Even then he said that there was no guarantee that the ligaments would reattach and I still might need a fusion. He ended up reattaching the torn ligaments and rerouting parts of other ones to help stabilize my damaged joint.

After surgery my wrist was immobilized in a cast/brace for four months. After that I spent lots of time in OT and PT. I was able to go climbing as soon as the cast was off, but at a greatly reduced level since my new wrist flexibilty was about 50% of what it was and super weak. After about a year I was mostly able to forget about it being different from my good wrist.

Now I'm climbing harder ever than before and still getting stronger. Some moves are harder/awkward but overall I don't notice much of a difference climbing. I practice yoga and strength train still too, but without the ability to complety flatten my hand to the ground - no pushups for me unless I use my pushup blocks.

That's my wrist story. I'm happy with the results, but we're all different. Be sure to keep looking for a doctor who understands the stresses you plan to put your wrist through after surgery. Dr. also told me that for the ligament reattachment to be the most effective surgery needed to be performed within a few months of injury. Personally, if I heard what your wrist doc is telling you (just wrap it up and hope things grow back together) I'd be running as fast as possible for a second opinion.

Of course your situation may be different than mine. On my MRI I had 7mm of space between by scaphoid and lunate bones. My doc said he recommends surgery after 3mm of space with normal being around 2mm.

Feel free to send me a pm if you have any questions about my rambling comment.

So glad to hear your story Chad. Mine was very much like yours, especially the scaphoid just "free wheeling" part. And yes, my hand was almost useless prior to surgery. I had surgery 12 weeks after snapping the ligament and was told that was almost too late to attempt a ligament reattachment. But Dr Jupiter was able to do it in a 2+ hour surgery.

Congrats on your near complete recovery Chad. Hope the same goes for you Tom.

P.S. Yes, I have not been able to do "regular" push-ups since 1997.

Thanks for all the thoughts guys. I missed the recent comments, and it's quite helpful to hear people's perspectives. I actually have spent most of last night and today looking at PubMed articles on scapholunate problems. It's definitely encouraging to hear that some climbers have had this problem, and are still climbing. Many thanks!

I also had a scaphoid-lunate dissociation. I went through OT for about three months and finally saw a hand specialist who diagnosed the problem. Because the injury was four months old I had to have a modified Brunelli procedure done. Has anyone had this done, and if so what can I expect as far as my return to climbing. The cast has been off for 4 months now and I am only leading low 10's. The confidence just isn't there yet in my left hand grip strength. Just curious if there are any climbers out there who have had a modified Brunelli for scaphoid-lunate dissociation and know what to expect long term.

Hi Chris
I haven't had a modified Brunelli procedure, but I have done a lot of reading of journal articles on SLL reconstruction. Looks like it works quite well for some people, less well for others, and unsuccessfully for others. There are a multitude of surgical and reconstructive options; one surgeon I talked to had actually done 12 different types of procedures himself (and multiple surgeries on many of those 12). My take-away message from that, which is unfortunately confirmed in the literature, is that there is not a procedure which is clearly a reliable way to fix the problem. I would definitely have some conversations with good hand therapists, and work like heck to rebuild strength and/or range of motion. Best of luck; hope your wrist lets you get back to climbing and pulling hard.

Tom Hope i am not to late i had a similar injury i have a screws from the scaphoid-lunate and scaphoid capitate fusion with screws and it's been 20 months now and i was released from the surgeon a year ago and i have BIG problems my hardware is loose i have seen 3 hand surgeons and they all run as in REFUSE to work on my wrist. I am in lots of pain use pain killers everyday lots of swelling. I failed to mention that i have wrist problems in both hand one worse than the other. I hand one hand surgeon tell me that i should enjoy what i have because he thinks that i could lose my hand in the future. When i was released from the hand surgeon that did most of the work i told him that i may get a second opinion and he told me that i will be hard pressed to find anyone that will do anything for me? I thought will see well i had one hand surgeon tell me to go find a mal practice atty. The others told me they think they would make things worse than better due to how the screws were put in. I sit and wonder what have i got into my primary care Dr is at the point of sending me to the mayo clinic and is very upset at these hand surgeons because they all agree that i have a complex problem and serious problem but don't want to get hung up in another surgeons mistakes. I will tell you that one surgery was 5 1/2 hours long. This surgeon that did this to me was a national renowned and has published many of books on hand surgery i feel that i was a experiment and let me tell you it is a TOTAL Fail. I have a appointment with him in 30 days boy is he going to get a piece of my mind.

Tom, hope everything went well and you are well on the road to recovery.

About the modified Brunelli procedure, the first two surgeons I saw recommended it. The third I saw and whom I ultimately went with recommended against it and did as much reattachment as possible. That was in 1997. Though the flexibility and grip strength never returned to the pre-injury level, I am happy to report that the wrist has been stable and almost 100% pain free since Nov 1997 (after six months of OT post surgery and some climbing).