I remember this patient well, "My wrist hurts by the pinky and I can't do anything without pain." Most patients who come my way have had a disabling hand injury for over 6 months and have had several X-Rays, MRI's and opinions. Over the last 8 years, 400,000 of them have come to me.
In America today, there is a shortage of Hand Specialists. Here are some interesting facts: http://www.aaos.org/research/stats/Surgeonstats.asp Yes, you just read that there are 28,000 hand surgeons in America serving 318 million people. Most hand surgeons carry a grueling schedule of over 60 patients a day. They are more interested in the urgent trauma cases: fractures, burns, etc. Their offices are filled with people waiting for 5 minutes of their time. Yes, 5 minutes.
A non-digital scale, you know, the one that is still in your grandma's bathroom? The scale that does not require a battery. This simple tool is available in every country. It is cheap. It is reliable. The test does not require a prescription or insurance to perform. There are few tools available to people to assess the function of the wrist. We have blood pressure cuffs available, blood sugar tests, ph tests, pregnancy test, urine tests, but nothing for the wrist.... Well actually, it has been sitting there for years, waiting for someone to push their hand on it.
I did. I found it incredibly accurate in assessing the wrist. You can get excited when it logs more than your spouse or friend. Since we know that grip strength is related to longevity, I am sure there will be research on longevity and wrist weight bearing tolerance. Stay tuned for 50 years.
Place a non-digital scale on the floor. Place one hand on the center of the scale, fingers pointed to the top. Position your elbow and shoulder directly above your wrist and lean onto it. Stop if it hurts and measure how much weight you can bear. Report your findings here: https://www.surveymonkey.com/r/KBQMD3G.
Weight bearing in an adult wrist is anywhere from 60 lbs to 140 lbs per wrist. The highest I have ever seen was 140 lbs. One gentleman reported 160 but I did not see that reproduced, to his dismay. Weight-bearing tolerance is defined by age, height, and bone density. There is NO difference between dominant and non-dominant wrists.
Typically, your grip strength (which requires a dynamometer-a sophisticated device. https://en.wikipedia.org/wiki/Dynamometer) is 15% less than weight bearing tolerance.
This test is important. Let's say you fall on a Friday night, Christmas Eve, or any of the many inconvenient times to fall, and simply won't go to the ER. Your wrist is not swollen or bruised. It just hurts to do most things. So you wait until Monday to see your regular doc.
He/She takes an Xray and sends you to a hand specialist. Xray comes out normal. Most family docs prescribe anti-inflammatories and a wrist splint and send you home to rest. Now it has been 14 days and you still can't do much with your wrist. Brushing your teeth hurts, turning doorknobs hurt, washing dishes is hard, cooking impossible, and heaven forbid you have to carry anything palm up.
You phone the specialists and you have to wait 3-4 weeks for a consult. Why don't you simply perform the test? Go slowly and do not exceed pain. If your results are : under 20 lbs, go to the ER. If your results are between 25 and 45 lbs, splint it and don't use it. When it gets to 60 lbs, phew, stable. Now you have an objective tool to measure your progress over time.
Try a few things. You can try taping it. You can try splinting it. Tape is cheap. Splints are cheap. Taping technique is easy. Take 2 pieces of non-elastic tape, each 1/2 inch in width and 13 inches in length. Retest your weight bearing tolerance. If it goes up- yippee. If it doesn't, then try a resting hand brace or wrist cock-up splint. This splint keeps the wrist in neutral. Wait patiently for your visit to the Orthopedist and make sure you take cookies. Be prepared for a 5 minute assessment and grateful if you get anything more.
This test in no way describes all of the variables of injuries to the wrist. But it does help define if you have a TFCC tear. The TFCC or Triangular Fibrocartilage Complex is an important structure. It serves as a stabilizer of the wrist. Without it, you can't do much. Hopefully, you don't want this injury or any injury, but the next time you hurt your wrist, at least, you will have something to help you know what to do. Go visit Granny and borrow her scale.