Wrist Tendinosis and Tenosynovitis in 18 year old violin player daughter
My daughter is 18 & healthy except for wrist pain.
She has played the violin since age 6. At 15 while playing tennis casually over the summer she developed pain in right wrist (right wrist on the left side of it (inside portion of the wrist) - pain is always in the exact same place - right smack in the middle of the wrist bone and the bone that is above the wrist bone).
Several years ago she had severe pain, saw an ortho (hand) and had a custom split of sorts made to the tune of $400 and lots of PT including cortisone patch of some kind....Advil (too much to say)...
At the time we thought the violin was involved but now that this is more chronic it does not appear that the violin is an issue.
What really seems to get this going for her is writing (she is right handed and grips the heck out of her pencil, holds it more like a lefty...we have added a rubber grip to the pencil).
She has no issues during the summer when she can practice and hour or 2 per day of violin with no pain but when school starts it acts up. Also making it act up are tennis and even throwing the ball for our dog Max.
At the moment her pain is at a 6-7 out of ten for days now.
Hand dr. can't see her until next Monday (in 5 days). Advil even 6 per day doesn't really seem to do much. Ice with a soft pack 3 times a day. Traumeel from our homeopath tried too....we can't see a consistent patern with anything helping. The pain is constant throughout the day...sometimes reducing but then it will flare again.
She is not using her arms at all in gym and is taking the week off violin to rest it, but must write and I fear the writing is a good deal of the issue...just a mom's opinion.
She had an MRI in 11/08 and it showed "Mild tendinosis of the extensor carpi radialis tendons can be seen with minimal fluid witin the extensor carpi radialis tendon sheaths noted on axial series 3 image #13.
No other tendinous abnormalities about the wrist are identified. The contents of the carpal tunnel appear normal. Everything else in the report is "normal".
I think what I worry about the most is that she will be off to college in the fall and it seems to me that we have not gotten to the "root" of why this is happening to her. (violin, handwriting, just the way she is built, hypermobile, etc???)
Dr. says she is "hypermobile"...I am not sure I truly get what that means. I have printed out your ice dipping technique and my husband is going to the store right now to buy the ice and we are going to try that.
She has another small hand brace (foam, thin, that you slip on) and she has been wearing that but we don't know if it helps at all or not really....so vague.
I was interested in the link about Magnesium as I take it for keeping heart palps in line and it does a great job. I have a quality Magnesium supplement and wonder if I should have her take one every day such as I do.
Our homeopath md does not want any kind of cortisone shot in her wrist and I can say we are shy and don't really see a long term benefit in that.
It has been recommended that she see an occupational CHT and see about the hold on the pencil (this advice from a performing arts doc.). She is a perfectionist type A personality, serious student, and her writing is very tiny and perfect...I do wonder about that but also I think an 18-year-old healthy girl is being so limited here...she looks for summer jobs based on "what won't hurt my wrist"...this is crazy to us at her young age.
Any advice is so very appreciated...I am already learning a great deal from your site..Thank you. Jackie (mom)
Thanks for all the details. That helps a lot.
So on the simple explanation end of things....lots of repetitive motion for the last decade. Nutrition isn't what it used to be, and teenagers aren't known for great nutrition. Possible family bloodline requiring higher magnesium intake. Type A = higher need for magnesium.
Even simpler: Muscles too tight. Connective tissue too tight. Acute and chronic Process of Inflammation.
I consider all the MRI 'findings' to be symptoms, I wouldn't really worry about all that. I like that you're interested in the ROOT of the problem.
Root #1 = TOO TIGHT TOO SHORT CONSTANT TENSION ON THE STRUCTURES
Root #2 = Some element of nutritional deficiency playing a role.
So you're already on the right track. Have her Ice Dip a minimum of 10x/day for at least a week. Ice packing just isn't going to do it.
Get her up to her tolerance level of Magnesium ongoingly for a while, see Magnesium for Tendonitis and Magnesium Dosage. Taking 'some' isn't necessarily effective.
I'd be curious for you to try Magnesium Oil too. I have some on the way for myself, and I've seen plenty of stories of people that don't get benefit from oral intake of mag getting HUGE results from transdermal magnesium.
Cheap, worth a shot.
Get her a Vitamin D level even if you have to make your doc order it.
It's also useful to know that Inflammation Causes Vitamin B6 Deficiency.
There's a lot I can say, but let's start with that. Get her icing like crazy. The more the merrier.
I can't wait to hear what the doctor says....splint, corticosteroid shot, PT, rest, surgery, PRPT (which is worth a shot, no pun intended).
Let's see how much we can get her pain levels down in the next 4 days. We can, it'll just take some work.
More questions, more answers.
Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert