To read part one, go here: http://en.armpower.net/article/en/wrist-isthmus-syndrome-pt-1-3228.html
Today we focus on other causes for writ isthmus

2.Pressure. Happens mostly in exercises where the bar or dumbbell are held diagonally across the palm. This position causes much larger pressure on the wrist canal. The position of central nerve under the lateral ligament that closes the wrist channel, intensifies the symptoms when grip is improper. Which exercises generate this issue:
- bar dips – a great way to increase triceps strength, especially with additional weights. Grip is very important here, hand should be resting on the bar either on the thumb thenar or small finger thenar. If we grip between these two raises, we will hit the radial nerve point. With additional weights, we increase the risk of injury further.

3.Increased pressure within the wrist. Happens in every above exercise, and in exercises where the wrist is immobile, and blood flow from forearm is limited. It’s also connected to enlarging of tendon structures, that literally take up free space needed by the more delicate structures inside the wrist.

This can happen when:
sparring – pressure inside the forearm is increased, all the more for the time of the fight. Tense muscles debilitate blood flow. If a fighter already has problems within his central nerve, a fight will only make it worse, due to increased tension. In this case, I recommend a break from training and consulting a doctor.
Forearm curls with bar / dumbbells. An identical situation happens here, as in an armfight. Pressure is increased within the forearm, negatively affecting delicate nerve structures. It’s worth mentioning here that pain often happens when letting the other fighters’ arm go. The pain lasts a short time and then goes away.

This is a sign that nerve structures are suffering and need rest.
Using synthetic growth hormones. HGH, besides many beneficial aspects, has a lot of side effects too. One of them is the tendency for the internal organs to grow. Muscles grow, but so do tendons, and at an unnatural rate and proportion. Increased size of tendons in the wrist area also increases the tension within the wrist canal, full of nerve structures and blood vessels. The side effect here is pain.

DIAGNOSIS
The wrist isthmus syndrome is often confused with disk problems (slipped disk in the C-7 section of neck spine). The symptoms are nearly identical, pin and needles and numbness in fingers and wrist. Patients cannot sleep and work out, often has to massage their hands. There is a simple method of diagnosis – the Phalen test. Put your palms together, as if in prayer, and then raise your elbows, so that the wrist is at a 90 degrees angle to the forearm. Hold for a minute. If symptoms intensify – it’s a sign that it might be the isthmus. A doctor should examine the central nerve reaction, using the Tinel mallet test. But it’s not so simple. Diagnosis is especially hard for people in strength sports. In armwrestling and bodybuilding, strains happens in the oblong pronator muscle, with symptoms nearly identical to isthmus. In this case, a therapist should make a test for the muscle trigger point.

TREATMENT
It looks simple. It’s enough to unburden the pressured nerve, with a surgical procedure. The healing process is quick, and we can get back in full shape in 4 weeks after the procedure. If the isthmus is caused by a pathological muscle state, there’s no need for surgery. Physiotherapy might be useful, as may be cryotherapy, ultrasounds and warmth therapy. Acupuncture might help too.

Tomasz Kopeć MA