Negative Ulnar Variance?

[Wayne77]

Last week I did a really long training ride. Later that day the bones just above my right wrist were hurting, with lots of swelling. I had very little mobility to move my hand. I ended up putting on a wrist brace until I could see my doctor. I assumed it was fractured either due to something on the long ride causing an old stress fracture to surface again...or something along those lines.

Yesterday my X-rays came back negative but my primary care doctor said it appeared I had something called "negative ulnar variance" and he recommended I find a good orthopedic surgeon.

Does anyone know what this is, and what the treatment options are? Googling it doesn't give me much other than some advanced medical articles with terminology over my head. Could this be carpal tunnel syndrome? Maybe its related to work - I do a lot of typing on a laptop and use the pad on the laptop and not the mouse...so maybe long rides are complicating the issue since my wrists are in some specific positions for long periods of time.

I'm going to consult with an orthopedic surgeon but I thought I'd check here to see if anyone knows about this.

Thanks!

[bigbill]

Could you have a ganglia cyst in your wrist? I have one and it matches your description in location and pain. Doesn't show on an xray but in my case the Dr could see displacement in my wrist bones.

[Wayne77]

Could you have a ganglia cyst in your wrist? I have one and it matches your description in location and pain. Doesn't show on an xray but in my case the Dr could see displacement in my wrist bones.

That's a possibility - I'll ask about that, thanks. The pain is subsiding a bit today but when I rotate my hand upward back toward my arm I feel a rough/gravelly sort of rubbing between my two forearm bones. Weird. Something with the tendons there I guess.

[sailorboy]

This is not a condition, just an (normal) anatomical variation in human skeletal anatomy whereby your ulna (one of the two long forearm bones that is on the little finger side) is slightly shorter than the typical length. There can be some injuries to the cartilage of your wrist that you may be more susceptible to because of this variation in your anatomy, so any orthopedic 'fix' you might be offered would likely be related to that. They can't at this point in your life, lengthen the bone or something. If you have swelling that persists and affects your daily activities and riding, you should ask your PCM for an MRI to look at the soft tissue especially if you feel it is bad enough to see a surgical specialist. The appointment with that person will be better spent if you have the MRI before you go. Not sure of the rules of engagement with your insurance etc if only the specialist can order high level diagnostics or something but that is how I would approach it if I were you.

Also, echo what bigbill said, that if the swelling is on the backside of your wrist, and on both sides, a ganglia would be high on the list of possibilities. Again, an MRI will flesh it all out better than any guessing.

[benb]

Yah I would go see a hand/wrist specialist, have them send you for an MRI and interpret it, not a PCP or normal sports orthopedist or whatever.

I did almost exactly the same thing you did in terms of symptoms after a long ride. In my case it was a bruised (not fractured) bone that wouldn't show up on an X-ray but did show on an MRI. The bone swelled slightly (how is that even a thing?) and the wrist is so tight you can't even see all the angles on an X-ray. Anyway that swelling caused pressure on my ulnar nerve, which then caused even more issues down the line... pain at the elbow, tendonitis at the elbow & wrist, etc.. horrible mess. Cause was like just a really bumpy road with too much pressure in my tires + a bike fit issue.. add that to a long ride and I somehow had enough weight on my hand to cause an injury.

Heck you might want to see 2 different hand specialists once you get the MRIs.

There are a ton of different things that can cause these issues.

Much sympathy, hopefully whatever you did is easy to recover from, when I got hurt it took years to get over it. I hurt my wrist in 2014, I would say I am 100% only this season in terms of biking not bothering it. (biking and pushups being the worst in terms of aggravating it.) For several years there it was bothersome in all kinds of daily activities that we normally don't even think about it. Be really careful!

[Wayne77]

benb & sailorboy - this is extremely helpful! My ride scenario is very similar. 100+ miles with lots of climbing and lots of fast descending. Some roads were very rough. A few cattle grates I bunny hopped at speed.

[sailorboy]

Yea, your ride does seem like a bit of an excessive ride. I'd give it some time to calm down and see if your typical rides don't cause the same syxs. Maybe nothing to really worry about, and MRI probably isn't warranted if it doesn't happen again. Good luck bud!

PS, were you feeling the itch to ride 100+ miles on rough roads like last April in Flanders or something??

[Wayne77]

Yea, your ride does seem like a bit of an excessive ride. I'd give it some time to calm down and see if your typical rides don't cause the same syxs. Maybe nothing to really worry about, and MRI probably isn't warranted if it doesn't happen again. Good luck bud!

PS, were you feeling the itch to ride 100+ miles on rough roads like last April in Flanders or something??

Cool, I’ll see how it goes. That ride was more or less me getting free reign to disappear for a full day because it was my B-day. Combine that with being in a beautiful area for riding (Zions National Park) and it was a recipe to overcommit myself. I had done several solo centuries this year, but jumping up to 135...not the wisest move :-)

[benb]

You know the hilarious part is I did it the first year I had a fat tire road bike.

I had not really figured out just how much lower you need to set the pressures when you're upsizing the tires like crazy. There was all they hype about the bike tires being such a help but it took a while IMO for the information about how to run the tires to catch up to the hype about buying a bike that could run them.

I might have had 70-80psi in the front tire on a generous 35c tire.. way too much. It was a really rough lesson. I'd probably be running 40psi in a tire like that today. I have 32c tires on that bike right now and I only put about 45psi in the front.

The bike fit was an issue for sure in the severity of the injury though.. if you have your fit right you're going to get a lot of jarring but probably not the really severe wrist injury AFAICT.