7 Symptoms of “Ice Axe Wrist”

As the weather gets colder, many rock climbers are shifting their focus from their outdoor sport climbing and boulder projects to training and gym climbing. For some climbers, however, the snow and cold weather mark the start of ice climbing season.

Ice climbing is the sport of climbing frozen waterfalls using tools such as crampons attached to boots for secure foot placement, ice axes, and ice picks for secure hand placements, and ropes and ice screws for safety. Ice climbing is a great way to get outdoors and enjoy climbing through the winter months. It is a unique sport because it combines the challenges of rock climbing with a rapidly changing environment as the ice formations can grow, shrink, and change overnight. Being a unique sport, ice climbing poses unique challenges which can sometimes lead to injury. One common injury seen among ice climbers is “ice axe wrist”.

Ice axe wrist (also known as intersection syndrome) is a painful condition affecting the forearm and wrist. Ice axe wrist is an overuse injury caused by prolonged activity involving flexion and extension of the wrist, especially while holding heavy tools (such as an ice axe). Ice axe wrist is also commonly seen in rowers, weightlifters, and skiers. Even heavy raking or shovelling can increase the likelihood of the injury.

Anatomy of the wrist:

The pain from intersection syndrome, or ice axe wrist, is usually felt at the top of the forearm approximately 2-3 inches above the wrist. This location on the arm is the site where two muscles of the thumb called extensor pollicis brevis and abductor pollicis longus cross over or intersect with two underlying tendons of the wrist.

Extensor pollicis brevis and abductor pollicis longus originate at the forearm and attach to the back of the thumb where they act to pull the thumb outward and backward. These two muscles cross over the tendons of two other muscles called extensor carpi radialis longus and extensor carpi radialis brevis which help to pull the wrist backward into extension. The tendons of the wrist are covered by a thin tissue called tenosynovium.

In ice axe wrist, the tenosynovium becomes irritated and inflamed. This causes pain as you move your wrist because the swollen tendons and inflamed tendon sheath rub against the thumb muscles at the point where they intersect. The pain may be localized to the top of the forearm but could potentially spread down to the thumb and along the side of the forearm. Increased friction between the wrist tendons and thumb muscles may also cause you to hear or feel a cracking sensation as you move your wrist or thumb.

Signs and Symptoms of Ice Axe Wrist:

-       Pain at the top of the forearm, the wrist, and sometimes the thumb

-       Pain typically worsens with activities that involve repetitive forceful wrist flexion and extension

-       Pain usually subsides with rest

-       Pain is typically worse with movements of the wrist than movements of the thumb

-       Creaking or cracking sensations when moving your wrist

-       Difficulty pronating the palm (turning the palm face down)

-       Redness or swelling over the affected area

Treatment of Ice Axe Wrist:

Ice axe wrist is a painful condition and can limit your ability to participate in the sports and activities you enjoy. If you are suffering from ice axe wrist, come see one of the physiotherapists at Elios Health. Initially, our physiotherapists will help you to decrease the pain and inflammation caused by intersection syndrome, prescribe exercises to strengthen your wrist, and provide you with advice on how you can best manage the symptoms at home.

Since ice axe wrist is a form of wrist tendonitis (inflammation of the tendons in the wrist) initial management of the injury will consist of rest and ice. During this phase if your recovery, your physiotherapist will help you modify your activity level so that the injury does not progress. In some cases, taping or a brace might be used to further alleviate symptoms and promote healing.

Once the initial pain and inflammation settle, your physiotherapist will prescribe exercises to increase the strength and mobility of your wrist and thumb, as well as improve your grip strength. Incorporating fine motor control and dexterity of your thumb and hand will also be incorporated into your rehabilitation protocol to enhance your recovery and improve functional outcomes. Your physiotherapist at Elios Health will advise you on the exact types, volume, frequency, and intensity of the exercises and ensure you are performing them with good technique so that you can maximize your recovery and return to ice climbing pain-free as soon as possible. Examples of the types of exercises that your physiotherapist may prescribe are shown below.

Since ice axe wrist is caused by overuse, close monitoring of your injury and recovery by your physiotherapist at Elios Health Clinic is crucial to ensure you are giving the injury adequate time to rest and heal, and that you do not aggravate the area during the strengthening and rehabilitation process. Your physiotherapist will monitor your symptoms and progress your strength and mobility program accordingly. As you get stronger and your pain decreases, your physiotherapist will advise you on how to gradually increase your activity levels and return to the sport you love. Visit us or give us a call to book your appointment today.

Original Article by Rachel Rubin-Sarganis

Photo Courtesy of Vancouver Mountain Guides