tenosynovitis in R wrist and drysuits

Hi,



I’ve got what will probably be a lifelong issue with tenosynovitis in my right wrist. I got it paddling on a trip several years ago when all the items that I wasn’t aware of at that time fell into place to cause tenosynovitis. Part of what contributed to the problem was too tight of a latex wrist gasket. I haven’t found a successful way to deal with this issue and still be able to use latex gaskets on that wrist for long periods since then. I’ve installed new (largest size gaskets available according to George Gronseth) gaskets and trimmed them back tremendously and that still hasn’t worked really well. I’ve got a couple of braces for that wrist that keep the wrist from moving and/or keep it warmer, both of which help with the problem. However, I’ve not used my top with the latex seals very often since the injury because I don’t want to aggravate this problem. But now I’m looking at shelling out quite a few dollars for a drysuit, the wrist gasket of which my aggravate the tenosynovitis rendering the suit useless to me in a way.



Before I invest this kind of coin I’m wondering how other folks with tenosynovitis have dealt with this issue? Any success? Ideas?



Thank you!

I had a team mate…
who had this problem: his issue was with diving and wetsuit/drysuit contacts…the answer was “Short Arm”…we had a custom dry suit made with the left arm shortened and the gasket placed mid forearm…simply cut the wetsuit arm to mid forearm…

George is a very good friend
and I know he can have custom stuff done through Kokatat. The previous post seems like a possible solution. Perhaps try a cheap custom top first. Have you run this question by George?

george
Yes, I’ve talked to George about this (albeit 3 years ago–it may be time to talk to him again)and he was the one that sold me the special order extra large size writs gaskets and the kit to put them on my Kokotat TecTour anorak.


Are you sure it’s the wetsuit?
As Derek Hutchinson – the founder of modern day sea kayaking – states, it is the “deathgrip” on the paddle, especially if you use a feathered blade, that is the root source of wrist tenosynovitis. Try your very best to a) use the thumb and index finger only on the pull side, and b) use your open hand on the push side. Good luck, wrist overuse syndrome is a bitch.

deathgrip in rough conditions
was but one of many contributing factors. I mentioned just he one contributing factor most pertainent to the post: latex drysuit wrist gaskets that were too tight.

I had trouble with that once…
When I first started guiding. The TS-vitis, not the tight latex seal.



I’ve never had the problem since. Somethings that help (I think).



develop hand/wrist strength,

loser grip while paddling,

bent shaft paddle (though I don’t use one),



Did your doc recommend any type of physio?



Good luck,

Ian

physio, etc.

– Last Updated: Jan-27-06 12:35 PM EST –

I've dealt with de Quervain’s tenosynovitis (guy's name who first diagnosed it or found it or whatever) for 5 years now and got it from paddling initially--death grip on paddle in rough conditions, too big a blade, cold temperatures, too tight of a latex wrist gasket, fully loaded double and too much milage all combined to give me the symptoms. I now am more careful with how I'm gripping the paddle shaft and use a bent shaft paddle in the hopes that might help to alleviate the issue (jury's still out on that one) I've managed to do just fine since if I wear a neoprene brace with an aluminum insert sized to fit me and made specifically for this condition to minimize wrist movement and keep it and my thumb warm. This arrangement lets me do essentially unlimited milage symptom free. However, as the brace comes halfway up my forearm, it's not very wrist gasket friendly.

I'm married to a physical therapist, so I've got that aspect covered and I'm aware of the other issues that lead to the initially injuries. The wrist is quite a bit stronger than it used to be, but as it often the case with this type of injury, according to my hand therapist (that works with my wife), the symptoms are still triggered easily and can be for a lifetime. It's just that the tight gaskets bring back the symptoms.

Maybe I should ask folks here more about stretching gaskets. I've kept pop bottles, for instance, in that gasket for weeks and it still seems too tight. And, keep in mind this is supposed to be the biggest gasket around (well, as of 3 years ago--I'm emailing Gronseth to find out what else might be available). I've cut off more than 1/2" of the gasket--probably closer to 1", and it still seems too tight. It'll probably leak now as it is. But perhaps there are some more stretching solutions or ideas folks might have?

Thanks for the ideas.

Stretching is a waste of time
Latex has an excellent memory and will return to its original size unless you stretch it to the point of damaging it. When trimming a seal, the only thing that matters is the fit; the amount your remove is irrelevant. If it’s too tight, trim it until it’s comfortable.



I’ve noticed that my right wrist aches somewhat when wearing a dry suit and dry gloves, despite using a Greenland paddle with a very loose grip and having the seals trimmed correctly. However, there’s no residual effect after paddling. It’s less of a problem in the summer when I’m wearing a short sleeve dry top and no gloves, but it still bothers me at times. I chock it up to too many years working with computers (mouse wrist).

Thanks
for the tip bnystrom. That’ll save me some heartache.



Have you heard of inverting the wrist gasket such that the gasket seals around the forearm and not the wrist? I guess you’d have to trim it back substantially for it to fit midway+ up the forearm like that without cutting off venus flow. The rest of the sleeve and protective neoprene cover would be down by the wrist in it’s usual location. The gasket is just pushed up to the forearm and inverted to do so. I was told this might be a solution to my dilemma. I’m wondering if anyone has tried it out there.



Thank you.

I’ve heard of it…

– Last Updated: Jan-29-06 8:57 AM EST –

...but I haven't tried it. I see signficant downsides to doing this:

1- Once you've trimmed the seals to work that way, there's no going back without replacing them.

2- Since your forearm is tapered, I would expect that the seal would have a tendency to creep toward the wrist and eventually invert itself, creating a major leak point.

3- It exposes your wrist to cold water, which reduces the warmth of the suit and may cause as much of a problem as the seal. OTOH, perhaps cold water may reduce inflamation.

4- You would also need undergarments that will fit comfortably around your forearm.

I may try it without trimming the seals to see if it has potential.

I’ll try this too . . .
My right wrist bothers me from the tight seal also . . . I’ve trimmed it but it still feels too tight. I’m going to try inverting it without trimming further to see if it’s simply the position of the gasket rather than the tightness that bothers me.



I have very tiny wrists and prominent tendons, so sometimes, no matter how tight the wrist gasket, it leaks in the dip between the tendons. Maybe inverting the gasket could help with that too, since there’s less of a dip up higher on the forearm.



Thistleback

Is there
Any way to incorporate dry gloves onto the end of the sleeves, eliminating the gaskets altogether, in the same manner that dry socks are attached?

Good point…
My impression about dry gloves (haven’t seen it) was that this type I had the conversation about had some type of O-ring seal that connected it to the drysuit. I’d like to see a picture of this. The shop I was talking to mentioned that they’d sold some to breast cancer survivors who’ve had their lymph nodes removed and couldn’t have anything tight against the wrist. So this type must eliminate the tight wrist gasket altogether. I wonder if this is more of a diving drysuit mechanism.



But are you not talking about a sewn in glove? Seems reasonable at first glance, aside from the wear issue. I wonder if any manufacturers have played with this.



Both of these options obviously have their drawbacks, but if that’s what it takes…

Here’s some more options…
I received an email from George Gronseth (kayakacademy.com) about wrist gasket sizes. He has three wrist gaskets for sale that are larger than Kokatat’s largest. I have and installed the 1004 size and it still seems too tight to me even severely trimmed (with 7 1/2"+ wrist and tenosynovitis). The 1004 is apparently one size larger that Kokatat’s largest gasket, but George has two larger sizes as well that I wasn’t aware of. I’m going to give one or both of these a shot when I get a new drysuit.



Here’s what George wrote:



“The 1004 is bigger than Kokatat’s biggest (L), but I have two more sizes to choose from that are even bigger.



My wrist is 7.0”. I either cut ½” off the Kokatat L or use the 1004 as is. The next bigger, 1104, is snug on me but leaks a bit in use (not quite snug enough). That one may be right for you, and if still a bit tight you could trim it. Then there is the biggest of all, 1114, but chances are it would be loose on you. I could mail you one of each to try on for size before having me install them.”






I also have 7" wrists…
…and I use OS Systems largest size and trim them to fit. No problems.

That’s not a good idea…
…for several reasons:



While it would eliminate pressure on your wrists, it also permanently reduces your dexterity. There are times when you need to remove your gloves and not being able to do so could be a serious liability.



If you were to use a glove thin enough to be reasonably dextrous, it would be subject to wear and leakage.



I use different gloves depending on the conditions. Built-in gloves would eliminate that option.



Using the ring system that divers use to attach gloves also eliminates pressure, but if you take the gloves off, you seriously compromise your dry suit.