HEAL YOUR TFCC INJURY AND AVOID SURGERY!

The TFCC is an important stabiliser of the wrist. It helps to coordinate rotation movements of the wrist and also can help us to grip items with power.

When it is injured it can present in the following ways:

Pain on the outside (little finger side of the wrist).
Tenderness to palpation of the outside of the wrist.
Swelling.
Reduced ability to rotate your wrist or grip items.
Instability.
A popping or clicking sensation when using your hand and wrist.

The good news is that these injuries can often be successfully treated and the minor ones often get better by themselves.

Significant TFCC tears can, if left untreated, lead to serious pain, weakness and instability. These are the injuries that often need further interventions such as injections or even surgical repair.

This article will talk you through the relevant strategies at the various stages of recovery to help you fully recover and hopefully avoid surgery altogether.

HOW DO YOU INJURE YOUR TFCC?

There are two main ways that a TFCC injury can occur:

Injury – such as a fall onto an outstretched hand or activities that compressively load the wrist into ulna deviation (the movement of the little finger side of the hand towards the forearm) these compressive loads can be due to repetitive strain such as when hitting golf shots or when batting in cricket. It could also be caused by a sudden forced overrotation.
Wear and Tear – when the soft tissue degenerates as you get older leading to degenerative tears in the TFCC.

HOW IS TFCC INJURY DIAGNOSED?

Your clinical presentation together with the mechanism of injury gives us the best guidelines for having injured the TFCC.

There are several tests that a Physiotherapist can also undertake to confirm the diagnosis.

An x-ray or MRI may be needed in certain circumstances.

TFCC TEAR TREATMENT

Acute Phase Management (Day 1 – Week 6)

During this phase of recovery, the focus is on protecting the newly injured wrist and managing the pain.

BRACE – You should consider using a light wrist support the TFCC
PROTECT – Avoid activities that bring on your pain. Also, avoid heavy gripping tasks or tasks that turn the palm over repetitively or with load.
ICE – Ice can be useful in the first few days post-injury to help manage your pain and swelling. I get my patients to take an ice cube and run it under a cold tap so that it is nice and wet and messy and then to use this ice cube to gently massage the painful area for 5 minutes maximum if it’s a small area. You can then do this throughout the day as long as you are giving yourself adequate periods of not icing. An appropriate strategy would be to ice for 5 minutes once an hour. Do this for the first few days of injury. For further information on how to use ice appropriately throughout the further stages of recovery read this article: Icing Injuries
MOBILISE – Look to gently mobilise the hand and fingers. Exercises such as finger opposition and finger flexor tendon glides. Avoid activities that overly stretch the wrist into extremes of range of motion at this stage.

INDICATORS TO MOVE ONTO NEXT STAGE:

The acute management phase could last from a few days to up to 6 weeks. Our main indicator that you are ready to progress with your management is that your pain has significantly reduced or stopped altogether. Once you have reached this milestone you are ready to move on to the next stage.

Sub-Acute Management Phase (once the pain has settled significantly or resolved)

REMOVE THE BRACE – You could start this gradually removing it for periods but keeping it on when you know you are going to be using the wrist and hand a lot and gradually weaning yourself out of it over a few days.
RANGE OF MOTION EXERCISE – Whereas before our goal was still to mobilise the fingers and the hand now we start to restore the range of motion of the wrist itself. This should be achieved with flexion and extension exercises and exercises that move the hand from side to side as well as up and down. We are still avoiding loaded supination and pronation. This is the position that turns your palm up or palm down.
STRENGTH EXERCISES – As well as increasing wrist range of motion, we are now also incorporating wrist strengthening exercises still avoiding supination and pronation.
MASSAGE/FRICTIONS – I like to use gentle wrist frictions over the portion of the wrist that was sore to increase blood flow and aid mobility. You should start gently and this massage should not increase your pain. It may temporarily increase your pain but this should resolve within 30-60 seconds. If it doesn’t it may be too early to start with the frictions.
HEAT – To increase blood flow you could also use some gentle heat before exercise.

Indicators to move onto the next stage:

Your pain has resolved and you can comfortably lift and carry. The wrist feels completely stable.

Return to Normal Activity

Your pain should be resolved completely and you should be able to accomplish all your range of motion and strength exercises in a pain-free manner.

SUPINATION/PRONATION – Start exercising in this range of motion. This is left til this stage as it is potentially the most stressful exercise on the TFCC. Start without resistance and then add in some load. You could try holding a hammer in your hand (near the head) and attempt to turn the palm over and then back up again. If you can do this for 10 reps without pain, hold the handle a little lower down. You are aiming to complete 3 sets of 12 reps pain-free.
GRIP STRENGTH - You should also look at working on general grip strength at this stage.

cONCLUSION

A TFCC injury needs careful management throughout each of the stages for successful rehabilitation to be achieved. If you carefully follow each of the stages above you will stand the best chances of healing the injury quickly and with no need to involve the orthopaedic surgeons!