I Was Rock Climbing and Now My Wrist Hurts – TFCC Injuries
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A TFCC injury involves possible tears of the fibrocartilage articular disc and the tissue that connects the disc to the triquetrum and other carpals. Basically anything on the ulnar side of the wrist (ulnar side is the pinky side, whereas the radial side is the thumb side of the wrist)
Common Causes: The most common cause of injury is a fall on an outstretched hand with your palm down (wrist in pronation). There are two main types of injuries as well, a compression injury vs. an extension injury (overstretching the ligaments). How do we suffer a compression injury? Falls, mantles, cross-over moves that close down the space between your wrist and ulna. How do we suffer an extension injury? This will be due to hyper radial deviation with wrist extension. So, basically: dynos that cause rapid radial deviation. Far-reaching moves to the side. A third type of cause is simply overuse. Think about work-related tasks. The most common is one that includes twisting of the wrist (going through constant pronation and supination). Think of work with a screw-driver, for example. But this can also be the result of any lifting or carrying type issues.
Symptoms: So, what kind of symptoms can you expect if you have a TFCC injury? The symptoms will most likely be on the ulnar side of the wrist (the pinky side). The pain will typically increase with any activity that requires forearm rotation through supination and pronation (turning your palm up and palm down) as well as activities that produce ulnar deviation (your wrist bending towards your pink side). People may find an increase in clicking, snapping, or crepitus in the wrist. They may also have decreased strength and in association increased feelings of instability in the wrist.
Tests: If you have those symptoms, how can you test yourself? First, you can perform a combination of lift tests. With your palm up, apply a little resistance to yourself by applying pressure with the unaffected hand through the palm of the affected hand. Slowly build your pressure. If this hurts, stop. If this does not hurt, attempt the table lift test. As it sounds, you will attempt to lift a table with your palms facing up and the weight being placed through the palms of your hand. Again, slowly build pressure and if this hurts, stop. These two tests will help test for pain or instability of the wrist. Furthermore, you can do the compression/grind test or the chair press test. With the compression/grind test you will place your wrist into hyper-supination, ulnar deviation, and extension (see the video) and load the wrist through your first with the unaffected hand. Pain indicates a positive on this test, positive for an injury. Finally, the chair lift test is simply using a chair with armrests, placing both hands on this armrest, then attempting to lift yourself out of the chair mainly using your hands. Pain here is again a positive test, meaning you have an injury.
Treatment: Treatment and recovery for this type of injury involves a first line of defense of bracing for four weeks. I highly recommend a wrist widget for this. You also need to look for irritating factors and try to reduce them, whether that be work related activities or otherwise. If you are consistently irritating the injury, it will take longer to heal and may form more scar tissue along the process. If you aren’t feeling better in 4 weeks, you need to see a specialist who can design a program for you. You may have developed limited mobility in the wrist from being immobile which may require specific interventions, or you may have lost proprioception and stability in the wrist which would benefit from a strength and stability training program. On the severe end of the injury spectrum, you may have a severe enough instability that would require a surgical consultation. Your specialist should be able to help with this decision as well. Of course, if you believe your injury is serious enough from the onset of injury, do not delay in seeing a specialist, particularly if it is impacting your day to day activities.