Rehabilitation for TFCC Injury!

TFCC

As mentioned in the previous article, Triangular Fibrocartilage Complex (TFCC) injury is one of the main culprit causing ulnar wrist pain. 

Once the ligament complex is injured, its poor blood supply makes the healing a lot slower than other soft tissue, leading to prolonged wrist discomfort and pain…

 

 What can we do to Treat TFCC injury before surgical interventions?

 

I. Resting & Protection (at least 6 weeks)

⭐ Long Arm Orthosis (Munster / Sugar Tong Orthosis) 

To promote healing after the ligament injury, it is essential to prevent forearm rotation (pronation/supination) as this is the most strenuous motion on Distal Radioulnar Joint (DRUJ) and TFCC.

Long Arm Orthosis is the best protective brace for such purpose. It covers wrist, forearm and elbow joints, to stop forearm rotation and any wrist motion. 

TFCC

 

⭐ Short Arm Orthosis (Wrist / Ulnar Gutter Orthosis)

Although a long arm orthosis may be the best brace to protect and rest your wrist, most patients complain about its cumbersomeness in daily life, which results in less compliance with this orthosis.

Therefore, a Short Arm Orthosis is introduced to provide a decent protection, also allow more motion for functional activities.

✨ However, most physicians and therapists still prescribe wrist brace for TFCC injuries, which does not provide enough support for DRUJ.

✨ An ulnar gutter orthosis is a better option as it compress on the ulnar head to stabilize DRUJ and reduce direct stress on TFCC.

* No matter what kind of orthosis you wear, I recommend to wear it for 24/7 to ensure the best outcome (only remove for skin care or showering time) !

 

 II. Other Wrist Supporting Methods

⭐ Wrist Widget

Wrist widget is a simple wrist strapping brace which is designed for TFCC injury.

However, it is more suitable for people in the later rehab stage. NOT recommended for acute injuries.

 

⭐ Therapeutic Taping 

There are a various of therapeutic taping methods for TFCC injury, I will share the simplest way to support your ulnar wrist!

The following taping technique is adapted from Kinesio Taping® Method .

III. Wrist Strengthening 

Since TFCC is the key stabilizer of DRUJ, all the exercises we do should focus on supporting DRUJ stabilization, which helps to relieve distress in the ligament complex. However,

“All the exercises should be Pain Free!”

* Using wrist widget or therapeutic taping (or both!) to provide a decent support during exercises is always a good idea!

 

⭐ Stage I : Isometric Strengthening (post-injury 6-8 weeks)

 

Isometrics are exercises that do NOT move the joint when strengthening the muscles!” 

 

Theraband is one of the best exercising tool for isometric strengthening. Nevertheless,  accurate positioning and holding is critical in this exercise.

* For TFCC injuries, we should strengthen Pronator Quadratus and Extensor Carpi Ulnaris (ECU) muscles, which helps to stabilize your DRUJ. (Hold 10 seconds for each repetition, 10 reps x 3 sets / day

 

⭐ Stage II : Free Weights Exercises (post-injury 8-10 weeks)

Only when you are able to complete stage I exercises for 2 weeks without any pain, you can start Free Weight Exercises.

Begin with 1 to 2 lbs weight, 10 reps x 3 sets / day. (Hammer is a great tool for forearm rotation exercises!)

 

⭐ Stage III : Weight-bearing Exercises (post-injury 10-12 weeks)

 

✨ Wall Push-up is a good gentle weight-bearing exercises for TFCC rehabilitation, try to hold for 5 seconds for each repetition, 10 reps x 3 sets / day.

 

In summary, rehabilitation for TFCC injury should consist of enough resting, appropriate protection, additional supports and strengthening exercises. 

Overall, proper resting and protection is the most important part of TFCC rehabilitation, never start exercising with any pain!

 

* Last but not the least, if the above therapy does not resolve your wrist problem, always consult your hand therapists and specialists for other treatment options!

Andrew Tan, OTR/L, CHT, CKTP, CEAS

Andrew Tan, OTR/L, CHT, CKTP, CEAS

Certified Hand Therapist / Occupational Therapsit at Rehab For A Better Life
The founder of "Rehab For A Better Life", specialized in ergonomic consultation,rehabilitation for upper extremity injuries, sports injuries and work-related injuries.
Andrew believes rehab-related knowledge should be easy to learn and follow at home, because "knowledge is power only when we can share it" !
Andrew Tan, OTR/L, CHT, CKTP, CEAS

Latest posts by Andrew Tan, OTR/L, CHT, CKTP, CEAS (see all)

Andrew Tan, OTR/L, CHT, CKTP, CEAS

The founder of "Rehab For A Better Life", specialized in ergonomic consultation, rehabilitation for upper extremity injuries, sports injuries and work-related injuries. Andrew believes rehab-related knowledge should be easy to learn and follow at home, because "knowledge is power only when we can share it" !

6 thoughts on “Rehabilitation for TFCC Injury!

  • October 6, 2018 at 1:06 am
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    I actually wanted to compose a message so as to express gratitude to you for these splendid tips and tricks you are sharing at this site. My incredibly long internet research has now been rewarded with awesome content to write about with my contacts. I would believe that many of us site visitors actually are very much fortunate to exist in a fabulous network with so many outstanding professionals with valuable points. I feel rather grateful to have seen your website page and look forward to really more fabulous moments reading here. Thanks a lot once more for a lot of things.

    Reply
    • October 15, 2018 at 11:43 pm
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      Thank you so much for your feedback!

      Reply
  • April 26, 2019 at 8:22 am
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    Hi, so a short story, i catch a ball so badly and i hurt my tfcc 8 month ago .. so i didnt know what it was.. i thought that it will be okay for 2 weeks … then i tape it for two weeks..
    And i start feeling stm whenever get stm in my hand … so after 6 month i went to the doctor and he told me its tfcc and a partial tear at the ulna .. but no need for surgery just PT
    So now its been 1.5 month that i go to PT and thanks god i feel really good about my ulna side of the wrist and i can put wheight on my hand but when i put my hand on the ground with right elbow it hurts .. my tfcc hurts and it piss me off .. dr tell me lets do a injection but i dont want to do .. i still wants to keep up with my pt but i like to hear some advice

    Thanks,

    Reply
    • May 5, 2019 at 5:23 am
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      Hi John,
      Sorry for the late reply.
      Did you get a wrist widget when doing your exercises?
      Weight-bearing exercises (especially push-ups) is extremely stressful to TFCC, so I’m not surprise you still feel pain.
      It just means you are not ready for this exercise yet.

      Ask your pt about isometric and dynamic strengthening exercises for your wrist, just remember, “patience” is the key, your tfcc will never heal properly if you stress it too early or too much.

      Hope you get better soon!

      Sincerely,
      Andrew Tan

      Reply
  • June 5, 2019 at 7:26 pm
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    Hello,

    Similar to the comment above, I just wanted to say thank you! I partially tore (according to MRI) my TFCC about 2 months ago playing tennis, though do not recall a specific moment of injury. I would say the lack of information on the TFCC and healing protocols on the web is dismal, at best. Even going to several doctors, I have been given very limited information and know most of what I know now from my own digging. I am going to keep a diary of what I do to heal hoping to help others down the road. I still have a lot of dull, aching pain throughout the day. Do you think PT should only be started after pain is gone- or is it ok to do the exercises as long as those specific exercises do not cause pain? Many Thanks in advance for all the TFCC peeps!

    Reply

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