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.
⭐ 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 believes rehab-related knowledge should be easy to learn and follow at home, because "knowledge is power only when we can share it" !