Rehabilitation for TFCC Injury!
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" !
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Thank you so much for your feedback!
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,
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
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!
Hi thank you for your feedback! I highly recommend you can see a certified hand therapist (CHT) to treat your TFCC problem. You can locate them using the website of American Society of Hand Therapist.
https://www.asht.org/find-a-therapist?field_therapist_list_first_name_value=&field_therapist_list_last_name_value=&city=&province=&country=All&distance%5Bpostal_code%5D=98012&distance%5Bcountry%5D=us&distance%5Bsearch_distance%5D=10&distance%5Bsearch_units%5D=mile
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firstly thanks for your valuable information
i have a tfcc injury since a year. i felt that day like a pop in the joint(between unla and radius) and after that i felt with very painful pain in distal radio unlar joint according to x-ray later . i go to doctor after 3 monthes and diagnosed me with use of mri and x-ray,my only problem now is in supination during load bearing i feel pain when i load heavy in this position only . I feel no pain in other positions. Do u think the injury need surgery or it is a matter of time to heal ??.another question is it possible to heal if i put cast now as i didnt put cast after the injury??,, the doctor didnt assure if the ligment is partially or completely torn
Hi there,
1. It depends on how bad the injury was on MRI, does the doctor recommend surgery?
2. If you are able to tolerate cast or splinting for 6 weeks, I will recommend trying immobilization before considering surgery, but again if the MRI showed you have full thickness tear, then surgery is probably your only option, especially it’s been one year already.
Take care!