Wrist: TFCC Tear

Anyone else out there have one? I just got diagnosed with one, and the swelling seems to have pushed the ECU tendon out of its happy home.

Do tell if you've been down this road.

Thanks
Andy

Andy-

You're too fragile! Great fun bumping into you at Eldo the other week.

Heal fast!

Tell me about, geez. I'm just getting over my foot surgery. I think I can blame this one on an offwidth/flary thing (P2 of Thin Ice at the Needles).... it was however, arguably, worth it ;)

Just came off a year of hell with a central TFCC tear.

What do you want to know? There's so many different types of TFCC injuries and treatments, in other words. More details about yours would be helpful.

Also, there's a bunch of info on rc about this topic, including stuff I posted.

Good stuff at rc.com. Thanks.

No traumatic event, just mild pain that increased over the course of a few days, and then one day woke up with a swollen hand.

From an MRI w/contrast it would appear I have a tear in the cartilage along with a slightly displaced ECU tendon. The doc advised the cartilage will never heal, but many folks have tears that become asymptomatic. So the current plan is 3-4 weeks of rest, etc. to see how it progresses.

Yikes, more injury acronyms I've not heard of to worry about now. Thanks, guys!

Andy Laakmann wrote:From an MRI w/contrast it would appear I have a tear in the cartilage along with a slightly displaced ECU tendon. The doc advised the cartilage will never heal, but many folks have tears that become asymptomatic. So the current plan is 3-4 weeks of rest, etc. to see how it progresses.

It sounds like your tear is central, then, like mine was. I would guess JSH's tear was peripheral based on her history here. Central and peripheral tears are fairly different, often have different treatments and different long term outcomes, and peripheral tears have the ability to heal (because that is the only vascularized part of the TFC). Thus, JSH had hers surgically repaired, but this is not an option with central tears.

The weird thing about TFC tears is that some people can have tiny ones with tons of pain, others can have giants ones with little or no pain. Studies have shown that most people have holey triangular fibrocartilage complexes by the time they're in their 5th decade, yet the majority of the population will never have symptoms. Every surgeon I saw (three of them) said acute vs degenerative tears are hard to separate and it is controversial about diagnosing one as either/or.

It's just poor, despondent cripples like us that are so fortunate to get the problems early in life, aye.

Way-too-long conservative treatment didn't help me at all. I didn't have any ECU tendon problems, so can't speak to that.

Aerili wrote: It sounds like your tear is central, then, like mine was. I would guess JSH's tear was peripheral based on her history here. Central and peripheral tears are fairly different, often have different treatments and different long term outcomes, and peripheral tears have the ability to heal (because that is the only vascularized part of the TFC). Thus, JSH had hers surgically repaired, but this is not an option with central tears. The weird thing about TFC tears is that some people can have tiny ones with tons of pain, others can have giants ones with little or no pain. Studies have shown that most people have holey triangular fibrocartilage complexes by the time they're in their 5th decade, yet the majority of the population will never have symptoms. Every surgeon I saw (three of them) said acute vs degenerative tears are hard to separate and it is controversial about diagnosing one as either/or. It's just poor, despondent cripples like us that are so fortunate to get the problems early in life, aye. Way-too-long conservative treatment didn't help me at all. I didn't have any ECU tendon problems, so can't speak to that.

Did you end up having surgery? Debridement?

I went through the whole TFCC injury last winter (hyperextended mantle move in Garden of the Gods). Some of those posts on rockclimbing.com might be mine but I'm too lazy to look.

After my injury I stopped climbing for nearly two months with no real improvement in the pain. I saw an ortho doc, we did the MRI revealing all sorts of damage including a healed ulnar fracture and was told surgery would be an option unless I wanted to try aggressive PT first. I took the PT route and a couple months later I felt the wrist was as good as it was going to get.

It's been over two months since I quit PT and there's still residual tenderness when doing a pushup and I doubt that will ever go away. My range of motion is probably 90% and strength maybe 95% what I was preinjury. This has easily been my worst climbing related injury (long term), I did break that same wrist several years ago while bouldering but 8 weeks later I was back at it.

Good luck with your tear. Aerili said it well, there's so many variables to TFCC injuries. It's difficult to know what will be best for you.

Andy Laakmann wrote: Did you end up having surgery? Debridement?

Yes. And a synovectomy around my radius. The synovectomy was far more painful/far slower to recover from. It still doesn't feel 100% normal even now in certain load-bearing, extended positions 9 months later, although I am sure it eventually will.

For me, surgery got me my life back. Trying conservative treatment first is probably the best idea, however. Doug is a great example of someone who had a very different recovery than me, even with the same injury.

Be aware, however, that no doc will know exactly what kind of tear you have, regardless of imaging diagnostics, until/unless they go in with a scope. My MRA was accurate, however.

Just curious Andy, How did your wrist heal up? About two months ago I partially tore my tfcc ligament. I had six weeks of PT and now I am trying to get it stronger, with the hope of climbing again soon. Still feels somewhat weak, and I am hesitant to really put any pressure on it. Range of motion seems to be coming back slowly as well.
Any advice on getting back into climbing without re-injuring it?
Is there any hope that It will ever feel normal again?

I posted about mine here (slightly different set of injuries, includes TFCC)

Injury was September 16th, 2013. I ended up not having surgery and am doing OK. I took a lot of time off and switched to running in the mean time. I was cleared to start climbing back in January but haven't picked it up fully yet (not because of a wrist problem detected, but I already started training for a marathon and kept at that and worked in a little climbing).

The main difficulty I have so far is with a 90 degree bend in a push up position. I've been exercising it and it is improving, though I get some pain during can still get some soreness after. I still have not had a chance to get back to a yoga class to see how it holds up for an hour. Climbing motions generally aren't a problem.

Thanks mojo! Some great info in that thread!! I also have some pain/tightness in the push-up position. Pull ups as well. I suppose I will hold off on climbing for a few more weeks. So glad I have running and hiking to keep me from going crazy.

I went through the TFCC debridement surgery back in May 2011 for a degenerative tear in my right wrist that got so bad I could not hold a spoon to eat.

It worked for me until very recently when I did more than I should have(career tile setter 24 years,not helping my situation-46 yrs old).

I ended up getting a cortisone shot to my wrist again (May 28th 2014) to get me back to life .Tear is and will always be there.A real pain in the ass...

Anyway,
I was climbing about a month after my surgery and trying to get my strength back in it with PT.
I cannot do a pushup or mantle palm down at all.I need to make a fist and keep my knuckles down in order to bear weight on it.I had to adapt to do certain moves when climbing and just be mindful of it.
Gotta keep on keepin on...

My 13 year-old daughter tore her TFCC last fall. It was not a single event, simply over-use. We saw a surgeon who suggested we try rest, which didn't work, then cortizone, and finally surgery. After the surgery, he told us that he had cut out a triangular shaped tear in the ligament, and that the shape of the tear had prevented it from healing. I am not sure where in the ligament the tear occurred. Surgery was orthroscopic and took about thirty minutes. Surgeon told us it was textbook and she should make a full recovery.

I think that waiting for surgery was the right course of action, given what we knew at the time. Of course, this meant an additional several months of restricted use, but we wanted to wait for surgery until we knew it was the only option.

He was rather tight-lipped about recovery. She had the cast off about two weeks ago and is still in a brace for another two weeks. He was optimistic about her return to climbing, but not sure exactly when this will happen.