TFCC with DRUJ instability

Before I start, yeah I've struggled with the medical system (see below). I injured my wrist 9 weeks ago in a diagonal finger crack and heard a pop on the pinky side. It's honestly not too tender to touch and I can do pushups (though I couldn't for the first 3 weeks). Various things hurt it, like opening sticky car doors that hinge up, heavy pans, and some door knobs. However, I have a very distinct prominence of the ulnar head, which is indicative of DRUJ instability. I've tried to push down on the ulna to see if it has more laxity than the other (piano key test), but doesn't seem so, but also I'm not a doctor. Nonetheless, my anatomy is fucked.

It seems like TFCC tears heal sometimes and sometimes not, probably because there are like 10 different ways you can tear the different structures within that complex. Has anyone successfully gone back to climbing with DRUJ instability, either after conservative treatment or surgery? If so what did you do? If you immobilized and it was successful, how long after the injury did you do it? I am a crack climber and would really like to be back pushing 5.12s.

I only splinted it for the first 2 weeks before I got an appointment with a doctor. I got referred by my PCP to a sports med doctor who has been convinced I just have tendonitis, told me to take off the brace, and has refused to refer me to a hand specialist. She did order an MRI which came back with negative results, but it was done without dye and at 1.5T, as opposed to 3T magnetic strength, so I don't trust the results. I've gone to a different PCP to finally get a referral to a hand specialist, but with the negative MRI results it won't be expedited and the appointment will likely be another 1-2 more months.

Lisa - like you, I love crack climbing and have had a torn TFCC for about 9 weeks. I had the fortune of getting an MRI with Contrast (positive tfcc tear) and visiting a hand/wrist specialist at USC (Dr. Mostofi), who performs many debridement surgeries for the TFCC. He performed a series of stability checks, which indicated DRUJ stability, which I guess is the best news you can get. Similar to you, I have a very distinct prominence of the ulnar head, but this didn't seem to deter my doctor from taking me off the splint immediately. He did not recommend surgery and essentially told me to begin thinking of this injury as a severe strain. This change in mentally helped me immensely, given that he sees patients with this injury all the time. Don't get me wrong, things felt very unstable at first (in a splint for 4 weeks), and there was pain still present at certain angles, but much of that has gone away after using the wrist everyday along with some light stretching. It took me at least two or three weeks post splint for things to feel fairly ok again. I still wear a wrist widget everyday, as I still get the popping and unstable feeling with the occasional weird angles. I started climbing 7 weeks post injury with a tight tape job on my wrist, along with a wrist widget but have abstained from crack climbing. Although there are certain problems (sloper and ulnar deviated) that continue to give me pain, I'm mostly back climbing. Mentally, this injury can be really straining, so I encourage you to look on the bright side and stay positive. I've accepted that this kind of pain is simply a part of my life now. Although crack climbing isn't back in my life yet, ANY climbing is better than no climbing. Stay positive and let me know if you have any specific questions.

Thanks for the info, it really does help mentally knowing that you can have "stability" in the clinic with the ulnar head popping out. I wonder what mechanically is going on though that leads to that. Perhaps the clinical tests are just specific to one kind of stability and not overall stability. Or whatever ligament tears that happened did heal, but in a wonky anatomical way. I guess I just had a freak out moment last night when I realized that the prominence of the ulna has been missed for the last 2 months of doctor visits and I didn't have any information about what that meant other than instability.

When you say that your wrist felt unstable at first, was that pre- or post-splint removal? I'm wondering if I missed my window for splinting or if it doesn't actually do anything in the long run. I'd say my wrist also feels less unstable, but it might just be that I'm conflating instability with irritation.

My wrist felt unstable before and after using the splint. Post splint, it just took some time to get the strength back, as well as the mobility. Splinting immediately after the injury likely helped me with recovery time. I would say that if there isn't any significant pain, use a wrist widget to get back to everyday life. 

Ahram Park wrote: My wrist felt unstable before and after using the splint. Post splint, it just took some time to get the strength back, as well as the mobility. Splinting immediately after the injury likely helped me with recovery time. I would say that if there isn't any significant pain, use a wrist widget to get back to everyday life. 

Hey how is your wrist now? I had my wrist injury 5 Months ago and still couldn't get full range of motion without pain. It hurts to pronate and supernate after a limit. It also hurts when I extend my wrist and radial deviate. The pain reduced only a little bit, will it take time to completely recover?

@kevin looks like you wanted a reply from the other person but appears I made this post. Geez, glad I’m not still dealing with that stuff.

I had my wrist casted for 6 weeks, don’t think it did much besides reduce my ROM more. At some point I rejoiced when I could cut a cauliflower without pain. After 2-3 months I started to climb and within a month I got on a hangboarding protocol that brought me back to health—prob 3 months before I didn’t have to think about it. I taped my wrist for a whole year before feeling ok not doing it. Every now and then I feel an unnatural shift in my wrist on a slower or lock but it’s not a big deal.

Hi Kevin!

TFCC injuries are really common among climbers. It sounds like you've had a frustrating experience trying to get the help you need. I'm going to attach an article from The Climbing Doctor blog that is overseen and written by physical therapists. This will help guide you through conservative care which is often the first line of treatment. It will also help you to determine if your symptoms are coming from the TFCC itself or if things don't line up it could be something else. Pain and injuries are very interesting where they don't always line up with what the imaging says. If you feel like you need additional support I would continue to advocate for yourself to get either physical therapy or occupational therapy. If you're in California, that is a state that allows direct access to PT meaning you can see a physical therapist without a referral. 

https://theclimbingdoctor.com/tfcc-injury-a-common-source-of-wrist-pain-in-climbers/

Keep seeking information and advocating for yourself and I'm hopeful you'll get back to climbing. Don't hesitate to reach out if you have any questions or need help finding a PT/OT in your area.