TFCC treatment protocol
Information to help you understand your wrist injury when you have ulnar sided wrist pain (pain to the back of the wrist towards the pinky).
• TFCC tears do not cause loss of motion. They also do not swell. A fracture can certainly swell and there can be a TFCC tear ALSO but generally, TFCC tears do not well.
• Purchase a protective wrist splint to prevent motion during the first critical 2-10 days. Make sure that there is no compression to the ulna head.
• If no swelling: go ahead and heat the wrist with a heating pad. Alternate warm and cold water in the shower. This helps with circulation.
• Make apt with general practitioner to get x-ray likely will take 1-3 week to get X-rays to rule out fracture.
Get a referral to a hand orthopedic specialist because these are hard to get. It takes time to get an appointment. Get a referal on the first visit to your general doc, just in case!
x-rays negative: continue with referral to hand doc.
x-rays positive: casting per your docs recommendation
• Define how bad the injury is based on Weight Bearing Test.
• If weight bearing tolerance increases with taping, you can conclude that your TFCC is injured. AND: you can’t rule out other injuries yet.
• If Weight bearing increases with tape: use WristWidget.
Weight Bearing Test
Weight Bearing = 65+ lbs / 30+ kg: Mild
You are now ready for the last phase. The main goal is to be pain free and equal weight bearing tolerance compared to the uninjured side.
Weight Bearing = 45 - 65 lbs / 20 - 30 kg: Moderate
If Weight Bearing is over 45 lbs / 20 kg you can remove generic protective spint at night while you wait for WristWidget to arrive. Continue taping.
Weight Bearing = 20 - 45 lbs / 9 - 20 kg: Significant
If under 45 lbs: continue protective splinting with tape underneath.
- Wear nighttime wrist splint over the WristWidget to prevent wrist flexion during sleep. Do this until your weight bearing tolerance is 45 lbs / 20 kg.
- Do not try to use hand too much. No lifting anything over a 1/2 quart of milk. Protect.
- Wear WristWidget throughout day and night
- Acupuncture 2-3 times a week
- If you can get a referral for a Menster Cast: Super! This eliminates motion of the elbow and eliminates any rotation off the wrist. This requires a prescription and an appointment with a hand doc and therapist.
- Do not eat a high protein diet
- Start green diet - low on sugar
- Cardio 20 minute’s daily: heart rate increase helps the body heal.
- In the meantime - referral to hand doc and likely a prescrition for an MRI
- These usually take 2-4 weeks to complete paperwork, authorization etc. At this point, you are 38 days post injury before treatment starts.
Moderate 45 lbs/20 kg - 65 lbs/30 kg:
45 lbs/20 kg is a ‘Functional wrist’. Yea! This means that you should be able to function for the most part around the home. Things like dishes, dressing, making a bed etc. should not hurt. This does not include carrying children, animals, heavy bags of groceries etc. this is a light functional task.
- Normal function should be pain free
- Not able to load it with sport or heavy lifting YET
- Wear WristWidget day and night
- Wait until weight-bearing tolerance is 65 before starting any load.
- 2-6 weeks
Mild 65 lbs/30 kg and more:
- remove WristWidget at night
- Wear WristWidget all day.
- Start stretching: pronator, bicep, pecotrals major and minor, internal rotators of the shoulder
- No push-ups. No bicep curls. NO rotated pull ups.
- OK to start strengthening with progressive weights: Rhomboids, triceps, latissimus dorsi and external rotators of the shoulder. Start with 2lbs weights and go through te motions. If pain fee, increase to 3,5, 15, 20, 25 lbs.
- Continue diet, cardio and acupuncture
- Consider deep tissue massage to bicep, pectorals major and minor, Subscapularis.