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WristWidget® (Black Adjustable Wrist Brace for TFCC Tears, One Size fits most. For Left and Right Wrists, Support for Weight Bearing Strain, Exercise

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Hogrefe, C. (2016). Wrist-TFCC Compression Test. Retrieved from https://www.youtube.com/watch?v=8Ru0RUsEoKc If you have a client who presents with a TFCC injury, one may experience one or more of the following symptoms: Simple palpation to the ulnar side of the wrist should be done to assess if there is tenderness within the TFCC region. To further assess TFCC injury, one may complete these three proactive tests: Care should be taken when provocative tests are performed as they can cause further injury if not done appropriately. Abbasi, D., & Vitale, M. (2019). TFCC Injury. Retrieved from https://www.orthobullets.com/hand/6047/tfcc-injury A debridement is a surgical option that induces bleeding to stimulate healing. Debridement has beneficial outcomes for central TFCC tears but has been shown to have worse outcomes in degenerative tears or patients with higher positive ulnar variance.

The extensor carpi ulnaris relies on the TFCC for movement, and thus alteration of the motion of the extensor carpi ulnaris may lead to abnormal force through the TFCC, predisposing it to injury [2] If a TFCC injury is severe, it may require surgical intervention. Often times patients will do a trial of hand therapy to see if this can improve symptoms before surgery. The goal of TFCC therapy is to reduce pain and inflammation along with improving wrist mobility while maintaining stability and strength (Rehab Solutions, 2018). If the TFCC injury is recent, hand therapists may create a muenster splint to limit supination and pronation or wrist mobility while the TFCC injury heals for the first 6-8 weeks (Barlow, 2016). During the wrist immobilization stage, the client should be instructed on the importance of gentle ROM of the digits to increase blood flow and decrease edema. Typical therapy regimes may include the following. Hypothenar hammer syndrome: Differentiate because there may be discoloration, fingertip ulcers, or splinter hemorrhages on the fourth or fifth digits. Angiogram may be able to diagnose this condition. At the end of the therapy, then move on to Strengthening exercises. The following exercises are all done with a weight in the hands or with a terra tire. [36] If there is a large tear to the central area of the TFCC then surgery is more likely to be required, as the central area has no blood supply and so has a much reduced capacity to heal. If non-surgical treatment is not successful then surgery is done arthroscopically (using a small telescope that is inserted inside the joint) and the tear is cleaned up (“debrided”).Corticosteriod injection are also used in conjunction with physical therapy in grossly symptomatic patients.

As with any health concern, it’s always recommended that you consult with your health care provider provider to find out why your wrist hurts and the recommended treatment. Applying ice and taking anti-inflammatory medication such as aspirin, ibuprofen, or naproxen can help with the pain and swelling. Resting your hand in a wrist brace or splint is important for healing and can help prevent further injury. Wrist Braces can be worn during the day and at night. In severe cases, surgery may be recommended.

Neoprene Wrist and Thumb Support

Function of TFCC: Main stabilizer of distal radioulnar joint (volar portion of TFCC prevents dorsal displacement of ulna and is tight in pronation and dorsal portion of TFCC prevents volar displacement of ulna and is tight in supination). Contributes to ulnocarpal stability [4] [5] Atzei, A., & Luchetti, R. (2011). Foveal TFCC tear classification and TFCC treatment. Elsevier, 27(3). 263-272. doi:10.1016/j.hcl.2011.05.014 The surgical scar of the ulnar side of the wrist can get adhered to deeper tissues and become tender during the early stages of physical therapy. DRUJ chondral lesions or osteoarthritis: Differentiate via radiographic evidence suggestive of a chondral lesion or osteoarthritis. If your symptoms suggest that you have a TFCC tear then a MRI (Magnetic Resonance Imaging test) is the best type of scan to confirm and assess the diagnosis. An x-ray is a good first test to look for a fracture and to assess the relative length of your wrist bones.

During an arthroscopy, a surgeon will make a number of small incisions on the outer edge of the wrist, which allows them to repair the damage to the TFCC. Sometimes, they may also shorten the ulna to alleviate symptoms. Corticosteroid injections or platelet rich plasma therapy can also be utilized in recalcitrant cases. Physical therapy to prevent stiffness and gain range of motion is instituted once discomfort due to acute trauma or inflammation has subsided. Strengthening exesices are usually begun after 6 weeks of successful recovery. In particular, unilateral isometric exercises are beneficial as they have been found to increase voluntary muscle activation bilaterally. This may be because the motor cortex is stimulated, resulting in greater neuromuscular control. [27] [28] In addition, controlled isometric activation of pronator quadratus in supination and neutral wrist position will help to stabilise the distal radioulnar joint (DRUJ). This can be used pre- and postoperatively in patients with TFCC injuries. [29] Isometric exercises should be included to help strengthen the area and reduce the risk of instability. [25] [26] Some types of splints will help stabilise the wrist, which will lead to an improvement in hand function. [17]

For degenerative (type 2) TFCC tears surgery may be directed at shortening the ulna bone, if it is abnormally long, and tightening the ligaments. Shortening the ulna bone means cutting it with a saw, removing a few millimetres of bone, and then fixing the bone ends together using a plate and screws. Because the ulna bone is relatively close to the skin and often rests against surfaces (eg tables, desks, computer keyboards) it is common that the plate and screws are removed once the ulna has healed. Arthroscopic techniques to clean inside the joint and to remove a few millimetres of the tip of the ulna may also be used for type 2 TFCC tears. Recovery after surgery varies, but typically four to six weeks should be expected for arthroscopy and approximately three months for an open approach. Patients will undergo physical therapy after the procedure. The exact time to begin physical therapy and the length of physical therapy depends on the type of surgery performed and the surgeon’s preference. [2] Physical therapy can also be beneficial for some people with TFCC tears. A physical therapist will guide the person through some gentle stretches, exercises, and activity adjustments for the injured wrist that aim to: In many cases, a TFCC tear will heal on its own. However, a person will need to avoid using the affected wrist to prevent further injury and to allow it to heal properly.

The TFCC compression test is performed by ulnar deviating the forearm in neutral rotation. Reproduction of symptoms indicates that the test is positive In the TFCC stress test an axial load is applied to a ulnar-deviated wrist which produces pain and discomfort. The piano key test is done to assess the stability of the DRUJ. It is done in pronated position of forearm. With the hand being stabilized, the dorsal ulnar prominence relative to radius is observed and the ulnar head in pushed volarly. A positive piano key sign is noted when minimal amount of resistance is felt againt volar displacement of ulnar head, suggesting the presence of underlying DRUJ instability. The test should be repeated with the forearm in supination. Comparision of the amount of ulnar displacement must be done with contralateral side because patients with generalized ligamentous laxity may have a substantial amount of abnormal baseline displacement. For people with severe or persistent TFCC tears, a doctor may recommend surgery. One surgical option is a type of minimally invasive procedure called an arthroscopy.

If a healthcare professional decides that you have a TFCC tear, there are a few ways you can help it heal. To relieve your pain, you can do the following: Hagert E., Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist, Journal of Hand Therapy, 2010 Jan-Mar 23, 2-16 Press test: Patient lifts themselves out of a chair using the wrists in an extended position. Pain indicates a positive test.

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