Triangular Fibrocartilage Complex Tear

Triangular fibrocartilage complex, abbreviated as TFCC, is a network of tendons, cartilage, and ligaments on the wrist's pinky side. Its main function is to stabilize the wrist and promote smooth rotational movements. Sadly, the TFCC is prone to tears because of degenerative changes or acute trauma. If you or your loved one suffers a triangular fibrocartilage complex tear in Las Vegas, Suarez Physical Therapy can help.

Types of TFCC Tear

TFCC tear is categorized as follows:

Type One

Type one TFCC tears are caused by physical injury, such as over-rotating or overextending your wrist. You can also suffer this injury if you fall on your hand while it is extended.

Type Two

Type two TFCC tears, also known as chronic tears, occur gradually. They can be caused by age or underlying conditions like gout or rheumatoid arthritis.

Symptoms

TFCC tears cause pain along the outer side of the wrist. The following are the additional symptoms you can experience:

• Swelling wrist

• A popping or clicking sound when moving the wrist

• Restricted range of motion in the wrist or hand

• Pain when moving or touching your wrist

• Weak or stiff wrist

Causes of TFCC

The wrist is among the most complicated joints in the human body. This is one of the reasons why it is susceptible to injuries and sprains. You can suffer TFCC tears because of the aging process, excessive use of the hand, or physical injuries. Additionally, some factors can increase the risk of developing a TFCC tear, and they include:

Playing Sports

You are at a higher risk of injuring your wrists if you play sports like tennis, football, and baseball. Some studies reveal that a significant percentage of sports injuries affect the wrist or hand.

Chronic Inflammation

Inflammatory conditions like gout and rheumatoid arthritis can cause significant damage to the wrist over time. Research shows that most individuals with severe rheumatoid arthritis develop TFCC tears.

Aging Process

Because of natural wear and tear, older people are more prone to TFCC tears. Age-related tears also occur because the body becomes less capable of repairing damage to the TFCC.

Diagnosis Of TFCC

Diagnosis will start with your physical therapist obtaining the full history of your injury. You should tell your doctor:

• Precisely where you are feeling pain

• The day the pain started

• Whether there were specific injuries that occurred

• Whether the pain started slowly or over time and

• The motions that aggravate or ease the pain

The physical therapist will also inquire if you have any swelling, weakness, catching, or clicking in the wrist.

Next, your therapist will perform a physical assessment. The therapist will palpate all around your wrist to ascertain the most tender area and if there is swelling or redness. The power of your muscles around the wrist, hand, and elbow will also be examined. The therapist can also advise you to resist certain motions while checking for power deficits as well as pain.

The therapist can sometimes perform a grip power test to determine if your injury has caused power loss. This will help them establish a baseline measure for easier tracking of your rehabilitation improvement.

Your physical therapist might also perform other tests to provoke the symptoms and test for restricted or excess motions at the wrist. Some of the tests can include:

• Putting your wrist passively into a fully extended position

• Loading your wrist in a position of ulnar deviation

• Hypersupination or overly rotating the forearm in a palm-up position

Carrying Out Fovea Sign Test

Fovea Sign is a relatively new test used to exert external pressure on the fovea area of the ulna bone. Your therapist will compare the normal wrist with the wrist affected. During this test, pain and tenderness are signs of a split-tear injury of the TFCC. Split tears are familiar with repetitive torque injuries sustained during golfing or bowling. This ligament injury can be noticed when the doctor applies pressure to the area of pain while using an arthroscope to examine the joint. The ligament opens up like a book when the doctor does this.

Use of X-Rays

If a bone fracture exists, X-rays will be used to show disruption of the TFCC. An unstable ligament without a bone fracture will look normal on standard X-rays. A wrist arthrography is an X-ray with an injected dye. If the dye, as shown on the X-ray, leaks into any of the joints, arthrography will be positive for a TFCC. There are three specific joint areas tested during this test. This test is popularly known as a triple injection wrist arthrogram.

Use of MRIs

Acute injuries can be severely swollen, preventing proper physical assessment. In this situation, your doctor will use more advanced imaging, like MRIs, to detect ligamentous or other damage to the soft tissue. The surgeon can detect TFCC injuries using MRI without injecting dye. However, the test will be known as an MRI arthrogram if the MRI is performed with a dye injected into the area. A tear of the soft tissues will be revealed when the dye moves from one joint compartment to another. Sadly, research reveals that most people with a TFCC tear can still have normal arthrograms.

Wrist Arthroscopy

The best method to accurately examine the seriousness of the damage with a TFCC injury is a wrist arthroscopy. The doctor performing the arthroscope will look for other related injuries of the affected cartilage or ligaments while evaluating the TFCC. He/she will perform the arthroscope by inserting a long, slender needle into your joint. The small TV camera at the instrument's tip will let the surgeon view the joint tissues directly.

Your doctor will test the integrity of the soft tissues using a probe and perform a special trampoline test to determine whether the fibrocartilage disk is fine.

During this test, the doctor can press the disk's center with the probe. The ability of the tissue to bounce back and good tension is a sign that the disk is not damaged or torn and is attached normally. The test will show a tear if the probe sinks as if on a feather bed. The benefit of undergoing an arthroscopic exam is that the doctor can offer you treatment at the same time as the exam.

Treatment For Triangular Fibrocartilage Complex Tear

Some of the treatments for triangular fibrocartilage complex tears include:

Nonsurgical Treatment

You will undergo conservative or non-operative care if your wrist is still stable. The surgeon can give you a temporary splint to wear for four to six weeks. In this case, the splint will hold still or immobilize the wrist, allowing scar tissue to develop in the injured area.

Your doctor can prescribe anti-inflammatory drugs and request you to go for physical therapy. The doctor can also schedule you for one or two steroid injections for several weeks.

The surgeon will, however, put a cast on your forearm and wrist if the wrist is not stable and you do not want to undergo surgery. Sometimes, the surgeon can recommend a splint for a period that does not exceed six weeks. This can be an option instead of casting and beginning physical therapy after immobilization.

If you receive the proper nonsurgical treatment and follow the rehabilitation program, you can resume your work or sports at a pre-injury level. Full strength and pain-free movement are possible.

Non-Surgical Rehabilitation

Using Ice And Heat

Reducing the pain and inflammation around the injury is the initial purpose of treatment for a TFCC injury. Putting ice around the wrist will help reduce a great deal of the pain and inflammation. Heat can be appropriate if you have chronic pain. The physical therapist can utilize electrical modalities to reduce inflammation and pain. Electrical modalities can include interferential current or ultrasound. At this stage, it will also be vital to go for a massage for the forearm muscles.

Avoiding or Changing Activities That Cause Pain and Inflammation

You should stop or change activities that cause pain and inflammation because most wrist movements aggravate the injury. Your physical therapist can recommend that you stop repetitive hand movements like:

• Turning and twisting motions of the wrist

• Wringing, and

• Heavy grasping

You should also stop lifting objects with one hand. However, if you cannot avoid using your hand, you can take regular breaks during an activity.

Putting Your Wrist In A Neutral Position

Apart from resting your wrist, putting it in a neutral position can also help in the recovery process. In this case, you should put the wrist in a straight line with your arm and avoid bending it down or up, or twisting it. If you have yet to do so, the therapist can request that you begin using a splint suggested by the doctor. Sometimes, strapping or tape can be the best option for a splint. Strapping or tape can also be used together with a splint.

Unfortunately, strapping is not as sturdy as a splint. It offers no optimal recovery environment or as much relief as a rigid brace. However, strapping is vital if complete immobilization of the wrist is not feasible.

Observing Your Sitting Posture And Daily Activities

As part of your treatment, the physical therapist can check how you perform your daily duties and your workplace posture. He/she will also guide you on healthy body posture and appropriate wrist positions. Most physical therapists assert that preventing future issues is a part of treatment, just like treating the present injury.

Once the initial inflammation and pain have been dealt with, your physical therapist will concentrate on improving the power and mobility of your hand and wrist. The therapist will take measurements of the wrist range of movement and the power of your grip. This will help the therapist establish if there are any specific shortcomings to work on and will also enable them to gauge your progress.

Simple Finger And Wrist Stretching Exercises

Your therapist can recommend simple finger and wrist stretching activities, which must be carried out within the pain limits. Your therapist can help you perform the following physical exercises:

• Twisting of your wrist

• Moving the wrist towards your thumb and towards your little finger

• Turning your palm up and then back over

• Exercises to enhance movements of bending and straightening of the wrist

Strengthening Exercises

You should also engage in strengthening exercises since they are highly effective. Strengthening exercises help to enhance the power of your wrist and the ability of the arm to grip and apply force. Wrist power is vital when bearing weight, grabbing, twisting, or doing functional activities like those needed for sports or work. Eccentric exercises for the forearm muscles are among the recommended exercises that can help improve the strength of your wrist.

You can experience eccentric contractions when the muscle lengthens, and the muscle and tendon are stretched. Dropping your wrist down gradually at first and then gradually returning to the neutral position will initiate eccentric exercises for the wrist. The drop part of the exercise will move to a faster movement. The exercises will develop the tensile power in your wrist's tissues and related muscles, allowing them to control and protect the wrist.

Your therapist can recommend strengthening exercises for bending movements of the wrist. He/she can also recommend them for you for movement where the wrist moves away and towards your thumb. These movements and rotations of the wrist are stressful to the TFCC area. However, the therapist will ensure that the injury is at the right stage of recovery. He/she will do this before introducing strengthening ulnar or eccentric exercises and radial deviation. These exercises usually put substantial stress on the area, affecting the recovery of the injury.

Putting weight-bearing force through the wrist is another stressful exercise for the TFCC tissues. This can involve pushing up or pushing the door open with the affected hand. The physical therapist will only allow you to do these exercises if he/she is sure the recovery process has progressed enough not to affect the wrist. You can start the exercises in a neutral position, like the position you will use when making a fist. The exercises should move to a position where weight is being exerted through your wrist while it is stretched like a floor or wall push-up position.

Expectations After Surgery

The physical therapist will start your rehabilitation immediately after your surgeon permits it. Surgeons have their specific activity restrictions depending on the surgery you underwent. A surgeon will only allow the exercise if your wrist is recovering as expected. He/she will ask you to maintain the rest of your body's fitness with regular exercise even if the cast is on and before extensive physical therapy starts. Exercises like using a stepper machine, stationary bike, or walking are easy exercises that you can engage in while your wrist is recovering. Avid runners can secure clearance from a doctor, allowing them to continue running.

Using weights or weight machines for your lower extremity and opposite arm is also recommended. You can do this as long as you follow restrictions on wrist recovery. Lifting any weight with your injured part is not advisable if your wrist is in the early stages of healing. A friend can help you do the exercises if you are willing to continue during this stage. Your physical therapist will guide you on keeping fit while following the surgeon's restrictions. He/she can also offer you a general fitness program that is specific to your requirements.

Once your surgeon removes the cast, you will experience minor pain when moving your forearm, elbow, or wrist. The pain occurs because you do not use the joints frequently when the wrist is immobilized and from the surgery itself. Your therapist first concentrates on pain relief. He/she will use electrical current, ultrasound, ice, or heat to reduce pain. This can also reduce the swelling around your wrist or any place along the arm or into the hand.

Your physical therapist can also perform massage on the elbow, wrist, forearm, or hand to enhance blood circulation and assist with pain.

The next phase of your treatment will concentrate on regaining dexterity and strength in your shoulder, elbow, hand, and wrist. You can achieve this through a home exercise program. The exercise can include using rehabilitation equipment like exercise bands and pliable balls.

Find an Experienced Physical Therapist Near Me

You should not take the injury lightly if you or a loved one suffers a triangular fibrocartilage complex tear. You will likely experience pain or inflammation that can hinder you from performing daily activities. Even if the pain from the injury is mild, ignoring the injury can worsen the situation. In most cases, the rear is treatable using nonsurgical methods. However, if the injury is extensive, you might require surgery.

A physical therapist will come in handy whether you undergo surgery or not. Strengthening exercises can help your arm regain strength, enabling you to engage in normal activities. If you need a dependable physical therapist in Las Vegas, contact Suarez Physical Therapy. Contact us at 702-368-6778 to speak to one of our physical therapists.