The TFCC with its discus, ulna-carpal joint and ligaments is crucial for stability and mobility of the wrist. Due to its anatomic complexity it is submitted to delayed generation when it is injured.
Expected lesions in the TFCC in young pregnant woman are due to overburden of extension-pronation stance of wrist after a long bicycle-trip.
I think you need to work to minimize the loading/ function of TFCC and allow it to heal effectively. Following intervention may be helpful for this issue...
Hi Alexia
I rarely see injuries to the TFCC itself- instead ulnar sided wrist pain are more commonly associated with ulnar carpal instability. I would always check for signs of ulnar sag- this is far more likely to indicate a dynamic instability than a TFCC structural issue. Usually correcting the ulnar sag will provide instant symptomatic relief.
My usual strategies are similar to Ratan's in some ways. I would:
- Offload the ulnar carpus (I use a wrist brace that dorsally elevates the ulnar carpus)
- Promote ECU activation in wrist neutral, gravity eliminated positions. ECU is the primary dynamic stabiliser of the ulnar carpus
- Isometric loading of the wrist, again to stimulate ECU activation
- Avoid ALL aggravating activities
I would avoid mobilisation if an instability is suspected, and given the changes we see in pregancy instability is much more likely to be an issue than stiffness.
Once symoptoms start to settle I would progress to eccentric ECU activation with very light weights (e.g. 200g, progressing to 500g, then 1kg ONLY when smooth eccentric contraction). A Wrist Widget can be helpful once symptoms have settled somewhat- this replaces the unlar carpal support brace. I also get people to pre-activate their ECU and lean body-weight onto the wrist to push dynamic control under load- again this is once they have settled a fair bit.
I would suggest being very, very patient. Ulnar-sided wrist pain can respond very well if you give them time and don't try to rush it.
Good luck!
David
Dear David, I agree with you too. Here I want to clear about the mobilization - I would mobilise the Carple bone specially the lunate in an attempt to improve wrist extension.
Hi,
I am aware this is not a forum that should be used to advocate a particular device, especially one that does not have any recognised research behind it, however I treat a lot of TFCC injuries and have been using a strap called the "Wrist Widget" with a lot of success. I do this having first ascertained through a weight bearing test that it is the TFCC that is damaged. The patient may also need a wrist brace initially to restrict wrist extension also.
Once symptoms have settled, I begin a program similar to the one David has mentioned. Please note that pronator quadratus is also an important ulnar stabilser and needs addressing in treatment also as appropriate.
In the elite and not so elite sports people I see, I employ a taping protocol for sport that does not compress the ulnar head. Education is also vital, especially with reference to gripping, and activities that demand forceful pronation.
Good luck,
Hamish
wristwidget.com
Hamish,
You are right that the purpose of ResearchGate is to inform other professionals with academic research worldwide. As, this pathology is not a common subject in scientific articles my question was in the first place directed to researchers who experienced successful treatment. The questions was edited actually by RG. Thanks anyway!
Last time when I worked in Hand therapy team, we fabricate TFCC splint to support the wrist joint, splint provide a more rigid support and limit the wrist pronation/supination. Subsequently change to the TFCC soft strap (as mentioned by others) during day time.
Other than exercises mentioned by other authors, the exercise programme include the use of Exercise ball for wrist stability training. You may check the research paper by Marc Garcia-Elias regarding the exercise ball.
good luck.
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