wrist injury - lack of weight bearing and tendonitis

[wendy howard]

Hello,

There is one thing common amongst people with TFCC tears, cysts related to TFCC pathology, distal radius fractures with TFCC involvement: pain with weight bearing. The lack of weight bearing comes in many different levels of dysfunction.
Most people dont test it objectively with a scale and this can be a great tool to define where you are so you can determine progress and change over the course of treatment.

Extensor Carpi Ulnaris tendonitis looks and behaves just like a TFCC tear as it also creates ulnar sided wrist pain. People with ECU tendonitis have normal weight bearing tolerance.

There is a division of the ECU which attaches onto the TFCC which can be torn and cause clicking with rotation and ulnar sided wrist pain as well.

Scaphoid Lunate dysfunction is more difficult to see patterns of symptoms but ulnar sided wrist pain from this injury is not predictable.

If you do have a TFCC tear- both peripheral and central- rotation places a stretch on this ligament. This is important because if rotation stretches it than rotation must be avoided for full recovery. Easier said than done!!! The time frame for recovery when immobilized is clearly 8-12 weeks. It is well known that casting of the elbow is required to fully immobilize the wrist from rotation. Nobody does this because of the great risk of contractures of the elbow..so a compromise is taken at 4-6 weeks.

About 50% of all wrist fractures involve the TFCC. 30% of golfers and tennis players get this injury.

I have found that if you take the wrist which has a TFCC tear, and squeeze the DRUJ without involving the hand, and without compression of the ulnar head, that there is an immediate increase of grip strength, decrease of pain, increase of weight bearing tolerance, and on 2000 patients so far, complete healing of the TFCC tear- both central and peripheral tears.

The splint WristWidget TM Orthopedic Brace - Clinically proven to reduce wrist pain. is designed to treat TFCC tears. It must be worn for 8-10 weeks continuously. It allows you to function while wearing it and is quite effective in managing strain to the TFCC during rotation, grip and weight bearing.

It has yet to be shown that any intervention including ultrasound, iontophoresis, estim, massage etc do not get down to the debth of the TFCC- through all of the extensor tendons of the wrist. This is a mechanical injury similiar to the meniscus of the knee which is slow to respond to most treatments.

It is also clear that the longer people have this injury, the more common it is to have ECU tendonitis which makes seeing through the woods more challenging.

You can try taping the wrist similiar to the wristwidget and see the change in grip and weight bearing. Careful not to compress the ulnar head. taping works but is quite difficult to get perfectly tight to prevent compression of the nerves of the wrist for the course of 8 weeks.

Research is going on and slowly coming out to support what I have learned over the past 5 years of study. Google Japan wrist splint and TFCC to see an independent publication of these reports.

It is a pleasure to share my work and I look forward to hearing from you all.

Warm Aloha,

Wendy Howard, OTR, CHT, Clinical Research Coordinator

[mira_16]

Wow Wendy that is all great info and very interesting.

Just wanted to share my experience. I have mentioned in this thread and others that I have experienced left wrist pain with lack of weight bearing for almost a year. I had an MRI that showed a TFCC tear and ganglion cyst. The odd thing was most of my pain was located central and dorsal and not ulnar. I waited about 8 months to finally get treatment (i know...) and it was slow recovery at first. I started to see another physio about 1 month ago on a regular basis and he's been working on mobilizing my carpals and cross friction to the ligaments (mainly the one between the radius and capitate..i think). I have experienced such a decrease in pain and am definetly more functional.
Right now I tried to weight bear and it's not painful. Sometimes this happens and pain develops later in the day but so far I've had great relief.

While I'm working I wear a wrist support. So I do recommend that to prevent reinjury and pain. Taping works well for temp relief but I would get the wrist widget or something similar to help with support. But ultimately you want to get the source of the problem fixed.

So once again I recommend to see someone that is a hand therapist or someone that is well experienced with hands and can located and actually feel the scar tissue in the hand ligaments.

Best of luck!