I had an accident eight weeks ago where I fell from my skateboard. My wrist hurt for three to four weeks. I went to a hand doctor and had an MRI (without dye) that showed a TFCC tear. I was placed in a splint for four weeks. Although it is feeling better, I haven’t done anything since it’s been in the splint. I recently went back to my hand doctor and he said I should be in the splint for four months! No climbing, lifting, even riding a bike. Is this normal treatment? What’s the natural progression for a TFCC tear? Do they heal? When does one decide to do surgery? Physical therapy? I’m getting weaker every day but don’t want to jeopardize my wrist.
—JT, via rockandice.com
Diddims! I haven’t had sex for months at a time. Imagine that! Dude, you’re only talking about climbing, get things into perspective.
Still, I’ve never heard of immobilization for that length of time. Four to six weeks is more common for a conservative approach.
The TFCC sits between the end of the ulna and the carpal bones on the little-finger side of the wrist, affording greater stability and functionality.
I tend to keep TFCC injuries quite mobile, making sure the patient avoids high-risk activities, like big-game hunting with Tasers. Although rehab therapy
has shifted away from prolonged immobilization, even for many fractures, there is a “Tea Party” faction in every group.
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TFCC tears may or may not heal, but like most cartilage injuries, they tend to settle down and life goes on until your next impact injury. Depending on
the severity, damage to the TFCC can lead to early arthritic degeneration.
Becoming weaker is a natural consequence of injury. In the short term you will become a worse climber, grumpier and generally a bit of an ass. But in the
long run it’s your choice as to whether you learn something from the horrid experience of not being able to climb. Take the opportunity to strengthen
your mind, talk to your partner, call your mama.
On the up side, you can learn a lot by lurking around at the local gym—like who is hot and single. You may also learn something about why certain
climbers fail and others succeed.
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Surgery really only becomes an option when the pain, even after conservative alternatives, persists. Surgery may also be an option when there is a precipitating
issue, such as positive ulna variance (the ulna is longer than it should be) leading to TFCC damage.
This article appeared in Rock and Ice issue 200 (March 2012).