TFCC Debridement Recovery Question

[rakhmetov]

My hand surgeon wants to do a wrist arthroscopy as he suspects I have a tear in the articular disc of the TFCC. I'm being ultra cautious and am seeking second and third opinions from top hand surgeons before I go ahead with it and may switch doctors. I have also talked with Wendy and have a Wrist Widget.

The surgeon is pretty convinced that all I will need is a simple debridement and I should go back to normal after a period of bracing/splinting and rest. Most of the peer reviewed scholarly literature indicates this and from what I understand a debridement is one small step beyond your run-of-the-mill wrist arthroscopy.

At any rate, my question is simple. Has anyone active on the forum had a TFCC debridement for a central tear without any complicating factors like wrist instability or ulnar positive variance (I am ulnar equal in terms of variance and my wrist is stable, so if this is a tear, it's a Palmar 1a that was missed by my MRI). If so, what were your surgical outcomes? How is your wrist today and what was the healing process like?

[rakhmetov]

OP here. It's been under two months since my question. No responses but I didn't want this floating out there without some kind of follow up. I figure someone somewhere will one day want to know how things were going since they're likely going through the same thing.

So my cortisone shot wore off three weeks ago and the pain in my wrist didn't return. I started doing a number of TFCC stretches and flexing of wrist according to Wendy of Wrist Widget and TFCC videos on YouTube. I also use an adjustable gripper and do 3x25 and have worked up to medium-advanced strength (~60 lbs of grip). I wear my wrist widget during the day and brace my wrist fully at night.

There are periods throughout my day where I feel a small amount of discomfort, perhaps a 1-2 out of 10. When it feels this way, my wrist can be cracked by squeezing it with my other hand's thumb and index finger. Then the pressure is gone and it goes back to feeling pretty good.

I had quit lifting for 3.5 months almost altogether.

I have now started hitting the gym but am focusing on lower leg extensions (due to knee injury that I should be cleared to squat on soon), calves, and for now only pullups. When and if things still feel stable, I'm going to add light shoulder work to the mix, perhaps next week by doing light load landmine presses with wrist locked in straight and zero flexing or bending. I'm going to do high reps of around 15 for two or three sets to make sure I'm not overloading the wrist.

If that shouldn't prove a problem, I'm going to think about adding a chest exercise of some kind that is kind on the wrist with same high reps and approach.

Note also that I've started doing home improvement projects and auto repair projects that involve loading of the wrist.

[rakhmetov]

So I'm scheduled for surgery in July. The last shot either took a lot longer to wear off or the pain just returned more slowly. At any rate, I've picked the absolute best hand surgeon in my area who works on professional athletes, publishes and presents on TFCC repairs, and seems like all he does is fix these things. I feel confident that I'm in good hands.

He can't be sure whether I will need a simple debridement or if the tear is peripheral and can be repaired. Funny as it sounds, but debridement doesn't sound that bad if I can get back to using my hand relatively quickly.

I will update accordingly as time goes on about my progress just to leave a record.

[rakhmetov]

So I had the surgery and it turned out to be a Palmar 1b tear with no avulsion right above the 6U portal. The doctor put two sutures in via the outside-in repair. They blocked my arm with a shot (lasted 18 hours) and sedated me. I was in a sugar tong splint for two weeks and eating ********s fr the first week. Taking ******** and advil were the key that got me straightened out with no pain or discomfort. The splint was a real pain as it was made of heavy thick plaster and pinched my skin in ways that aggravated the stitches in the portals. It felt like getting a fishing hook stuck in the skin and yanking on it when the nerve and skin would get stretched out. I ended up going in and getting a new splint that was a little looser. It helped a little but what helped most was pulling the skin of the back of my hand forward in the brace. I didn't realize it was nerve pain, however, until I got my full arm brace at two weeks. I was having bad nerve pain from where the doc moved the dorsal sensory branch of the ulnar nerve (dsbun - it runs right through the 6U portal).It was tingling and numbness along the back of my hand (the transverse branch of the dsbun). At 4 weeks now and I have good days and bad days. A lot of it is irritation from the brace. It rubs the area the wrong way. Bandaids over that area help a lot.

I had a full-arm brace for two weeks after the sugar tong splint and then they said at 4 weeks I can only wear the bottom portion of the brace. I can also suppinate and pronate up until I don't have pain. That means I have about 30 degrees of rotation. I have pain at the repair site similar to tfcc tear pain (worse than before but my repair is just now getting into the proliferative scar tissue phase). I can finally drive as well. I have iced it from time to time after I take my brace off to shower and that helps it. I wear the brace for 2 more weeks and then can take it off but have to take it easy.

I see the doc again in 5 weeks and start therapy. I hope I continue to heal and that my left hand becomes more useful while I take it easy.

[rakhmetov]

So I'm out of any type of brace now (I use the old wrist brace I used to use pre-surgery when I sleep). I had been in a full arm black brace (Hely and Weber MTC fracture brace - a two piecer that went from thumb to back of elbow) but lost the forearm to thumb brace piece a week ago. I can now move my hand front and back in addition to whatever rotation I can bear. I don't know degrees of motion but I get more of it every couple of days. The swelling has gone down to almost nothing as well. Moving and cardio have helped with this. I've had pain off and on, especially when I do something to aggravate the area. For example, I caught my hand on a table yesterday and it hurt like hell for a few minutes. It subsided but was upset all day. I got a good night's sleep with my brace on and it feels pretty decent again.

Also, at seven weeks, I started typing with two hands with my injured hand flat down on the keyboard (a split one for arthritis that makes it easier to lay hand flat). I also picked up my guitar last night and was able to play again for 10 minutes after trying to the past week. Knock on wood, my hand feels like it's starting to come back bit by bit. The hard part for me is tucking my dress shirts in along the injured hand side. This is still too painful but I can do everything else hygiene and dress wise that I couldn't after the surgery like button a button and buckle a belt. The surgery is an old memory already, as is the ******** fog I was in afterwards.

I start therapy in two weeks. I am taking it easy with my wrist but introduce activities and motion as I can. I also hope therapy helps with the pain and tightness I feel around the TFCC area right beneath the 6U portal where the sutures went in on the edge of the TFCC and where the outside of the sutures are tied underneath the skin. The surgeon said that in 33% of cases, the sutures don't dissolve like they should. If they don't and they bother me (as would be likely as I have a very lean wrist), he has to make a tiny incision and remove them but he does this at 6 months so perhaps mine will dissolve still. They're just a small bulge at this point but I think they are in close proximity to the Dorsal Branch of the Ulnar Nerve and they might even be rubbing it. That would explain the continued tingling. But it's way, way less than it was. The scars are healing nicely as well.

[dk503]

I just stumbled upon this thread and it's exactly what I'm going through.

I hope you're recovering well!

Did you only get debridement without ulnar shortening? Are the outcomes for debridement for central tears any good? I keep hearing that central tears aren't treatable and are permanent since they're avascular.

Also, how did the doc test for wrist instability?

I had an Mri recently and it pointed to a tear on the articular disc. I'm super depressed of not been able to workout for more than 6 months and I'd really appreciate any insights.

Thank you!

[rakhmetov]

I did not have ulnar shortening. I am ulnar neutral. The procedure sounds brutal, frankly, and is a last resort if the pain from an acute tear isn't fixed with surgery. I don't think I'd have it done unless my only other option was wrist fusion.

The outcomes for central tears are quite good. One doc, who does the most of these in my major metropolitan area, said I had an 80% of getting my wrist back to 80%. Another doc said it's a 90% chance I get back to normal. The surgeon I chose does these on pro athletes and said the athletes (who return to their sports) never come back for problems in that exact same area again. The scholarly literature says the outcomes aren't so good, perhaps around 70% to get back to good to excellent. The better the surgeon, I would imagine the better the outcome.

The recovery is pretty quick from debridement of the central disk. Five to seven days and you are out of the bandage (a very big, puffy looking ace bandage) with no restrictions other than not pushing it if it hurts. Your wrist could always give you a little nagging afterwards. One doc told me I might feel it after lifting heavy at a 2 or 3 in pain (instead of 7+. which is where I was in December) but that it would go away.

The best comparison is the meniscus, which everyone seems to know about. A peripheral tear of the meniscus is apparently a bear to recovery from. A more central tear where there's no blood supply can be cleaned up quickly and you're back on you're feet in a few days (but with substantially higher risk of arthritis in that knee down the line). The good news is that a tfcc tear in the avuscular area, once cleaned up, while still permanent, will not lead to arthritis as it's not in the wrist capsule.

Just know that the MRI is occasionally wrong in diagnosing tfcc tears (if they used a dye for contrast it's more reliable). Mine said I had a strain of the meniscal homologue (part of the tfcc but not exactly where I had my tear). The gold standard for diagnosis is the arthroscopy itself. And since you only want them in there once to fix whatever is wrong, you want the absolute best surgeon. Especially, you want someone who knows what other structures to look at that could cause similar problems to a tfcc tear. Candidate number 1 is the ulnotriquetral ligament (UT ligament), which can get a longituninal thickness split tear (think mozzarella cheese stick split in half down the middle lengthwise but still attached on the ends). Similar symptoms as tfcc but not all hand surgeons know to check this. The recovery is the same as a tfcc repair like I had.

As for instability, we're talking about the DRUJ (distal radioulnar joint). Your surgeon should definitely test this and compare it against the other. They palpate the bones (radius and ulna) to see how tightly they're being held together. Another way to determine your stability is to try the Wrist Widget weight bearing test (see video on Youtube). Try the test and see if tape in the form of the Wrist Widget doesn't help. Wendy of the WW would probably be willing to talk with you about your tear. She knows a lot about it and has helped a lot of people. Some apparently even heal or have symptom resolution without surgery. But in the end, the WW didn't help me. My tear didn't produce any instability, just lots of pain with pronation and supination and popping (like a knuckle) that gave very temporary relief.

Another way to test your wrist is for them to give you a grip strength test. I had 160 psi in my good hand and 145 in my injured hand (which is my non-dominant hand, so I expected it to be lower).

A tear of the disk can't be fixed but the symptoms can go away with time. One study (with what I feel was way too small of a sample size) conculded that there is no difference in pain resolution after a year between those who had the surgery and those who didn't.

Immobilizing in a long arm brace that locks everything together for six weeks is the standard way to see if it heals. I wish I had done this right after the tear but I kept lifting hard. So I missed that window where things can get better without surgical intervention if it's in the blood supply area. Even if you're six weeks+ out, it's worth it to try. If I could go back and brace it like this, I probably wouldn't have needed surgery since my tear was where there is good blood supply. But of course I couldn't be bothered.

But lifting will probably just make the pain worse. But, oddly enough, it won't make the tear any worse. My surgeon told me: "I'll tell you what I tell my pro athletes getting ready for playoffs: you can play through the pain or you can stop right now and have the surgery and call it a season. It won't make any difference other than the pain you're in."

I know the feeling about being depressed about the lifting. I took six months off and lost it all. In that time, however, my determination to lift transferred to a resolve to heal my wrist. I'm back to lifting my legs now and am feeling pretty good about my wrist as it continues to strengthen. At first, I was stuck down a dead end street mentally. But then I somehow made a mental pivot to be positive and focus on what was ultimately much more important: a healthy wrist that allows me to do the things I enjoy.

I am lifting my legs now again after the surgery. I picked up a five pound weight to try to lift it for a shoulder dumbbell raise (not a press) and my repaired wrist wasn't quite comfortable. I went and did another set of calf raises and it didn't affect me in the least mentally. Remember that we are at least as strong mentally as we are physically and just as our bodies can grow, so too can our minds and spirits. Hang in there - it will get better.

What other symptoms do you have? Popping, clicking, pain, relief when you pop it, looseness compared to the other side?

[dk503]

I did not have ulnar shortening. I am ulnar neutral. The procedure sounds brutal, frankly, and is a last resort if the pain from an acute tear isn't fixed with surgery. I don't think I'd have it done unless my only other option was wrist fusion.

The outcomes for central tears are quite good. One doc, who does the most of these in my major metropolitan area, said I had an 80% of getting my wrist back to 80%. Another doc said it's a 90% chance I get back to normal. The surgeon I chose does these on pro athletes and said the athletes (who return to their sports) never come back for problems in that exact same area again. The scholarly literature says the outcomes aren't so good, perhaps around 70% to get back to good to excellent. The better the surgeon, I would imagine the better the outcome.

The recovery is pretty quick from debridement of the central disk. Five to seven days and you are out of the bandage (a very big, puffy looking ace bandage) with no restrictions other than not pushing it if it hurts. Your wrist could always give you a little nagging afterwards. One doc told me I might feel it after lifting heavy at a 2 or 3 in pain (instead of 7+. which is where I was in December) but that it would go away.

The best comparison is the meniscus, which everyone seems to know about. A peripheral tear is a bear to recovery from. A more central tear where there's no blood supply can be cleaned up quickly and you're back on you're feet in a few days (but with substantially higher risk of arthritis in that knee down the line). The good news is that a tfcc tear, once cleaned up, while stillpermanent, will not lead to arthritis as it's not in the wrist capsule.

Just know that the MRI is occasionally wrong in diagnosing tfcc tears (if they used a dye for contrast it's more reliable). Mine said I had a strain of the meniscal homologue (part of the tfcc but not exactly where I had my tear). The gold standard for diagnosis is the arthroscopy itself. And since you only want them in there once to fix whatever is wrong, you want the absolute best surgeon. Especially, you want someone who knows what other structures to look at that could cause similar problems to a tfcc tear. Candidate number 1 is the ulnotriquetral ligament (UT ligament), which can get a longituninal thickness split tear (think mozzarella cheese stick split in half down the middle lengthwise but still attached on the ends). Similar symptoms as tfcc but not all hand surgeons know to check this. The recovery is the same as a tfcc repair like I had.

As for instability, we're talking about the DRUJ (distal radioulnar joint). Your surgeon should definitely test this and compare it against the other. They palpate the bones (radius and ulna) to see how tightly they're being held together. Another way to determine your stability is to try the Wrist Widget weight bearing test (see video on Youtube). Try the test and see if tape in the form of the Wrist Widget doesn't help. Wendy of the WW would probably be willing to talk with you about your tear. She knows a lot about it and has helped a lot of people. Some apparently even heal or have symptom resolution without surgery. But in the end, the WW didn't help me. My tear didn't produce any instability, just lots of pain with pronation and supination and popping (like a knuckle) that gave very temporary relief.

Another way to test your wrist is for them to give you a grip strength test. I had 160 psi in my good hand and 145 in my injured hand (which is my non-dominant hand, so I expected it to be lower).

A tear of the disk can't be fixed but the symptoms can go away with time. One study (with what I feel was way too small of a sample size) conculded that there is no difference in pain resolution after a year between those who had the surgery and those who didn't.

Immobilizing in a long arm brace that locks everything together for six weeks is the standard way to see if it heals. I wish I had done this right after the tear but I kept lifting hard. So I missed that window where things can get better without surgical intervention if it's in the blood supply area. Even if you're six weeks+ out, it's worth it to try. If I could go back and brace it like this, I probably wouldn't have needed surgery since my tear was where there is good blood supply. But of course I couldn't be bothered.

But lifting will probably just make the pain worse. But, oddly enough, it won't make the tear any worse. My surgeon told me: "I'll tell you what I tell my pro athletes getting ready for playoffs: you can play through the pain or you can stop right now and have the surgery and call it a season. It won't make any difference other than the pain you're in."

I know the feeling about being depressed about the lifting. I took six months off and lost it all. In that time, however, my determination to lift transferred to a resolve to heal my wrist. I'm back to lifting my legs now and am feeling pretty good about my wrist as it continues to strengthen. At first, I was stuck down a dead end street mentally. But then I somehow made a mental pivot to be positive and focus on what was ultimately much more important: a healthy wrist that allows me to do the things I enjoy.

I am lifting my legs now again after the surgery. I picked up a five pound weight to try to lift it for a shoulder dumbbell raise (not a press) and my repaired wrist wasn't quite comfortable. I went and did another set of calf raises and it didn't affect me in the least mentally. Remember that we are at least as strong mentally as we are physically and just as our bodies can grow, so too can our minds and spirits. Hang in there - it will get better.

What other symptoms do you have? Popping, clicking, pain, relief when you pop it, looseness compared to the other side?

Thank you so much for your reply. You seem really knowledgable on this issue and I commend you for your diligence to extensively research it.

Funnily enough, I've been using the Wristwidget for a few months (on and off since it sometimes leaves my wrist quite sore) and I think it *may* have helped a tiny bit, but i'm not too sure since the wrist widget didn't necessarily solve the pain issue when I tried forcing my wrist into supination (pronation didn't hurt after a few months).

The main issue I have with pain is when I try to push down on my wrist while simultaneously exerting pressure on the ulnar side when the hand and forearm and both at a 180 degree angle (completely flat on a surface)... If I were to push down using a 90 degree angle (like pushups), then it doesn't hurt much at all. There is some clicking when I rotate my wrist too. When it clicks, it hurts a teeny tiny bit (not that much though).

I guess the good news is that my wrist has been improving without the help of cortisone nor any type of physical therapy, albeit at a snail's pace.

Pain is 100% gone if I don't move my wrist. There is still, however, a nagging feeling of fear that if I force my wrist, it'll give in. Also, if I really try hard to force the pain, it does come back to a slight degree, but less than before (I have been avoiding doing this since I don't wanna reinjure it). There is still popping when I supinate my wrist while making a fist.

In terms of the DRUJ, it seems to be stable. All of the specialists I saw were hesitant to go forth with the surgery and only recommended it as a last resort if the wrist hasn't healed after a while... It has already been 7 months and, while it has improved, the nagging feeling of instability and slight slight pain is still there. The last 2 doctors recommended physical therapy, which I will begin starting today. Not quite sure how physical therapy works since my assumption would be that I'd be irritating the wrist even more while doing exercises, but I dunno much about it so I'll still give it a shot.

The MRI diagnosis I got (albeit it was without any contrast dye), seemed to say the following:

Findings:
There are no bone marrow signal changes.
Joint articular cartilages and preserved signal, without focal defects.
Suggestive image of horizontal rupture of the proximal inferior surface of the cubital and dorsal third of the articular disc of the triangular fibrocartilage, with suggestive image of a regional flap. Moderate edema and synovitis of the dorsal fibrous capsular junction of the triangular fibrocartilage complex, associated thickening and edema of the dorsal capsule in the insertion in the back of the pyramidal.
Radial insertion and ulnar periphery without signs of injury.
Scapholunate and lunotriquetral ligaments of normal aspect.
Extensor and flexor tendons in normal limits.
Joint fluid in physiological amount.
Regional nerves without alterations.

Impression:
Signs suggesting a horizontal rupture with a small flap of the proximal surface of the ulnar-dorsal third of the TFCC joint disc, associated with edema and focal synovitis of the dorsal fibro-capsular junction, without being able to rule out a regional partial lesion. Signs suggestive of sequelae of a partial sprain of the dorsal capsular ligament.

Not sure if those findings point to a central tear but it does point out a flap and some tears on the articular disc.

Thanks again for your time and I hope your wrist is getting better!

[rakhmetov]

The symptoms you describe sound like a tfcc tear to me. I had and to a very slight degree continue to have the same pain with my wrist and forearm straight out (180 degrees as you describe) when I press down on a flat surface. I had it before. I could also do pushups without any pain but they didn't feel quite right. I had pain with pronation and suppination but that makes sense as my tear was right out by the subcutaneous layer so it would have moved much more than one more centrally located to the ulna.

It sounds like you are doing the right things. I noticed improvement (not enough to avoid surgery) even at 10 months (three or so after stopping lifting) so I encourage you to keep going. I could also easily disturb it by testing it to see how it's doing and then I'd have a setback.

It's important to keep in mind what you're dealing with. Healing might happen but it might not, and by healing we just mean resolution of pain since there's no way that flap is going to heal itself. But the body is continuing to try to heal that area even though it can't as there is no blood flow in the damaged tissue itself. As I understand, the body gets stuck in a healing loop where there is synovial fluid and edema released/produced in the area but no actual resolution past that stage. The swelling and inflammation don't help matters and the flap of the tfcc is likely irritating things (and the tfcc is somehow really well innervated according to the scholarly literature, so the four or five nerves that supply the tfcc fairly evenly are picking all of this up in stereoscope). This is where I thought I was with a central tear just prior to deciding to meet with other hand surgeons and literally the last conversation I had with that doctor was exactly about why it hurts. He said I would always have some type of pain and irritation there because of the flap he thought I had. Thus, that's why he recommended surgery.

I'm jealous in that you have a much clearer diagnosis from the MRI than I did and that your doctors feel there is a role for PT. My MRI was basically useless (and insurance billed $2,600 - I paid under $100) and they said therapy can't do a thing. Since I've been meaning to put this information up here, I wanted to indicate the surgery cost. It was $29,640 total (I paid $220), with $10,000 to the surgeon $10,000 to the anesthesiologist, and the rest to the facility.

Definitely follow your doctor's advice and try the therapy. If you can get back to health without surgery, that would be great.

Gotta run. Keep me posted.

[rakhmetov]

So as I start therapy at nine weeks (supposed to be eight but the doctor is away on vacation) in a few days so I thought I'd do a progress report. I was able to type this past week so at eight weeks I could turn my wrist over enough to type (I have one of those split arthritis keyboards and it helped out SO much the first few days).

My wrist continues to feel stronger. I jumped over a high standing wall where I put my two hands down like I'm doing a duck walk with my hands to support myself and had no pain or any lingering side effects. I did this twice and was amazed at how solid it felt. That doesn't mean I'm not still babying it but I get fewer reminders from my wrist as I go about my day that it's injured. I can hold perhaps 10 pounds in a bag without any pain now or even thinking about it. My grip strength is coming back. My grip is strongest when it's just a fist - very little pain if I don't push it too far. But if I grip something like a handle and squeeze then I have some pain.

The wrist bones on the ulnar side don't feel like they're fused together quite as much anymore. There's the slightest bit of play in them now as if the scar tissue is beginning to move into some other phase.

One thing I haven't mentioned is cracking my knuckles. It's a bad habit I have but I've used it to measure what's painful for me. All my fingers were stiff and could barely be cracked when I took the brace off. Now I can bend back my middle finger to crack it straight back and can sometimes even bend the ring finger straight back to crack it. This is stressing the tfcc but I have no pain with the middle finger and just a tiny bit with the ring finger. It tells me that things have already tightened up and are beginning to loosen.

Things like opening jars are getting better slowly too. I can use my left, injured hand to steady a jar and crank down with a moderate amount of force with my right hand (good hand). But if I push it I can tell there is a world of pain on the other side of that activity. So I don't push it.

The skin on the back of my hand still has a dead type of feeling like it fell asleep. When I press on where my sutures are at, it still feels weird but I don't get the strong pain messengers up the nerve into the back of my hand anymore. Putting my left forearm along the window sill of my car with the window open seems to irritate the nerve in a very strange way as well. I wish I could report more improvement in this area.

As for rotation, I have 135 degrees from my wrist flat down on a desk as if I was typing to having my hand almost palm up with about 40-50 more degrees to go total. The pain at the ends of my suppination and pronation range isn't the same raw pain I had before the surgery. It's dulled some as if it is protected somehow. That's a big improvement so I'll take it.

[dk503]

The symptoms you describe sound like a tfcc tear to me. I had and to a very slight degree continue to have the same pain with my wrist and forearm straight out (180 degrees as you describe) when I press down on a flat surface. I had it before. I could also do pushups without any pain but they didn't feel quite right. I had pain with pronation and suppination but that makes sense as my tear was right out by the subcutaneous layer so it would have moved much more than one more centrally located to the ulna.

It sounds like you are doing the right things. I noticed improvement (not enough to avoid surgery) even at 10 months (three or so after stopping lifting) so I encourage you to keep going. I could also easily disturb it by testing it to see how it's doing and then I'd have a setback.

It's important to keep in mind what you're dealing with. Healing might happen but it might not, and by healing we just mean resolution of pain since there's no way that flap is going to heal itself. But the body is continuing to try to heal that area even though it can't as there is no blood flow in the damaged tissue itself. As I understand, the body gets stuck in a healing loop where there is synovial fluid and edema released/produced in the area but no actual resolution past that stage. The swelling and inflammation don't help matters and the flap of the tfcc is likely irritating things (and the tfcc is somehow really well innervated according to the scholarly literature, so the four or five nerves that supply the tfcc fairly evenly are picking all of this up in stereoscope). This is where I thought I was with a central tear just prior to deciding to meet with other hand surgeons and literally the last conversation I had with that doctor was exactly about why it hurts. He said I would always have some type of pain and irritation there because of the flap he thought I had. Thus, that's why he recommended surgery.

I'm jealous in that you have a much clearer diagnosis from the MRI than I did and that your doctors feel there is a role for PT. My MRI was basically useless (and insurance billed $2,600 - I paid under $100) and they said therapy can't do a thing. Since I've been meaning to put this information up here, I wanted to indicate the surgery cost. It was $29,640 total (I paid $220), with $10,000 to the surgeon $10,000 to the anesthesiologist, and the rest to the facility.

Definitely follow your doctor's advice and try the therapy. If you can get back to health without surgery, that would be great.

Gotta run. Keep me posted.

Thanks again for your input on this.
I'm rooting for the both of us to get better, stronger, and properly healed up.
We're in this together, my friend.

I started going to PT last week. The PT gave me some quick exercises (wrist flexion, wrist extension, grip using a small foam roller, roll wrist on foam roller, thumb flexion, and 3-point pinch).

She also taped me up with some Kinesio tape along my forearm and my wrist, but ironically enough, this actually made my wrist feel a bit more sore than usual (dunno if this was my head, but it did feel a bit off... so i took it off).

I've been able to do these exercises without much pain, but the lingering sensation of something "off" with my wrist is still there. Sometimes it flares up in a very minor way if I extend my fingers and open my hand as much as I can.

I'm still using a Wrist Widget and somehow helps a tiny bit (maybe placebo effect) with stability.

I'm slated to go to 9 more PT sessions until probably the end of the year, early 2018.

And yea, I hear you on the insurance costs... I've already spent around $2,000 out of pocket with all of the costs for this injury... Probably $3,000 if we count the additional PT sessions. Insurance and healthcare in the US is a joke.

In any case, I've been exercising my wrist everyday since last wednesday and hoping it'll improve in the coming weeks.
So far, no change in pain.

[rakhmetov]

I'm pulling for you. It's no fun and it is one long slog. I was determined to heal as well and did what I could. In the end, all that treatment basically helped me determine that there's nothing left but surgery. In the end, when they were prepping me for surgery, I remember thinking - at least I'm finally getting this done so I was at peace with the decision. Given your tentative diagnosis, I think you're in a good spot as you're moving forward even if you don't know the ultimate outcome.

I definitely had the lingering sensation. Once irked at some point in the day, the sensation would turn into annoyance or even pain for the rest of the day. A good night's sleep would let it reset.

Knock on wood but that is past me now. When I tweak it a certain way, it will hurt for a few minutes. But then the pain resolves and I'm back to whatever level I'm at (I'd say I just passed 50% out of 100% where 100% is pre-injury). Also, I now have the exact same pain when I extend my hand all the way back and extend my fingers all the way back. When I let the fingers rebound and snap forwards a bit, I get this tight pain right in the tfcc area that, somehow, someway, reminds me of a metallic feeling in the wrist. I can't describe it better than that but it's not pleasant so I don't do it.

I started therapy but mine is different. It is intended to break up and realign the scar tissue. It's mostly passive holds at the edge of my ROM (but without pain) for several minutes at a time. This is great because I've found some activities painful when I hold it. This form of therapy should help me get full ROM back and move past those painful moments.

I was cleared to lift weights again but only five pounds. I think I'll hold off until I can come back at it with both a healthy wrist and some wisdom about what the wrist can bear. The hand therapist said eight months is the magic moment where most people say 'hey, I think things are better.'

One other thought from a post-surgery perspective. I feel like I'm on the rebound finally. The aftermath of the repair surgery sucked and not having a functional hand for 5-7 weeks at all really sucked. But things have been getting better quickly now and that makes me wonder why I delayed (even though this contradicts what I said at the outset of this reply). Had I had this last summer, I could have had this in the rear view mirror altogether by now. I lost all the muscle I gained anyways once I quit in December. So I'd really be ahead and enjoying lifting my upper body and not just my lower body. Oh well, hindsight and all that.

Keep me posted. I'm interested to see if you have symptom resolution.

[rakhmetov]

I go in for my 12 week visit (last one covered under post-op period). Since my last post, things haven't felt like they've progressed as quickly but progress they have. I have been doing my stretches off and on but I find that just using my hand for everyday things is helping it to loosen up as well. It's still really tight when I pinch together with my other hand the pisiform on the palmar side and the ulnar styloid on the dorsal (back) side. But I am getting my full range of motion back. A few days ago I woke up and my hand felt good all day. The next day, I had slept on it wrong and it felt wrong half the day but then it felt better the rest of the day. I started sleeping with my forearm brace on. Most braces irritate the suture bump in the foveal area but I just keep the brace loose and it prevents me from putting it in a bad position in my sleep.

The good news is that the wrist keeps getting better, despite the occasional stupid things I do. I overloaded it a week ago by putting my hands flat, palm up under a wood desk to pick it up. The heavy end was on the injured wrist side and then the thing slipped and tilted as I put it in the car and the TFCC caught it. It strained the TFCC repair and it hurt for a few days and I was worried. But then I woke up a few days later and it was better.

I still have typical TFCC pain when I pronate and suppinate but the range has come back pretty well.

I started doing weight training again but on the machines. I am doing high rep low weight stuff for my upper body the past week (legs are still lifted heavy). While I'm sore from the lifting, I'm amazed at how quickly I'm bouncing back. In a week, I can tell a huge difference in my left arm, which atrophied quite a bit after the surgery. I don't do anything that requires me to bend my wrist at all. I did have a twinge of pain on rows today so I changed my grip and that helped me.

The sutures in my wrist still suck and they seem to be rubbing on the DSBUN still. When I palpate one side of the suture bump, I get a weird shooting sensation up the transverse part of my hand. I'm going to ask that the sutures be taken out at the earliest possible date.

I got stung by a yellow jacket in my right hand and it's swollen and painful as if the bones in my thumb are bruised. I caught myself thinking about how my left (injured/repaired) left wrist is the good wrist and my injured right wrist is still giving me trouble. I looked down and realized that I had things mixed up simply because of the pain signals. That was encouraging as perhaps I can mentally start moving past having an injured wrist (while still babying it) since my brain-on-autopilot was comfortable doing that.

[rakhmetov]

So I was cleared to return to any activity I want as long as I listen to my wrist. I picked up some Kottos wrist straps and am back in the gym. I started out doing high rep low weight stuff and am not bending my wrist in any fashion when I lift. So far, so good, but knock on wood.

I'm upping the weights and decreasing the reps with the aim of getting back to Strong Lifts (SL) eventually. I've been able to bench 95 @ 3 sets for 15 reps, 115 @ 3 sets for 8 reps, dead lift 145 for 10 reps, and other exercises at low weights. I'm going to even all my lifts out at a comfortable weight at 5 reps for 5 sets and then jump back into SL. I also curled 30 pound dumbbells with wrist locked in neutral position (thumb and pointing finger on top) today just for fun and had no wrist pain during or after. I can do a chin-up but am still nervous about this one. I can't bend my wrist enough without pain to do a push-up but no real complaints. Overall I'm really encouraged.

I'm doing a large painting project in my house and my left wrist feels as good as it ever did as the helper to the right as I do drywall repairs, climb ladders, and paint.

I've gotten almost all of my flexibility back as well and range of motion. The wrist is a little tight at the outer range of my ROM but it's getting better very slowly.

[macheese70]

I have read this entire post and thank you both. I was diagnosed with ulna sided wrist pain @the tfcc in October. On Monday, I got a cortisone shot in the tfcc to try and “calm it down” in my surgeons word. We did this as the next step after wearing a arm/wrist brace for a month which showed great improvement in pain and range of motion under load.

Thanks for all of this information and also for the progress updates. I am very interested to hear how this progresses for both of you. Both surgical and non surgical.

[dk503]

So, just a quick update on my end:
It's been close to a year and the pain is still lingering.

I'm unfortunately thinking that surgery may need to happen at some point since the pain is still lingering, albeit not as much as before. I've been using the wrist widget religiously for over 8 months without that much improvement. The one thing the Wrist Widget did help at was making my wrist "feel" a bit more stable. I write that with quotes because I still felt a slight bit of pain when forcing my wrist in certain positions.

All I can really do at this point is go back to the doctor (which most of them have been absolutely useless) and get it checked up once again to see if there's any progress in my healing. My positivity on this injury is not that great anymore since I was trying to give it time for a long time. Granted, the wrist did feel a bit better during the 8-month mark, but then slowly began to feel sore once again due to unknown circumstances. The wrist still cracks as I rotate it with an ever slight lingering pain that is about 2/10. The clicking has rarely ever stopped and it keeps feeling as if there's something wrong...

I will keep updating you guys in case I do choose surgery, but as of right now, I'm just waiting it out just a bit more.

[rakhmetov]

I have read this entire post and thank you both. I was diagnosed with ulna sided wrist pain @the tfcc in October. On Monday, I got a cortisone shot in the tfcc to try and “calm it down” in my surgeons word. We did this as the next step after wearing a arm/wrist brace for a month which showed great improvement in pain and range of motion under load.

Thanks for all of this information and also for the progress updates. I am very interested to hear how this progresses for both of you. Both surgical and non surgical.

That's really great that you have shown some progress in pain and range of motion. That it's under load seems very promising. I hope things work out for you. Keep us posted.

[rakhmetov]

So, just a quick update on my end:
It's been close to a year and the pain is still lingering.

I'm unfortunately thinking that surgery may need to happen at some point since the pain is still lingering, albeit not as much as before. I've been using the wrist widget religiously for over 8 months without that much improvement. The one thing the Wrist Widget did help at was making my wrist "feel" a bit more stable. I write that with quotes because I still felt a slight bit of pain when forcing my wrist in certain positions.

All I can really do at this point is go back to the doctor (which most of them have been absolutely useless) and get it checked up once again to see if there's any progress in my healing. My positivity on this injury is not that great anymore since I was trying to give it time for a long time. Granted, the wrist did feel a bit better during the 8-month mark, but then slowly began to feel sore once again due to unknown circumstances. The wrist still cracks as I rotate it with an ever slight lingering pain that is about 2/10. The clicking has rarely ever stopped and it keeps feeling as if there's something wrong...

I will keep updating you guys in case I do choose surgery, but as of right now, I'm just waiting it out just a bit more.

Sorry to hear that. I was there and remember the hoping and waiting and the disappointment that things didn't proceed quickly. The tfcc isn't like other injuries that heal or go away on their own in quick order. It's a slog either via the non-surgical or the surgical option.

As for myself, I'm happier everyday that I had the surgery. I had popping (I could squeeze my risk and pop it for a bit of relief) but no clicking. The lingering soreness was there for sure.

Keep in mind that the surgery is actually relatively simple if it's just a tear that they suture or debride (although they often find other little and/or big things in there while they're at it). It's just that very few surgeons do it often enough, or at all, to trust them with something as important as your hand. The same goes for the UT ligament split tear. This isn't open heart surgery but it's an area where a tiny mistake can cause lasting consequences as there's just no margin for error in the ulnar side of the wrist with its razor-thin gaps, the tiny bones, and the insane complexity of ligaments all inside of 1 cubic inch. There's a reason that medical science didn't identify and define the tfcc for what it actually is until the late 1980s. So finding the best surgeon available or covered by insurance is the best thing you can do and it sounds like you've done it.

I hope you experience the healing you need either route you choose.

---

An update:

As for my progress, I am back in the weight room and am putting real load on the repaired wrist. I'm repping 150 on the bench, curling dumbbells up to 40 pounds each, repping 180 on the deadlift, and continuing to add weight each workout to see what my wrist can handle. If I lift 5 days in a row, the wrist starts to hurt on the 4th and 5th day after a workout but it is a mild ache and is easy to forget and resets itself by the next morning, if not sooner. When I quit lifting last December, I didn't know if I'd ever be able to do so again. So to have come this far in a year is something I'm grateful for.

The numbness on the back of my hand seems to have gotten somewhat better and I seem to have become normalized to its still imperfect state. I don't think about it most days. I no longer have strong electrical zingers (they're very mild now) traveling up the transverse branch of the dsbun when I tap on the suture bump. The bump under my skin where the sutures are has gotten slightly smaller and as swelling is now all but gone I noticed another small bump of sutures on the other side of the ulnar styloid from the others. I don't think I'm going to get them out even though I was dead set on it a month or two ago.

The wrist is very tight when I squeeze the ulnar styloid with middle finger and pisiform with thumb but overall it's as loose and flexible at all range except the last 5% as the other wrist. I have mild pain with pronation and suppination but it's because the tfcc has lots of scar tissue holding it together and it will take many more months for it to remodel itself so the scar tissue easily gives the way it is being forced with motion.

[limtunghao]

hi rakhmetov

How about your wrist today?
Last week I have received open surgery to reconstruct my TFCC using tendon graft method.
I really love weightlifting.
How long can weightlifting again with pre-injury level after open surgery.
Someone tell me it is impossible for 100% healed. I am very worried about it.
Thanks

[rakhmetov]

hi rakhmetov

How about your wrist today?
Last week I have received open surgery to reconstruct my TFCC using tendon graft method.
I really love weightlifting.
How long can weightlifting again with pre-injury level after open surgery.
Someone tell me it is impossible for 100% healed. I am very worried about it.
Thanks

My wrist is doing pretty well but I must have had a less severe injury than what you had. Did you have a palmar longus tendon they could use?

There is a thread on another site somewhere about a female power lifter who had the same graft surgery and managed to get back into the gym, albeit at lower weights and not as a power lifter anymore (if recollection serves).

When things start to feel stable, you'll be able to listen to your doctor and your wrist as to what you can and can't do with it. What is your surgeon saying the outcome might be?

[limtunghao]

hi rakhmetov,

Yes, my palmaris longus tendon was used by my hand surgeon to reconstruct my torn ligament.
could you tell e about your medical treatment or procedure?

my hand surgeon told me the outcome may better than conservative treatment. I can play badminton or tennis after 1 year, but i don't know about weightlifting.

[rakhmetov]

hi rakhmetov,

Yes, my palmaris longus tendon was used by my hand surgeon to reconstruct my torn ligament.
could you tell e about your medical treatment or procedure?

my hand surgeon told me the outcome may better than conservative treatment. I can play badminton or tennis after 1 year, but i don't know about weightlifting.

Pretty much everything I've gone through is up top in this thread.

Being able to play tennis after a total reconstruction is pretty good. If you can do that, why not experiment a bit with very light weights to see what your wrist can handle?

[rakhmetov]

So I had my six month follow up. The wrist is not so tight between the pisiform and ulnar styloid as it was. Also, it turns out I have an extra stitch in the TFCC in the 6R portal in addition to the one under the 6U (thought both were under the 6U but not the case). The 6R suture has mostly dissolved but the 6U suture still has some presence in there that I hope goes away. I'm not going to have the sutures removed as I don't notice them at all unless I prod there. I still have some numbness on the back of my hand but it's much, much less noticeable now and I hope it continues to go away. My PCP told me 6-12 months for this to go away.

As for the gym, I've switched from low rep high weight to high rep low weight, which is where I started back three months ago. I have made decent gains since I started back. My injured side bicep fell down to 11" due to no use after surgey but it was over 14" last time I measured it. I'm going hard and eating right so I'm hopeful to get it back to 16" before summer (which is where it was when I quit last December) and then with any luck push for 17 or 18" (I'm really tall so that's a lot for lanky me). I'm taking it slow as this experience taught me it's not about winning the game in the first inning. It's about enjoying the whole thing and being healthy enough to go to bat in the 9th.

So, less philosophy and more updates: my wrist is getting looser and the high weights seem to make it too loose such that after lifting heavy it tightens back up and feels good. When it's loose feeling like this, it feels like a piece of leather cord that's stretched out too much. But as it's tightening it feels funny and then passes. The surgeon and therapist both said this is normal and that it should get a bit better at 1 year and usually takes 3 full years to fully go away. One of them said I still have bits of scar tissue in there (lots, in fact) and it takes a long time for all of it to get remodeled. So that's good news as I thought I'd messed up my wrist lifting. Now lifting lighter weights for more reps doesn't wear my wrist out at all (I still wear my wrist straps and don't do exercises that pass weight across the TFCC too much, which is what causes tears when it's overloaded).

My wrist pops as if the scar tissue is catching at a certain point. This is not the same pop I had before where I squeezed my wrist with my other hand. I can pop it with other thumb and pointer finger by squeezing between pisiform and ulnar styloid and the tightness goes away and it feels perfect for a minute. But then it tightens up again. So I don't pop it and most days it feels as good as the other wrist, even when lifting light at higher reps. The area where it pops changes just slightly week to week so I know there's remodeling of the scar tissue still going on. I'm still hopeful it all goes away one day. The research backs this up that it can take up to 5 years to get maximum healing and remodeling and pain relief.

That was probably my last visit with my surgeon unless something bad happens, as it is often wont to do. I'm not sure what kind of updates I will have but I'll check back in every so often to see if anyone chimes in with their experience.

One tiny but fun detail. My surgeon told me after the surgery that I have a Type II lunate. So if you're having your wrist scoped and they're in this area, ask them to tell you. It matters down the line for various things and knowing can give you a leg up as the only way for them to know is through an arthroscopy or MRI (I think). There's a great page on Lunate Morphology that explains this but the short end of it is that I'm predisposed to hamatolunate degenerative arthritis due to hamatolunate impingement syndrome. Type I has its own problems so you can't win.

[macheese70]

So it’s been a while since I posted. Thanks for the additional information on the long term recovery.
My worst felt great after the shot. I saw a hand therapist who basically told me there is nothing she can do for me since I 1. had 0 pains when I saw her and 2. full range of motion. she did give me a hand strength test and the difference was 10lbs from injuried to non injuried hands. I did ask her long term prognosis if I did need the surgery and her response left be depressed and quite fearful. She said it would be life altering and you would never get back to 100%. I was shocked.
For me, my pain has returned. It’s nothing like it was and certain positions and movements will defiantly leave me knowing something is wrong. I can grip for pull-ups and do push ups but it’s angry afterwards. I stopped straight bar benching because it was too much and I also have a shoulder injury on that side as well. I started wearing wrist wraps which have helped with positioning and over all strength.
I have to schedule a follow up with my hand specialist to see what he thinks. I would love to put off surgery however I know continuing could do further damage. I have yet to hear from anyone who has recovered 100% from this injury.

[irishlad8787]

So it’s been a while since I posted. Thanks for the additional information on the long term recovery.
My worst felt great after the shot. I saw a hand therapist who basically told me there is nothing she can do for me since I 1. had 0 pains when I saw her and 2. full range of motion. she did give me a hand strength test and the difference was 10lbs from injuried to non injuried hands. I did ask her long term prognosis if I did need the surgery and her response left be depressed and quite fearful. She said it would be life altering and you would never get back to 100%. I was shocked.
For me, my pain has returned. It’s nothing like it was and certain positions and movements will defiantly leave me knowing something is wrong. I can grip for pull-ups and do push ups but it’s angry afterwards. I stopped straight bar benching because it was too much and I also have a shoulder injury on that side as well. I started wearing wrist wraps which have helped with positioning and over all strength.
I have to schedule a follow up with my hand specialist to see what he thinks. I would love to put off surgery however I know continuing could do further damage. I have yet to hear from anyone who has recovered 100% from this injury.

Hi im just wondering does anybody know what causes this, i recently injured my tfcc in my right wrist and it took two months or more physio to get it back more or less ok but still have popping when i push my baby finger against my palm and a few days ago i have now injured my left wrist same symptoms, is it poor from that is causing this, any info much appreciated, i got microcurrents to heal last injury. I bought a wrist widget so planning on using that in gym now.

[macheese70]

From what I have been told and researched it could be a combination of genetics, body mechanics and lack in range of motion while under load. Also, accuate injuries (falling with your hand/arm outstretched) is another cause.

[macheese70]

Update after MRI. Confirmed TFCC tear in addition to a tear along the top middle of my wrist in the carpal tunnel area. In agreement with my surgeon we are exploring every option before surgery (another new brace) He said it’s promising that if my wrist is taped or put under pressure I have 0 pain through range of motion. He said there is minimal chance this will “heal” without surgery but it could become pain free with being conservative with working out and day to day life.
If I get to the point of surgery, he said that the repair would be determine once in there to fully understand the tear. He said he would do everything to repair the tears althat would allow me to resume my lifestyle without minimumal restriction.
While not the news I wanted to hear I know here to go from here. We have a plan in place and moving forward. Surprisingly, he didn’t recommend pt since I know all of the exercises, treatments and timelines to progress with them. I did buy a wrist widget but developed a pressure sore because i need it very tight.

[Nobeta]

My hand surgeon wants to do a wrist arthroscopy as he suspects I have a tear in the articular disc of the TFCC. I'm being ultra cautious and am seeking second and third opinions from top hand surgeons before I go ahead with it and may switch doctors. I have also talked with Wendy and have a Wrist Widget.

The surgeon is pretty convinced that all I will need is a simple debridement and I should go back to normal after a period of bracing/splinting and rest. Most of the peer reviewed scholarly literature indicates this and from what I understand a debridement is one small step beyond your run-of-the-mill wrist arthroscopy.

At any rate, my question is simple. Has anyone active on the forum had a TFCC debridement for a central tear without any complicating factors like wrist instability or ulnar positive variance (I am ulnar equal in terms of variance and my wrist is stable, so if this is a tear, it's a Palmar 1a that was missed by my MRI). If so, what were your surgical outcomes? How is your wrist today and what was the healing process like?

I had one in 2015 mate exact same surgery on my left wrist was best thing I ever done it was a slow recovery though I had roughly 20lbs weight bearing tolerance before surgery and 1 year later I had 50-60KG's! I also had one of the highest grip strength Wendy had seen and was top 1% of population I think she said. Wendy is the creator of the wrist widget which is an amazing invention but my job was too physical and I would never recover I suffered for over 4 years by the time I got cut open due to being misdiagnosed by doctors and physios.

If you havnt spoke to Wendy I suggest you do I can dig her email for you if you want, or alternatively join her ******** group 'TFCC and ulnar sided wrist pain' it's a closed group with over 800 members with the same problem I had you have all the info in the world is there plus Wendy is on and no one understands this condition more.

But like I say it was a slow recovery I was on the sick got 3 months it was literally the last couple weeks of that 3 months when pain started to subsidise and 5 months where I could work normally with my left hand but wasn't until after a year where I was pain free. I've been trying to dig out my recovery process info if I find it il post it

[Nobeta]

Also I never realised there was so many replies to this thread and havnt read it all yet but DO NOT TAPE your wrist over the ulnar head there should be no compression to the bit where the bone sticks out your wrist cause that makes everything worse.

[Nobeta]

Irishlad, Mate don't do anything at the gym until you have confirmed you have a stable wrist by doing weight bearing tolerance test(google it) and even at that would start very light if anything and would take advice of a hand and wrist specialist not a physio. They are tricky injuries and with me often lured me into thinking I was healed when I wasn't then bam would flare up again your either really lucky but I don't think you will be healed after two months