TFCC Tear, Prolotherapy?

[John Everingham]

So I messed up big time. To make a long story short I was an idiot and tried to train around wrist pain. While it didn't hurt while training it slowly got worse over time and now 7 months later I am still trying to recover from a tfcc tear that occurred as result of poor decisions. I haven't done a handstand in 5 months (for 2 months I kept trying to see if it was better, not smart) and while most of the pain is gone while doing normal activities my wrist still feels unstable and I suspect it will come back if I try to resume training.

 

I was thinking about trying prolotherapy but I do not know if it will help see as if my tfcc was going to heal completely I think it may have done so by now. I still have popping and cracking in my wrist so I am pretty sure the tear is still there just the inflammation has dissipated somewhat.

 

Has anyone had any success with prolotherapy for healing a tear that just wont seem to get better?

 

Are there any other treatments I can try other than PT, which I am currently doing.

 

Is there any hope that I can eventually master the foundations series with my wrist in this condition? 

 

 

 

[Nick Murray]

The TFCC, being fibrocartilage, will heal slowly, if at all. I've recently seen a patient who had been doing gymnastics "stuff" and capoeira - planting the hand and doing that semi-cartwheel twisty thing, whatever it's called.

 

There are a range of different types of TFCC injury, as I'm sure you've probably already researched. I've heard of prolotherapy being useful for sacroiliac joint laxity, but haven't heard anything about TFCC uses.

 

you could try VERY slow, progressive isometric holds in neutral wrist flexion & extension,, and perhaps axial loading (ie make a fist, keep it in a non flexed/extended/radial deviation/ulnar deviation position) and try a plank against a wall, increasing the resistance as you can tolerate it.

 

Else, get it ultrasounded, see what type of tear it is and perhaps consider a surgical repair, though this is not always successful.

[Alessandro Mainente]

Tear in TFCC usually does not heal. the solution is some stem cells injection or surgery.

Remember that tear in this part has an high predisposition to ulnar luxation.

[John Everingham]

Nick,

 

I had an mri I have a central tear of the tfcc. I can basically do most normal activities so I don't know that I want to do surgery. I was thinking I would take your advice and try to slowly see if I can get the other tissues around the tear to adapt even though I don't think the tear will ever actually heal because it is a central tear. Perhaps I can get some level of adaptation.

 

Alessandro,

 

Have you had the stem cell injection yourself?

 

Thank you to both of you for replying  

 

 

[Alessandro Mainente]

No I have not stem injection. I have a middle inflammation, and it healed in 9 months.

On the other side one my friend that is a orthopedic has a bad fall on ski. basically he has TFCC complete tear and partial ulnar ligament tear. ligament was sutured while TFCC was not surgically repaired since he also have manipulation work sometime. from this moment he has to dress a particular support on the wrist to avoid ulnar luxation.

[Joseph Blazuk]

Central portion is avascular so will have difficult time healing.  Prolotherapy is designed for conditions that "should have already healed" so I wouldn't stress about timing.  It should be cheap enough to try.  PRP may be more efficacious though there's no science to really prove either for TFCC tears and will be a bit pricier than prolotherapy.  Stem cell therapy in my opinion would be a very expensive experiment, especially if you have a structural abnormality, such as a relatively long ulna, that is predisposing you to TFCC injury.  No injection will fix that, only surgery.  May be worthwhile talking to a hand surgeon.

[John Everingham]

Thank you all for the help.

 

I think I may try to recondition my wrist over the few months working mostly on rings or parallel bars. I will just most likely have to ditch planche training for a while. I don't have a lot of money right now being a grad student and from my understanding stem cell therapy is not covered by insurance so I may have to wait and in the future if it is still giving me problems maybe go to that as an option.

 

Alessandro,

 

How did you treat your recovery? Did you just do things that don't cause pain? Because for me I find it difficult to know what hurts and what doesn't because often the wrist isn't sore till after the activity and not during. Usually it gets back to normal after a night of rest. Should I just avoid things that cause sharp pain or if I have some fatigue or dull pain after should I stop all of those activities as well?

 

Sorry for so many questions I just want to do the right thing. 

[Vinni Williams]

Physical therapy student here. I had the same injury 3 years ago and I treated mine conservatively with physical therapy and ionotphoresis treatment. Ionotphoresis is basically a process where an electrode pad soaked with anti-inflammatory medication is pushed through the skin using a small amount of electricity at the injury site. To give you an idea of the severity of my tfcc injury, I had pain for 6 months before I started PT/ionotphoresis (physical therapists perform ionto treatments). It took 2 months to get back to 95% while taking a break from any activities that caused any wrist pain at all. During my PT treatment: performed lots of pronation/supination exercises 50-60 reps a set at low weight, iontophoresis, and some ultrasound. The best current research says that prolotherapy is not an effective form of treatment, the results are so hit or miss that it is not worth the time and money. From what you've said about the current condition of you wrist slowly getting better and having minimal pain, I DO NOT RECOMMEND SURGERY. Let your body take its natural course of healing. It's been 3 years and I have not had a single issue with my wrist since then. I'm not trying to sound arrogant but I have experience in this situation and I know exactly what you're going through. Waiting for it to heal sucks but taking a rest from doing things that aggravate it will get you back in the gym quicker in the long run. You have to find the right intensity of exercise you can perform without the wrist hurting. If it hurts during the exercise decrease the load so that you feel NO pain or find a new exercise. Also, the pain should not last more than an hour after doing an exercise. Hope this helps.

[Nick Murray]

Just an update. My TFCC was, I think, caused by being run over by a 4WD/SUV 20 years ago, falling on both wrists, outstretched. It goes through periods of being painful, and I can't even lift a cup of coffee, to being completely pain-free. At present, it hurts a lot (no idea what aggrevated it), yet I can perform bent-arm half-straddle planches with no pain in the area during and after. At all! It seems it's very much a positional thing.

 

I haven't had any treatment beyond self-administered physical therapy.

 

TFCCs are able to "scar up" and for some people this is enough. For GST purposes though, the loads are a lot higher.

 

+1 for what Vinni20 said though.

[John Everingham]

Thank you for the input Vinni and Nick,

 

I will keep trying to treat it conservatively. It might just mean doing a lot of experimentation to figure out what actually hurts it and what does not. I will see where I am at by the end of the year and hopefully I have made some significant progress. 

 

Again thanks to you all I hope this information can give others the peace of mind it gave me.

[John Everingham]

I did have one more question though.

 

I notice I really don't get any sharp pains while doing most exercises but sometimes my wrist still ends up hurting like 2 - 3 days later and it sort of lingers. Should I just do nothing until it doesn't hurt at all?

 

This is just so difficult because I can't tell what is hurting it and what isn't....

[Matthew Jefferys]

I did have one more question though.

 

I notice I really don't get any sharp pains while doing most exercises but sometimes my wrist still ends up hurting like 2 - 3 days later and it sort of lingers. Should I just do nothing until it doesn't hurt at all?

 

This is just so difficult because I can't tell what is hurting it and what isn't....

I'd say that any load bearing on the wrist should be avoided for a significant amount of time. After a connective tissue injury, people often jump straight into rehabilitation, and when it feels 'better', resume some kind of training only to reinjure that area or slow the healing process from months to years. It's very easy to rush connective tissue rehabilitation because it's difficult to 'feel' how your connective tissue is coping, aside from the fact that it's avascular so it takes so damn long to adapt!

 

Rest, completely. I wouldn't use that wrist for anything if I could help it. Then slowly move onto wrist circles, and then start load bearing (once non load bearing motion was painless or not significantly restricted). The H1 series has great exercises for the wrist, but you will have to be very cautious due to the nature of your injury. 

 

You'll have to come to terms with the fact that this injury will either take years to become manageable, or just always be a nuisance provided you don't have surgery (is arthroscopic reconstruction surgery possible for you?). If you do something, and it hurts a few days later, do something less strenuous. Mild pain is often normal, but it should be mild enough to ignore/forget about.  

[John Everingham]

Mercurial Flow,

 

Thank you for the reply.

 

According the wrist surgeon I was working with he said the he could go and debride the tear but he did not say that he could not reconstruct or suture the tear because of its central location and he didn't think it would heal. But he still didn't want to operate because he said that debridement is hit or miss on whether it will work and because my pain is not debilitating.

 

Like I said my pain level is almost zero when doing normal daily tasks though I don't feel like I can trust it at all. It has been 8 months since the initial injury the tear does not seemed to have really repaired because the wrist still crunches a lot and pops in ways that my other wrist does not at all. Its a tough pill to swallow that what seemed like a small training injury has pretty much changed my entire lifestyle but I guess there's not much I can do about it.

 

I am still only 22 do you think that it would be worth waiting another 6 to a year to see if I can get the tissue to adapt or have you seen anyone have success with the debridement?

[Matthew Jefferys]

Provided it isn't causing you much pain, for this kind of injury, very little can be done. 

 

Debridement greatly depends on the severity of the injury. If scar tissue is causing adhesions and getting caught between things, debridement will work. If the joint in unrestricted, and the only issue is the tear itself, it won't benefit you much, if at all. You will just have to live with it, unfortunately. Until some new technology comes about, or it heals enough for your wrist to regain function (but that will take a very long time, if it happens at all).

 

My suggestion is still just slow mobility work (no load bearing), until it does not cause pain. Then you can start very slow, cautious, light load bearing on the wrist. Strengthening your wrist extensors and flexors will also somewhat protect it from further injury. This will always be your weaker wrist, so treat it with care, though you should easily be able to build up to hanging and support positions given enough time. Be thankful you're not a weightlifter; this kind of injury is career-ruining.

 

Don't be disheartened by the bad news; if you're not experiencing much pain, you're luckier than most. Really focusing on rehabilitation can do wonders for the body. Keep at it.

[John Everingham]

Well I will just keep it up. I have a wrist widget I have been using it I expect to do anything strenuous or I start to feel any pain so I guess I will just keep doing pt exercises as I can tolerate them and see where I can get too. Thanks again for the support it seems like there is just not a super large amount of information about the tears that I could find at least. So hopefully this will help others as well because I felt really hopeless before getting responses from you all.

 

Big thanks to everyone who replied. 

[Nick Murray]

One more thing. I've found that doing static hangs from rings tends to aggrevate my left TFCC via the increased tension in the flexor carpi ulnaris (muscle). This is because the rings tilt towards each other, and your arms tend to go into ulnar deviation.

 

For the past week it's been giving me hell.

 

If you do your hangs from a straight bar (that doesn't move, obviously), you can transfer some of the load to the radial (thumb) side of the arm. I've tried this for the last two training sessions involving hangs, and while not pain-free, it's a lot more comfortable.

 

You may still need to start with only partial loading, then gradually build up.

[Jake Andrew]

Just wondering how you guys went with your tfcc? I have a similar injury and am wondering if light load over time might eventually heal it

Thanks

[Nick Murray]

Mine is manageable. Work occasionally makes it unhappy (I'm a massage therapist). When doing any pressing element (eg SPL/SE3), I doing a lot of wrist and forearm warmup first.