Wrist TFC tear

As crossfitters, we’re accustomed to a lot of acronyms…
WOD. AMRAP. HSPU. SDHP. TFCC. KBS. MU.

Wait, what? One of these things is not like the other.

TFCC. Triangular Fibrocartilage Complex

Triangular-Fibrocartilage-Complex

What is it?
More popularly known as the wrist meniscus; a kind of shock absorber for some of the joints in your wrist. The TFCC can tear with rotational movements, like an awkward fail on a heavy Turkish getup or falling out of a hand stand.

What does it do?
Remember, your wrist is collection of many joints that roll and glide, allowing you to bend, straighten, twist, and move side-to-side. The TFCC is connective tissue shaped like a triangle that gives stability to all the aforementioned motions.

My wrist hurts, how do I know if it’s the TFCC?
Some common signs and symptoms of a TFCC tear are:

  • Pain, localized to the ulnar (pinky) side
  • Pain that gets worse with simple gripping and rotation movements (opening a door or using a can opener)
  • Swelling
  • Clicking, snapping, or crackling (crepitus)
  • Sensation as if something is “catching” inside the joint
  • Instability
  • Positive fovea sign

A TFCC definitive diagnosis takes history, mechanism of injury, and imaging. Even with MR Arthrograms, the dye can leak and produce a false positive. The most accurate way to determine damage is through arthroscopy.  Nifty, because your surgeon can fix the issue right then and there!

Is it always surgical?
Not always, mild to moderate tears can scar down if immobilized in a cast or splint for 4-6 weeks followed by physical therapy. Surgical treatment is based on the type of injury. It may involve a cleaning up “debridement” or a reattachment with wires/screws to help hold the tissue in place as it heals.

How is it going to affect my WOD?
Clean & jerks and snatches are probably out of the question, along with thrusters. Consider front squats if you are able to hold the bar like this:

Goblet squats or double kettlebell front squats are also a good substitution to avoid putting your wrist in an uncomfortable position.

Pushups can be modified if you’re OK doing them on your fists.

For HSPU you can use paralettes or heavy dumbells (but stack up plates/abmats so you aren’t doing deficits).

Muscle ups might get dicey, especially if you use a false grip and rely on your upper body strength to get over the rings. A big kip that carries you higher into the dip position will lessen the forces on the wrist, but be especially careful since the rings are already an unstable apparatus; combine that with wrist instability and you’re looking at a sloppy fail.  If you absolutely must keep doing muscle ups, doing them on the bar is a better choice, but you may want to exclude them all together and focus on pulling and pressing strength with your wrist in a more neutral position.

What can I do to manage this on my own?
Keep in mind that a TFCC injury is a stability issue, so motor control within the appropriate range of motion is important. If you already have full, normal range of motion,  then doing wrist mobility exercises will not help. However, maintaining function and grip strength through that range of motion will keep the musculature supporting your wrist (forearm muscles) in good working order. Try making your own wrist roller with pvc pipe and a rope to roll up (concentric contraction) and
lower down (eccentric contraction) a light plate (about 5#).

Be sure to use a thumb hook grip when doing deadlifts to lessen the load on your forearms. Similarly, don’t death grip the handle when rowing. Wearing wrist wraps or taping for compression may provide the extra support to keep you pain free during a WOD.

Ultimately, you can work around a mild TFCC injury if you maintain grip strength and can control the range of motion you have. If pain persists, be sure to seek appropriate medical attention.

 

Written by Liz Caruso‏

6 Comments

  1. Thanks for this post. I’m a Dutch Crossfitter and I too have been struggling with a wrist injury. Pre-crossfit I used to do quite a lot of boxing. During that period I have had a couple of weeks where my wrist would really hurt. I always got anti-inflammation medinces and after a week or 2 I would be ready to go again.

    After 3 times my doctor send me to a specialist who also thought my TFCC was torn ( This time the pain was so bad, i couldn’t even twist my hand / see my own palm of the hand). I had an arthroscopy back in August. Luckily it was just very inflammated. They removed the inflammated tissue and the recovery could begin.

    At first I thought it would take a week or 3 for me to be completely back at lifting and doing all the movements again. Unfortunately this wasn’t the case. My physiotherapist told me it was going to atleast take 3 months for me to fully recover but to be safe I should think about 6. I was allowed to start training again though but just don’t train when I feel “pain”. ( Which I still don’t really get. When does something really hurt?)

    Anyway, its 3 months later now and my wrist is starting to feel better and better by the week. I still avoid front squats / thrusters / muscle ups etc. but i can fully deadlift / bench / pull up / push up / hspu etc. I tried to research about recovery other cases where people would only have there inflammated tissue removed but I really can’t seem to find any. I’m still not 100% about my recovery even though it keeps feeling better and better I’m scared that I will push too hard and end up with more inflammated tissue or even worse a tear.

    What my comment basicly comes down to is that I hope someone can tell me if it is normal to still experience stiffness and minor pain in my wrist 3 months post surgery and after how long I could start doing other lifts like front squads / muscle ups etc.

    ps. Sorry for my English

    – Shane

    • So 3 post surgery on the wrist is ok to still have pain typically. You should check with your surgeon about the return to lifting part.

  2. So options here are typically try to modify and back off the weights, cortisone injection, occupational therapy Surgery for tfc tear and or surgery for the ulnar variance are options the second one with a more extensive recovery

  3. Dr. Sean-

    First off, this post really enlightened me quite a bit – thank you! I’ve been in the dark lately with trying to make sense of my injury.

    About 6 weeks ago I injured my left wrist during this wod:
    5rds:
    20 wall balls (20# rx)
    10 ttb
    200m run

    I felt no pain during or immediately after the WOD, however the next day I woke up with a balloon-sized wrist and some rather severe pain/mobility restriction. I’m not sure what actually caused the injury but I suspect the wallballs. I’m guessing through fatigue I must of caught one awkwardly and put pressure on my wrist.

    I wrote it off as a simple sprain and laid off of it for a few weeks, provided some R.I.C.E, and followed the “if it hurts don’t do it rule” while training. Although the pain and swelling had subsided, it became much more centralized over time (the ulnar side), causing some concern. I can stretch and flex the wrist slowly with little pain (flexing the wrist back does hurt quite a bit however when I make a fist for a wrist curl type motion), however any quick, jarring motions (such as the catch during a clean, big kip for bar muscle ups, etc) causes some serious pain and tightness. It seems to be getting worse, so I went to see an ortho to get some insight.

    After a series of xrays, MRIs, and an EMG, I was diagnosed with a positive ulnar variance and a (suspected) TFCC tear. The MRI cannot confirm a tear but it shows swelling in the region which could be the result of a tear (or not – I hate the uncertainty).

    The doctors recommended surgery to fix my ulnar variance and TFCC tear, however they insist on telling me that I cannot lift weights anymore (ever), and that I should also stop doing crossfit altogether, or at least in a competitive manner with heavy weights.

    I’ve been lifting weights since I was 17 (24 now), and have been training in olympic lifting for the past 2 years. I just recently got into crossfit to continue my journey into competitive fitness (with a strong background of strength athletics, it’s really a great thing for me) and I absolutely love it. It’s my life, my escape from stress, and my passion – I just want to get back to doing what I love without pain.

    I refuse to accept that, at my age and fitness/strength level, that I am physically unable to recover and continue to do what I love to do at and the high level I’ve worked so hard to make an attempt to achieve. I’m only 24 and this is my first “game changing” injury. I’ve seen people completely fracture, dislocate, or just all out shatter both wrists during failed clean attempts and make full recoveries to the sport.

    Do you have any insight? What about non-surgical recovery options (is this possible)? Any help would be greatly appreciated. I’m very frustrated and depressed – I need a doctor that understands the mind, drive, and passion a crossfit athlete possesses. When I tell my doctors I’m a “crossfit athlete and competitive weightlifter” they practically laugh in my face and tell me to quit.

    I live in the Philadelphia Area and am even considering making the trip just to have you evaluate my injury.

    -Justin

  4. Good luck with it, I hope it quiets down for you.

  5. Thanks for this post. I believe I damaged my TFCC in a mountain bike crash a few years ago (I fell hard off a drop onto my outstretched hand). I never got an official Dr. diagnosis, but I had a sports therapist give me PT (he believed it was the TFCC based on the way i fell and the symptoms). It would ache every now and then, but never really both me until Murph three days ago. I only did 100 pushups but my wrist has been in pain doing even the most trivial of tasks (actually while I type). I’m going to use your modifications for exercises to get me back on my hands (so to speak).

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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