T Nation

Any T-Nation Wrist/TFCC Experts?


#1

Hi there everyone
Ive been lifting powerlifter style and what not for about a year now
Dont got pictures or anything to prove it but I managed to get to 195kg x2 raw on deadlift

i got into olympic lifting awhile back when i saw how much Military press changed my body.

I started cleaning with bad form,eventually getting it right, underly a real lifter in our gym.

Fast forward one year, best results of my life, but then in December 6th 2011, one reptition in a max out session went horribly wrong and I tore my wrists quite severely.
Was Put in casts and splints and now im in Boomerangs.


Been Told by doctors to forget lifting and also by my specialist physio

My right wrist has quite a bad TFCC Tear- 80% which is avascular
Left wrist is just torn so badly but the TFCC is Ok

But nonetheless- Im in a big Pinch

This is basically my injury except with 100kg http://www.youtube.com/watch?v=Bj-gyl-e4y0


my question - Ive read basically every single kneee,shoulder,lower back article in existence on tnation but when i try to find wrist articles, theres only this one "13 tips for mighty wrists and eblows"

But none for actually "Rehabing" a wrist injury ,despite the countless shouolder ,lower back rehab articles that Tnation excells in.

Please can anyone Help?
I do not want to give up lifting.
I found my passion and its weight training. I plan to do a course in Fitness training/physiology and then become a trainer and even pursue some coaching career in my town

But cannot do any of it if my wrists are disabled

Any members/tnation authors/ well knowledged in TFCC tears/ wrist tears?

This is a genuine appeal to anyone that can be of any help!

Many thanks

DeeDuub


#2

my question - Ive read basically every single kneee,shoulder,lower back article in existence on tnation but when i try to find wrist articles, theres only this one "13 tips for mighty wrists and eblows"

But none for actually "Rehabing" a wrist injury ,despite the countless shouolder ,lower back rehab articles that Tnation excells in.


hmm. sometimes 'rehabbing' something is about regaining the movement one should have and then strengthening it. in other words, you basically do the same work for rehab as you would do for prehab or for training rather than doing anything specially different. one might well want to start really light, though (e.g., unweighted) to get the movement smooth and comfortable before weighting it.


#3

are you getting physio?? ask them...


#4

Physio STILL cannot tell me if i can lift again.
After April it will be 5 months since the in jury and still I cant get a word if i can train again or not.

Im severely depressed since december as its my only passion. Wrist injuries are so bad as you cant do anything basically ( and please, im not going to run or do legs forever)
-
Due to the a vascular nature of the TFCC, hence I don't think I will ever heal

BUT
thees doctors are the same people that say squats are bad for your knees , deadlifts are bad for your back, when in fact, are the best thing fro your body if done correctly

is their ANY tnation experts that can help please??????????
Any members with a screwed up wrist in rehab/finished rehab/knows anything please?

Thanks
DeeDuub


#5

I have a slight tear in my TFCC, it was caused by an ECU Subluxation in my right wrist. The subluxation was repaired surgically, but the tear was left alone because the doctor thought it wasn't the source of my pain. Got the surgery in June 2011, I started lifting in December doing only bicep curls, by mid january I moved to dumbbells and was doing most lifts/bodyparts, just no barbells. I just started using barbells about mid May, so 9 months post op. My wrist hurts some, still scares me.

Not exactly your injury, but it was a bitch. I don't know if surgery is going to be required in your case, but yeah the wrist doesn't heal much. FattyFat on this site has had a history of wrist issues, though im not sure if he still posts on here.

Can't offer you much because I don't know how bad your wrists are/what options are availible, but I will say when you return to lifting start with dumbbells.


#6

i meant physio could tell you what exercises you should be doing to rehab your wrist...


#7

I have no specifics for you on wrist injuries or rehab protocols, but there is no reason for you not to be lifting if you love it. You still have legs right? I just got a cast off of my broken left hand, so my upper body work has been limited to wrapping an ankle cuff around my cast and doing band exercises to prevent atrophy of my upper body. But I've been crushing my legs and getting stronger in front squats, barbell hip thrusts, banded leg press, bulgarian split squats, step ups, jumps, extensions, curls, abs from ab straps and on swiss balls, etc.

My advice is to keep searching for info on your wrists, and get back to lifting. Is it perfect, no, but at least it's still lifting and will alleviate your depression.

You could also send a pm to Michael Ranfone on here, real real smart dude when it comes to training and injuries.


#8

Hi there
Thanks for the insights into the alternatives
my passion more specifically was the compound olympic lifts + upper body compounds.
Clean n jerk,snatch and deadlifts, military press- all i ever did

Where can I find that guys contact details ( to PM)?
Thanks


#9

I've been seeing a few wrist threads and figured I could chime in with my experiences. I've been a gymnast for about 25 years (I'm 30 now), I competed through high school, D1 in college, and have stayed active in the sport since graduating about 7 years ago. After my senior year in high school, I was having real bad wrist pain, especially when supporting myself with my wrists in full extension. It turns out my ulna was a bit too long and was crushing the TFCC. I had an ulna shortening procedure done in which 7mm of bone was removed and the ulna was put back together with a 4" plate and 7 screws. Most people who have this surgery stop gymnastics completely, but I just couldn't do that. I was in a cast for about 6 weeks, and then slowly worked back into everything over the next 6 months (which was relatively quick for this procedure), eventually becoming fully functional again. However, my wrist never felt like normal again; it might have gotten to about 85%, but I learned to live with it and modify my workouts and skills.

Two years later, the same thing was happening in the other wrist. So, I had the procedure done on that wrist as well. This one was a bear. Getting it back to being functional took about twice as long as the first one, and this one might have gotten to about 70% of normal. Again, I learned to live with it and figure out how to work around the deficits. I eventually had to drop pommel horse (which is most wrist intensive), but I could manage on everything else and I continued competing for three more years.

Now, seven years later, I still get in the gymnastics gym about 3 days a week. I mostly do a lot of strength, but I still swing around on high bar and rings. I have the most pain doing strength stuff, especially when a bending moment is placed on my forearms. I have a feeling the plates are creating stress risers on the contact points of the bone. Again, I've learned to live with that pain during workouts, but also icing after workouts helps tremendously. The TFCC area has given me no issues since prior to the surgeries. I do feel like the plates in my arms have limited my strength in some areas, but for what I cannot do in those things, I devote my energy to the things I can do. I suppose what I work is a little different than most, but to give you an idea of what I can do with my wrists now...I can hold 1-arm handstands for about 30 seconds, do planche presses, sets of 15-20 handstand pushups, inverted crosses, and overhead squats with about 195.

Long story short, my wrists have never felt like they were normal after going through the surgeries. I realized that forcing my wrists to adapt to my habits was not going to work, and instead I had to adapt to them.


#10


Ill chime in as well. I used to be on the Power Lifting World Team for Womens Bench Press. Had a 305lb bench press and competed in the 148 weight class. I was at the top of my game as well until I decided to do a session of power cleans in the summer of 2009....

I wont bore you with the details but I was misdiagnosed by 6 drs for 20 months. Had 2 "negative" MRI's and and exploratory sugery done in which they said the tfcc was intact, stable and had no signs of instabilty.

The more I rested it the worse it got and the tendonitis was insame. Not only could I not lift I could not function. I could not open doors, start a car, hold a glass...and all of these drs said the pain was in my head.

I didnt give up.. but with 2 strikes against me...a negative MRI and a negative surgery report no one would give me the time of day. At this time i would "clunk" on rotation and have the sensation of pushing my hand back on my wrist it was that unstable.

Finally found a dr who could help me and was experienced in the joint...apparentlly all the other wrist surgeons where idiots becuase not only was my tfcc torn it was completely severed from my ulna....and he was able to see this from the first MRI (the one taken 2 weeks after I hurt myself). Meaning the first surgeon that did the scope must have been blind not to see the hole complex ruptured off. I had lived like this for nearly 2 years. I severed both my RU dorsal and palmar ligaments. I went from the pain being in my head to having my DRUJ reconstructed.

Im 14 months post op from my reconstruction and I am lifting. Not like I was before though at any means. Power lifting is over but I can still lift weights. Like the previous post my wrist is 80% back. Cleans and heavy bench are out but I can still do most upper body excerises with minor pain.

These injuries are a nightmare but the real trick is getting a correct diagnoses and a surgey best suited. I spent 20 months searching for an answer but I finally found one!

Below is a picture of my surgery. I no longer have a tfcc. I have bone holes drilled in my radius and ulna and a cadaver tendon weave theaded through. This is my "new" tfcc.


#11

Hi,

I've received a few PMs regarding wrist and TFCC issues I replied to.

@OP

Wrist injuries usually boil down to ligament and cartilage damage, as with your TFCC injury.

My wrist injuries so far:

  1. partial (2/3) ligament rupture in ulnar wrist + TFCC damage

Got it thanks to a botched clean and press attempt.
Consulted with two sports physicians who only X-rayed my wrist, did very little in terms of palpation and diagnostics and told me it was just a sprain, I should keep on lifting as long as it wouldn't cause me pain.

And so I did, for about 15 months. Only noticed mild discomfort / pressure during pressing exercises, but no real pain. My wrist got very loose, though, so I consulted with a hand surgeon who did an arthroscopy and found the aforementioned partial rupture and damaged TFCC tissue. I guess I incurred the TFCC damage during the 15 months training post ligament rupture.
The surgery went fine, got a full cast on my arm for 4 weeks and a half-cast for another two weeks. My arm had atrophied a LOT (lost almost 4"), but it all came back pretty fast (after 5 weeks of training, give or take) thanks to the almighty memory effect.

I made a few mistakes, though:
- got into lifting too soon and too heavy
- didn't appreciate the importance of proper rehab: ROM exercises and self-massage to minimize scar tissue
- went too athletic too soon: push-ups, burpees, you name it - pretty dumb

6 months post-op I fell and tried to brace my then-200 lbs with my just rehabbed hand. Things went downhill from there and try as I might, I couldn't find a doc who could help me out.

  1. ECU subluxation in other wrist
    Got it two and a half years post-op during narrow-grip supinated 'bb speed rows' - I simply went too fast and my other wrist was too relaxed - I just wasn't focused enough, I guess.
    My wrist lost a good deal of stability and sometimes there would be some swelling at the ulnar wrist, with rashes surfacing the back said hand.
    Again, docs couldn't help me.

Now to the stuff that did actually help me:

  1. TFCC damage

There's a cool wrist wrap called 'Wrist Widget' - I'd definitely give it a try.
Basically, it's doing the TFCC's job without taking stress off the muscles responsible for wrist stabilization. The inventor claimed it should be able to heal TFCC damage after wearing it for at least 6 weeks non-stop. That I did - and my wrist really got better.

I'd just stay off pressing exercises for at least 3 months and use straps for pulling exercises - better safe than sorry. Also, depending on wrist flexibility, I'd lay off barbell squat variations. Don't do exercises where force applies perpendicular to your wrist. Rows and shrugs should be fine, curls aren't.

  1. Cartilage regrowth

Some people claim they managed to regrow cartilage by using Adequan. Just google it. It's an injectable for horses and canines, but inspired by its efficacy on their horses joint improvement some horse owners have taken to using it on themselves, too. The same substance used to be made for human use in the late 80s, but was taken off the market in the early 90s due to some complications (google for Arteparon).
Some forum locals have given Adequan a try. If I had severe TFCC damage, I'd give it a try.

  1. Regenerative injection therapy aka prolotherapy / proliferation therapy

A very promising kind of treatment making use of the body's own healing capabilities.
Upon injury, your body starts healing the injury site. Sadly, this doesn't last forever. After 40-odd days the ground work has been done. This is bad news for avascular tissue like ligaments, tendons and cartilage.
Basically, regenerative injection therapy is just a means of externally stimulating the body to restart the healing cascade at an injury site. Usually, a dextrose solution is utilized, but there are other injectables.
Now, this procedure requires a doctor skilled in administering these injections: it's not a simple matter of needle-in, needle-out. This is a big topic on its own, though, so I won't delve further into it.

Just rest assured:
ligaments can be healed or at least stabilized using prolotherapy. I've had it done on my wrists (and other joints). But this takes some time and requires good eating and living habits, i.e.: eat well, get enough sleep.

I've had my first wrist injections 11 months ago and didn't eat or sleep enough (I averaged 4h a night). My wrists got better during the course of 6 months, but they still seemed somewhat delicate. For the last 5 months I've increased my sleep (I average 6h a night, now: still not enough, but definitely better) and also my caloric intake, most of all my protein intake. Additionally, I made sure to get a lot of vitamin C (improves collagen cross-linking integrity).

Some practitioners claim the same holds true for cartilage repair. I'm not sure if conventional prolotherapy can get it done, but I've read about PRP (platelet rich plasma) - based prolotherapy being promising in this regard.

To sum it up: if there were conventional treatment modalities, I'd use them. But after consulting with too many asinine docs who did nothing for me but telling me to maybe switch to cycling, I took matters into my own hands. I've found a doc who helped me a lot, but his practice is a 3h drive away.

My wrists are still getting better.
Currently, I'd rate them a solid 80%. There's no grinding anymore and only rare clicking.
I can do pain-free lateral raises which I hadn't been able to do since 2004.
The same with curls.
Making a fist doesn't end in clicking, grinding and hurting, anymore.


#12

I would seek a physician, specifically, a sports medicine physician. You need to see a physician who is accustomed to see athletes.

beef


#13

Hi there
Many thanks your input and insight

I am going to see the surgeon again on May 2nd. Also, there are AdidaS Sports doctors about 45minutes from my area. Will have to sort out a referral to them. My TFCC clicks witht typing everytime and writing is OK but stil, not normal.

Mind you, i forgot to mention one thing. The day after I had the clean and press acccident, I deadlifted 160kg next day no problem. Little did I know though, the ligaments would have been stretchd like hell after that.. Very stupid of me ..but..the powerlifter and doctor in my area said..that if you could do that the day after..as stupid as it was...they said that it means there is hope..as no way you(me) could have done that if my injury were shattering..but now..5months later..its insanely bad.....I think that deadlift that day is a huge part fo the injury...... Stupid I know........


#14

Hi there
many thanks for your input
I will show this forum and its details to my physio specialist---Surgeons wont look at this since they are too ''bigshots''...
Many thanks
May 2nd next orthapedic surgeon appointment...
Adidas sports doctors in my town as well might be able to do something...Il see and let you guys know
P.S Does anyone understand MRI reports here?( the worded ones?)

Thanks agin


#15

Does anyone on tihs forum know how to read MRI reports?
I can post it on..And someone can just give me their proffesional opinion?
the TFCC injured population all know that the doctors and surgeons utterly suck at diagnosing and giving solutions/treatments

I'll post it up anyways but yea many thanks for anyone giving their input!


#16

@DeeDuub
About a week after my initial wrist injury, I started doing heavy rows, again only for my wrist to dislocate and reduce again. Kinda stupid, I know, so you're not alone in that regard.
I'd still try my luck with at least showing the gist of the above posts to surgeons. Most physicians I've been to, so far, are arrogant (and unfortunately incompetent) asses, I'm not beating around the bush on this one. Still, you might get lucky.

Also, self-education is key. Try to strike the right balance between making it known to your doc that you know what you're talking about and aren't a pushover as most patients are and being respectful. After all, when it boils down to medical knowledge, the doc's still the expert.

On a side note:
my private messages are broken. Sometimes I'm receiving PMs, but my replies don't seem to go through. I've had some people contact me via email asking me why I didn't reply.


#17

@FattyFat

How long after your surgery (fixed the 2/3s ruptured ligament) did it feel solid and strong again? Im still experiencing popping, clicking and grinding but it doesnt hurt. I had a pretty complex surgery...so Im assuming its scar tissue.

Also does your repaired hand feel as strong as your non injured hand...and how long did that take? Example mine feels stable now but not as tight at my good hand. I had my surgery done at the Mayo clinic. Decided to go with one of the best hand surgeons in the World since I got dicked over with idiots local drs. He gave me 90% or normalcy but couldnt really tell me "when" that would happen. They say surgeries take a year to recover from. Im past that now so Im getting abit nervious.


#18

Hi ajj6603,
I can relate to your case, I've also had two docs misdiagnose me.

Please keep in mind that your surgery was definitely more complex than mine.
Can you locate where your wrist popping, clicking and grinding occur?
Preferentially, try to determine the movements along with modalities (force application) that cause the aforementioned symptoms or just list the respective exercises.

Strength-wise (let's say low rep range), yes.
Strength endurance - wise? Nope, not by a long shot, at least at first.
Then, while being on the mend, it started to catch up with its counterpart. But then I fell on my hand and made matters worse.
I'm very confident I would've made a full recovery had
- I taken rehab more seriously
- I returned to training in a more sensible manner
- I not fallen on my outstretched hand

Seeing how you had your TFCC replaced by a tendon is definitely a game changer - or put in other words: there's a reason a human body has a TFCC and not a tendon :wink: Amongst other things, the TFCC is also a shock absorber. What I'm getting at is that maybe (but I'm not qualified to make a definite statement on this one) your popping/clicking/grinding is no major cause for concern.
If you're nervous, you should definitely get back to your surgeon for re-evaluation.

But your problems could also stem from ligament laxity. In that case, I'd definitely consider prolotherapy.

Also, the fact that you used to be a high-level athlete should be taken into account.
Care to give me a breakdown of your post-op training efforts?
It's not unheard of for athletes (and your were a high-level athlete) to place unreasonably high demands on their training capabilities during rehab. Instead of applying their hardcore goal-oriented mindset to proper rehab modalities, they focus too much on playing catch-up with their former training.
I was no different (I wasn't competing, but given my numbers I easily could have) and you've been putting up quite the numbers, so don't take my suspicion the wrong way. :wink:

Fire away if you've got further questions and feel free to keep me in the loop.


#19

Surgery I had sorta mimics an ACL repair but of the wrist. I was in casts and splints for 12 weeks. After than it was just getting my ROM back...and try to use the hand for daily living. At 5 months I started at 2lb dumbells and worked my way up to 15lbs (wrist curls, biscep/tricp..basically any movements I could do with a dumbbell....I mean i took it REAL slow....

I was told to forget about heavy weights but normal weights and fitness would be just fine. Sadly I still dont know what "normal" is since a 300lb bench was normal for me. Also, I was very atrophed when I had that surgery since I was misdiagnosed for soo long...my arm was all bone. I figured this is why its taking forever for me.

Im about 15 months post op. I wake up pretty cracky in the mornings over the tfcc area and there is some slight swelling here and there. All the popping, cracking and snapping is on the tfcc side but it doesnt hurt...just annoying. They do these repairs super tight..I still feel I have to crack my hand for relief. I think my repair is "fine" since im not in severe pain and pushing my hand on my wrist every 5 mins...but there is nooo way this is 90% of normalcy which concerns me. Im still working mainly with dumbbells...up to 30lb curls, dumbbell press...stuff like that. My wrist actually feels the best when I work out...but again not normal. I also stretch between sets which does help.

Im wondering what your dr told you after your surgery....since it sounds like he just repaired a ligament...but yet you still notice a difference. My surgeon told me he does these ALL the time and how i will be FINE and to have some faith....lol right. Then he started mentioning a few high profile athelets he has done these too and they are back at the top of their game...

So when you fell on your reapaired hand i take it you didnt distrub the repair.... Did you sprain it and there is more laxity? Im still pretty stiff in the mornings...but it goes away.

Any info on your rehab would be greatly appreciated.


#20

OK, good to know.

That's what I wanted to ask next. Did your surgeon specify what he meant by 90%? 90% in relation to what?

I'm wondering about the swelling part. I'd like to know if the swelling you describe is a result of irritated connective tissue or irritated bone.

This I know from personal experience. The more stable my wrist got, the less I had to crack my hand for relief.
What movement do you perform to crack your wrist for relief?
Ulnar flexion?
Radial flexion?
Palmar flexion?
Dorsal flexion?

In my opinion, your last statement is a good sign. That used to be the same with my wrist after having fallen on my hand 6 months post-op. More on that farther below.

My surgeon didn't repair the ligament, he reconstructed it by using a tendon from my palmaris muscle of the same hand. So, as with your case, my biomechanics had be altered by the reconstruction. Only I got an autograft, whereas they used an allograft on you (cadaver tendon).
Sadly, my doc just spared 5 mins to recommend a physiotherapist to me. I wasn't told about the big impact a proper rehab has. At that time, I totally underestimated it.

More the reason you should consult him, again. Just make sure to convince him that you sensibly eased back into training. And have a detailed breakdown of your training ready. It's important your training can be ruled out as the cause for impeding / slowing your recovery.

You bet it did!

  • I got some minor ulnar-sided swelling and ulnar flexion always resulted in annoying and uncomfortable clicking.

  • my wrist lost stability, got more lax

  • loaded dorsal flexion (as with a push-up) hurt a lot: ulnar-sided and dorsal-sided, at the stem of the wrist

  • generally, pressing exercises made matters worse - unless I maintained a straigh wrist (avoided dorsal flexion)

  • actually, the only things that didn't aggravate my wrist were exercises with the force applying straight into the forearm: push-ups on fists, maintaining a straight wrist during squats, pressing exercises etc. Curls, lateral raises, triceps exercises weren't feasible.

  • and, as with you, my wrist felt most stable during training. No wonder, the pumped-up forearm muscles provide temporary stability by reducing empty space created by lax ligaments.

I tried a lot.

  • at first, I tried laying off training (which was hard). Didn't do jack.

  • then, I took it up with the surgeon. He ordered another MRI done which - surprise! - showed nothing of significance. According to the MRI my wrist was perfectly fine. There you go :wink: Of course, the doc palpated my wrist and couldn't deny that something was out of whack. But short of another arthroscopy - which he strongly advised against - he couldn't offer more counsel.

  • so I read and researched until I found an interesting article outlining how loaded eccentrics can improve tendinopathies. At first I was only marginally interested, but the premise sounded worth a try. I surmised that maybe the tendon graft became irritated. So, I did eccentric wrist curls, with my forearm propped on a bench I kneeled before and using my free arm for the concentric portion of the wrist curl. 2-3 weeks later, I was mostly pain-free. The clicking subsided. If I had to guesstimate, I'd say that my wrist just clicked in 1 of 100 ulnar flexions. I still felt some dorsal pressure during heavy pressing exercises, but that was about it. Still, I took my sweet time, about 6 months, before reincorporating stuff like curls into my training. And even then, only moderately. But all in all, I was able to pull and push a lot, again. Still, the biomechanics had been altered and with every pressing I did, I maintained the straight wrist - no exceptions. I was too happy with the level of functionality I got back. Additionally, I modified all exercises to maintain neutral or at least neutral-pronated grips. The more neutral you go with your wrist (thumb pointing upwards), the more force is distributed along the radius which usually can bear a lot more with TFCC-plagued people (barring an plus/minus ulna/radius variants).
    Still, doing stuff like triceps pushdowns wasn't doable. But I was able to work my way up to standing unilateral 165 lbs dumbbell overhead press for a good 8-10 reps at a bodyweight of about 190 lbs in 2009 (can't do that anymore because I fucked up my shoulders big time, but that's another story).
    I also worked my way up to a 190 lbs unilateral dumbbell row for a good 4-6 reps. But my wrist didn't like that much :wink:

Also, you might want to consider your nutrition. I have a history of not eating enough to compensate the stress I put on my body with my training (both heavy lifting and lots of cardio). I've once read in a study that your body 'prefers' to utilize nutritional protein to repair muscles over connective tissue. Which makes sense: muscle tissue is well vascularized whereas connective tissue is avascular in comparison.

So, at the risk of sounding like a broken record:

  1. have your wrist re-evaluated by your surgeon
  2. if your surgeon can't help you, consult another one
  3. if lax ligaments contribute to your symptoms, consider prolotherapy