An injury to the TFCC or triangular fibrocartilage disc is an injury to the part of your wrist at the end of the ulna, which is this bone running up from your elbow to your wrist.
Loading the player...What is a Triangular Fibrocartilage Complex Injury of the Wrist - Marpole Physiotherapy Gordon Bohlmann, BSc.PT, IMS, Physiotherapist, discusses what is a triangular fibrocartilage complex injury of the wrist (TFCC)
Loading the player...Wrist & Hand Injuries in Hockey Behnad Honarbakhsh, MPT, BHK, CSCS, CAFCI, D.O.(c), discusses wrist injuries in hockey.
An injury to the TFCC or triangular fibrocartilage disc is an injury to the part of your wrist at the end of the ulna, which is this bone running up from your elbow to your wrist. The disc is a very strong ligament and cartilage type structure that sits between your ulna and your wrist bones. The function of this disc is to stabilize this joint and allow it to rotate and move freely.
Your physiotherapist would ask you about the mechanism of injury. For example, did you fall on an outstretched arm or was it an injury that occurred while you were using a power tool such as a drill where the drill bit got stuck and the drill torqued your arm and caused a big rotation.
So the mechanism of injury is important. Secondly, there are some orthopedic tests that your physiotherapist will do, such as the piano key test or the distal radial ulna joint stress test and that will give your physiotherapist information about whether or not your TFCC complex was disrupted or torn.
Once your physiotherapist has determined whether or not there are any other aspects that could be involved such as a tendonitis of one of the extensors of your forearm. The TFCC would mostly be treated conservatively first, which probably involves a period of time where it’s braced or immobilized.
That would be a period of time to allow scarring to occur and for that ligament complex to heal. Secondly, you’d be looking at some strengthening exercises to try to increase the strength of the adjacent muscles and tendons.
And if after all of those efforts have failed then your physiotherapist would be the one who would refer you to the appropriate practitioner to deal with it in a non-conservative way if you’d fail a conservative therapy.
In terms of the whole team of care you would be looking at a physiotherapist, potentially a specialist in bracing, such as a hand therapist, which is a specialized physiotherapist or occupational therapist, and eventually if things are not healing well you’d potentially need a consult with an orthopedic surgeon to determine whether that was the correct treatment form for you.
Wrist and hand injuries are very common in ice hockey, and sually it's again falling on an outstretched arm to sort of catch your weight, and you end up with what we call in skiing a – skier's thumb - which is a tear of the ulnar collateral ligament in the thumb.
You can also fracture the wrist and sometimes these go unnoticed in an X-ray, and that's why we do repeat X-rays to try and catch those. You have to make sure that you get to a qualifed physiotherapist as soon as you can so we can determine the severity of this and to get you the right equipment perhaps if you need a splint or a wrist guard so that first of all you can function in your day-to-day activities and not reaggravate the injury and also to make sure if we need to immobilize the part in case of a fracture or severe sprain, that that's taken care of as well. A local chiropractor may work with your local family physician and your local physiotherapist to create the best health or rehabilitation plan for your situation.
From there the rehab process starts right away and we'll start moving the parts that we can, and we start protect, we protect the parts that we should and make sure that you're on your way to an optimal rehab program.