TFCC Tear/Repair Stretches & Exercises Triangular Fibrocartilage Complex- Wrist Pain.

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Hi folks I’m Bob Schrupp, physical therapist. Brad Heineck, physical therapist. Together we are the most famous physical therapists on the internet in our opinion of course Bob. Today Brad we’re going to talk about the TFCC that’s the triangular fibrocartilage complex And if you’ve tore it or you’ve had a repair done, or if you’ve injured it We’re going to show you the stretches and exercises you need to do. It happens to be a wrist injury It is a wrist injury It’s the wrist injury that’s more on the non thumb side it’s on the pinky side That’s where you feel it, but before we go any further. Do you mind if we say this right now? Sure. If you are new to our channel, please take a second to subscribe to us. We provide videos on how to stay healthy, fit, pain-free, and we upload every day, also go over to Facebook and “like” us because right now we only have one friend, and we’re trying to increase our numbers, so All right, let’s start talking about this Brad. What is it first? Let’s bring up Napoleon here I actually have it on this one Brad. Oh you took it Okay, so he’s sitting here with the hand out. The thumb is actually right here This is his thumb, so right here at the end of the ulna, this long bone right here there’s actually a little bit of cartilage there like you’d find in your knee and So we’re talking about right in this area Yep
And that serves and helps Provide a little bit of a joint right there when using the wrist, but in addition to that In addition to this there’s ligaments that are covering this all up, ligaments hold bone to bone, and there’s even a little capsule Brad A covering all the way around the whole thing and that holds some synovial fluid Yeah, just like a knee right, so you got some lubrication so your wrist works in all these directions So if you fall, one way to do this, one thing if you’re older it can deterioate Just like any other thing. I mean it can deteriorate from arthritis But a common injury is to fall on your hand like this Your hand is stretched. It’s stretched out like this, your arm is straight And you fall right on your hand and that’s a good way to injure this It’s a good way to break the bone too sometimes, but if you didn’t break it You might have injured the ligaments. I have a patient right now that has this He’s a younger man, and he plays football, and he hurt it doing exactly that, he fell right on it So one thing. I’m gonna show you how you can test for it, I’ll show you on Brad So that’s the ulna styloid right there, there’s a little kind of a gap right in there, lot of times if you push right in there there’s point tenderness, right in here and there was on him, but you can also hold the hand like this I’m taking this one, I’m kind of squeezing it. I’m pushing it down like this. You can see the compression there. I’m pushing the bones together, and now I’m rotating So that would be hurt yeah, that would hurt produce some pain And it did on him Okay So the other thing I found is a lot of times Like if you measure your hand how far it goes this way and this way His went further this way on this hand, the injured hand, than it did on the other hand because I think his ligament is tore A little more relaxed which is not a good thing sure so You know typically what they might do is they may put it in a cast or they may put it in a brace you may try a brace like this and We’ve got this link before. This is a nice brace what’d we call it, the Coreflex right? I’ll put a link down below, it actually on our website Is where it is, easy to get on, nice velcro, and it’s got a nice system to yeah Brad show they’re you know they can see that It’s gonna be hard to see black on black, but there’s some nice cords there, and you simply go over, and it works well, so while he’s in the brace You can do elbow range of motion. I probably don’t want to do this one and this one Yeah, no you can do this one, and you can make sure the fingers keep the fingers moving, touch them to each other and doing the claw and All those, so things don’t tighten up, right so things don’t tighten up. If you’ve had surgical repair They’re gonna have a protocol for you to follow You’ll be doing all these exercises But they’re going to let you know when you can do that and usually these protocols go week one Start range of motion No strengthening yet week two and then they have it all listed out, if you’re recovering without surgery you can try these and if it doesn’t hurt basically you can kind of progress, that’s pretty much a common rule with rehab after a Surgery or an injury is that it’s pain free exercises, you’re not going to irritate it, make it worse, so we’re gonna start off with Active range of motion once you got the brace off instead of the cast off you’re gonna start with wrist flexion And wrist extension now you can do this off the end of a table, that works out really nice doesn’t it Brad? So if I’m doing it like this Yeah, and then you’re gonna also do Ulnar deviation radial deviation so he’s going back and forth like that, you can see Brad doing back and forth like that Okay now usually This one which is called pronation and supination So you’re turning your wrist this way you get your elbow on your side You’re opening the palm up, now palm down, This is the one that they hold off a little bit onto because it just puts a lot of stress on that area, a lot of stress on those bones You know what’s good for range of motion Bob? What’s that? I’m not being real serious here, but you know when you take the flashlight and you make the shadow on the wall and you can make Yeah it’d be good range of motion Always have fun with your rehab, all right the thing that you might use along with this And we’re just gonna bring this out because the reason I am using this with my patient right now I sent one of these home with him, okay And this is the Thermatex infrared and the reason I liked it with him is the Thermatex as opposed to regular heat Which hardly ever even penetrates it only goes a millimeter past the skin this goes 60 mm, 6 cms or actually 2.36 in so if you put this on And they have a wrist unit, I’ll put a link down below for that, too They have one that you can use just for your hand especially if you have arthritis or something, and you you’re constantly having trouble So this is going to penetrate all the way through the joint and help get more blood flow to it, help it heal quicker, and then of course you can do the hand motion with it on and then when you take it off you can do the rest of the wrist range of motion If you don’t have the wrist unit but you have the platinum unit which we really like, Brad and I, because you can use it for pain anywhere in the body right, you can make it into a muff basically It’s got two straps, and you take the smaller strap, and you can just slide your hands in there You can actually do both at the same time if you want. Yeah you know it’s winter time here right now Feel my hands It makes you feel good that way, so it’s a win-win situation, but yeah so again I’m having them do this and then I have them do the range of motion exercise, the other thing you might try, again because the ligaments were damaged They may have been stretched, and they’re starting to heal and they’re starting to lay down scar tissue That scar tissue can hurt I mean if it’s just scarred down so we actually do have people rub like this and this is what I’m having him do, cross friction massage. I’m gonna go this way, and this way. Oh somebody answer the phone Killing me yeah So I’m having him do this now Brad. I’m having him try some rubbing, now The key that you’re looking for on this though is to start to feel better after around 30 seconds or so It’s should start to numb up, on him it didn’t It kept hurting so we’re backing off on that a little bit right now, and then we’re gonna have him do it later again, okay? So you’re rubbing on it, it might hurt at first, but if after 30 seconds it starts to feel good Or feels like a numbish feeling that’s the green light to keep going for a few more minutes That’s a great sign then and if not if it keeps hurting then it’s the red light you stop and wait a few days Yeah, so now we’re gonna go to let’s say everything’s going well. You’re not having any pain, you got some pretty good motion We’re now gonna do some strengthening You can order one of the stretch bands, which we recommend it’s actually the the sanct bands, SANCT And they have a lot of different levels of strength we like these because I think they hold up the best of the bands, they’re strong and they’re well made and The peach is the smallest one or the least resistance, that’s what I got right here So you can do this, you can just wrap it around something. He’s usually actually using one of the loops the sanct band loops, this one is a band you can buy them at four foot lengths I think they’re five foot, so you’re gonna go ahead, and you just put your hand like this So I’m just going back like this, you can see how it’s given resistance here Or I can go up a little more like this, and it’s giving me wrist resistance as I extend the wrist So you can do ten of those, again It’s not a lot, but as you get as you get stronger you can double up the band Or you can start going with a higher level band like a darker band. Be careful not to We don’t want to do this. Stabilize the wrist, I like to grab the wrist with the other hand and that reminds me Going into flexion here, one thing you do need make sure about the band is it you don’t get across the sharp edge because it doesn’t matter who makes it if you get a sharp edge, it’ll tear, so I went extension flexion now I’m gonna go radial deviation So the thumbs going towards you and then you can also do ulnar deviations So I’m going the other way towards the pinky now, which is this motion So I could use this there you go, yeah, you could actually just hold onto it We’re inventing it as we go along here. I like these loop ones Yeah, those loops are just real handy to do a lot of different exercises of them And then eventually you’re gonna want to go into working on the strengthening for this supination and pronation And what works really well for that is a hammer and you can start by gripping up Near the top of the hammer and just working back and forth like this, it’ll also give you a little bit of stretch I’m sitting here for a reason Bob. I think it works good if you have your forearm on a table And it just allows you to have more stability, see like Bob was saying It’s easy here, and you’ll be amazed after an injury This might be all you can do, and as it gets stronger, then you know you can eventually Go to this and there’s a big difference between this and then you get that big maul eventually yeah that big sledge Bigger, strong like bull I can make anything go so and usually repetitions of 10 to 15. And then eventually you want to do some grip strengthening, too You can just use a ball you can squeeze a towel if you want to These nerf hard ones They’re not as good because it’s basically isometric, it’s nice to have something you can squeeze into and you get these at any big-box store and just carry around and squeeze and get the strength back up again, so There you go, give it a shot and remember Brad and I can fix just about anything this matches your shirt Anything but that broken heart. But we’re working on it day and night. You

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