Understanding TFCC Wrist Injuries in Climbers
Triangular fibrocartilage complex injuries in rock climbers certainly are “complex.”
This portion of the wrist has a fitting name. The TFCC is indeed complex.
It has multiple moving parts, each with their own histology makeup, and is composed of the following:
A triangular shaped fibro-cartilaginous disc (shock absorbing, guiding motion)
Ligaments between the ulna and radius on both sides (palmar & dorsal)
Ligaments between the ulna and the carpal bones
A meniscal type homologoue (shock absorbing)
Sub-sheath of the ECU tendon
CAUSES AND SIGNS OF TFCC INJURY
The primary mechanical stressors for the TFCC are repetitive axial loads to the wrist when the hand is in ulnar deviation and pronation.
As with any athletic injury, it is certainly not that the position is problematic, but the dosage of it. Our bodies are incredible at adapting to abnormal stress, but there certainly is an upper limit to how much we can tolerate.
Most people who present with TFCC injuries have pain with rotation (turning a door knob) and often present with grip weakness and clicking on the pinky side of the wrist.
TFCC injury diagnosis
It turns out that the diagnosis with orthopedic testing and imaging is quite reliable and accurate. Management, including rehabilitation, is much more tricky. It’s not as simple as the progressive overload strategy which works well for tendons.
The Palmer classification is the most widely used scheme to identify injury types. It separates degenerative tears from traumatic tears. In many cases, the extent of the tearing leads to instability and requires surgical intervention.
Even though it is still recommended to do conservative management first, the statistics show that only 1/3 of patients get symptomatic relief. That number is highly dependent on the compliance but does show how tricky these injuries can be.
Key takeaways:
Progressive overload rehab might work for tendons, but not so much here.
For many sport’s injuries you can “leave them alone” and make the assumption they will go away. This is not one of those injuries. You certainly want to get some professional help.