"A Revolutionary way to treat TFCC tears"

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TFCC- It is not just about the wrist. The Pronator Stretch, Shoulder and Neck.

After 11 years of looking at the TFCC full time, all day, every day, I have seen a dynamic in patients that is predictable.  I see many elite athletes who find that their tfcc injuries heal to about 90 10.  The last 10% seems to take the longest to acquire.  I have long known this and started to closely examine the structures of the elbow, shoulder and neck.  

I have long known the relationship between the wrist and the elbow and have long promoted the pronator stretch.   Locust Pose

Same yet more potent benefits as "The Cobra". Also cures tennis elbow, and is excellent for firming buttocks and hips.

Ulnar Variance- important things you should know.

Oftentimes when speaking with patients, they report that their doctor states that they have a positive ulnar variance.  They are discouraged as it sounds permanent and only resolved with surgery.   I thought is was an important topic to discuss.  Ulnar variance is a measurement that is taken from X-rays to define length of the ulna bone relative to the radius.  This is an important measurement because the dynamics of the wrist are dependent on the ulna and radius translating force through the wrist.  Normally, the translation of forces 80/20.  80% translates to the radius and 20% to the ulna.  This is lone of the reasons we see more radius fractures than ulna fractures. 

Why is the WristWidget® one size fits MOST?

It has taken me 10 years to figure out why some people complain that the WW slips over the ulna.  It isn't common but it is important.  This blog is dedicated to my sister: the dreaded slippage of the WW. 

This is also for the rare patient that sends the message, “My WristWidget slips down my arm.” I hope to help you understand your “unique wrist” and the challenges that they pose. 


MRI's and TFCC tears

Over the past 12 years, I have had the incredible luxury of following thousands of cases.  One of the most frustrating aspects of this injury is the lack of reliable MRI results.   There have been so many positive MRI’s that show TFCC tears yet when surgically treated, later show no pathology to the TFCC.  

Happy 10th Anniversary WristWidget®!

This month marks 10 years since the development of the WristWidget.  As I sit in awe looking back at the journey behind me, I am astonished at its success, the wonderful emails that I receive all day, every day, and the accomplishments I have made in changing what we know about the TFCC.  10 years ago, I was busy sewing each one, voraciously studying its effects and solving the many challenges to get it where it is today. 

I am grateful for the life that the WristWidget has afforded our family.  The WristWidget has allowed me time to spend following patients closely.  It allows me a balance of work, rest and play.  It brings our family great pride in helping so many people around the world.  It allows me the freedom to complete research and passionately proceed through my day.   Although I probably "work" too much, I am consistently excited about my work, knowing deeply that there is still extraordinary influence it has on so many lives.  

The Piano Key Sign- Understanding compression of the ulna head

I often receive emails from patients with TFCC tears who report wrist splinting (normal wrist extension/cock up) makes their wrist hurt more than without the splinting.  The Piano Key Sign is a common test performed by physicians as a part of the clinical assessment of the wrist.

Non digital scale and wrist pain. A happy couple.

I remember this patient well, "My wrist hurts by the pinky and I can't do anything without pain."  Most patients who come my way have had a disabling hand injury for over 6 months and have had several X-Rays, MRI's and opinions.  Over the last 8 years, 400,000 of them have come to me.  

In America today, there is a shortage of Hand Specialists.  Here are some interesting facts: http://www.aaos.org/research/stats/Surgeonstats.asp Yes, you just read that there are 28,000 hand surgeons in America serving 318 million people.  Most hand surgeons carry a grueling schedule of over 60 patients a day. They are more interested in the urgent trauma cases: fractures, burns, etc. Their offices are filled with people waiting for 5 minutes of their time.  Yes, 5 minutes.  

A non-digital scale, you know, the one that is still in your grandma's bathroom? The scale that does not require a battery.   This simple tool is available in every country.  It is cheap.  It is reliable.  The test does not require a prescription or insurance to perform.  There are few tools available to people to assess the function of the wrist.  We have blood pressure cuffs available, blood sugar tests, ph tests, pregnancy test, urine tests, but nothing for the wrist....  Well actually, it has been sitting there for years, waiting for someone to push their hand on it. 

Digital scales are not used because they take a simple "snapshot" during the weight-bearing - you don't know if it was at the beginning of your press, the middle, or the end.  With a non-digital scale, you can visibly see and determine the exact weight.   

I did.  I found it incredibly accurate in assessing the wrist.   You can get excited when it logs more than your spouse or friend.   Since we know that grip strength is related to longevity, I am sure there will be research on longevity and wrist weight bearing tolerance.  Stay tuned for 50 years. 

Place a non-digital scale on the floor.  Place one hand on the center of the scale, fingers pointed to the top. Position your elbow and shoulder directly above your wrist and lean onto it.  Stop if it hurts and measure how much weight you can bear.  Report your findings here: https://www.surveymonkey.com/r/KBQMD3G.

Weight bearing in an adult wrist is anywhere from 60 lbs to 140 lbs per wrist.  The highest I have ever seen was 140 lbs.  One gentleman reported 160 but I did not see that reproduced, to his dismay. Weight-bearing tolerance is defined by age, height, and bone density.  There is NO difference between dominant and non-dominant wrists.  

Typically, your grip strength (which requires a dynamometer-a sophisticated device. https://en.wikipedia.org/wiki/Dynamometer)  is 15% less than weight bearing tolerance. 

 This test is important.  Let's say you fall on a Friday night, Christmas Eve, or any of the many inconvenient times to fall, and simply won't go to the ER. Your wrist is not swollen or bruised.  It just hurts to do most things.  So you wait until Monday to see your regular doc.

He/She takes an Xray and sends you to a hand specialist.  Xray comes out normal. Most family docs prescribe anti-inflammatories and a wrist splint and send you home to rest.  Now it has been 14 days and you still can't do much with your wrist.  Brushing your teeth hurts, turning doorknobs hurt, washing dishes is hard, cooking impossible, and heaven forbid you have to carry anything palm up.  

You phone the specialists and you have to wait 3-4 weeks for a consult.  Why don't you simply perform the test?  Go slowly and do not exceed pain.   If your results are : under 20 lbs, go to the ER.  If your results are between 25 and 45 lbs, splint it and don't use it.  When it gets to 60 lbs, phew, stable.  Now you have an objective tool to measure your progress over time.    

 Try a few things.   You can try taping it.  You can try splinting it.  Tape is cheap.  Splints are cheap.  Taping technique is easy.  Take 2 pieces of non-elastic tape, each 1/2 inch in width and 13 inches in length.  Retest your weight bearing tolerance.  If it goes up- yippee.   If it doesn't, then try a resting hand brace or wrist cock-up splint.  This splint keeps the wrist in neutral.  Wait patiently for your visit to the Orthopedist and make sure you take cookies.  Be prepared for a 5 minute assessment and grateful if you get anything more.

Wrist Pain solution

This test in no way describes all of the variables of injuries to the wrist.  But it does help define if you have a TFCC tear.  The TFCC or Triangular Fibrocartilage Complex is an important structure.  It serves as a stabilizer of the wrist.  Without it, you can't do much.  Hopefully, you don't want this injury or any injury, but the next time you hurt your wrist, at least, you will have something to help you know what to do.  Go visit Granny and borrow her scale.  

What is the TFCC?

If you are like most, you reached this site by searching TFCC on your search engine.  It is quite difficult, as a patient, to get a ton of information about the TFCC.  The internet is full of conflicting information with very little consistency, and non-specific information.  If you are like most, you have already visited your physician and are searching for more information.  

The TFCC was not identified in medicine until the 1980's.  It is considered "the black box" and certainly deserves its name!  What you need to understand is that the TFCC is the most important ligament for stability in the wrist.  It is deep in the wrist.  When injured, it sends pain to the pinky side of the wrist with rotation, grip and weight bearing.  It typically does not swell.  It typically is injured in a fall, a twist or an accident.  This is not always the case, as some present for no reason at all.  

It hurts with use.  It is not normally one of those injuries that "aches".   

The first thing that your doc will do is an Xray to check for fractures.  Then they evaluate your wrist for a TFCC injury. Then they will request an MRI.  The challenge with the clinical exam and the MRI is that both have a high level of inaccuracy and interpretation reliability.  This ligament is quite small!  It is also loaded sensitive.    An arthrogram is a gold standard in the US although it has risks (injection of a dye) and is expensive. Most patients receive an MRI. 

I have researched TFCC tears full time for 9 years.  I have established a great test to objectively evaluate the wrist.  The weight bearing test is simple, cheap and accurate. All you need is a non-digital scale.   You can see the test on www.wristwidget.com.  If you have less then 20 lbs of weight bearing tolerance, you are unable to do anything.  If you have 45 lbs, you are able to function with light tasks around the house.  If you are over 65 lbs, you can load the wrist.  Most adults have a normal weight-bearing tolerance of 75-120 lbs.  

So- try the test, wrap your wrist with tape just like the WristWidget® (non-elastic- no compression to the ulna bone) and retest.   If you see an immediate jump in weight bearing tolerance then you know that your TFCC is involved.  In a normal wrist without an injury, the WristWidget® will cause the weight bearing to drop. 

I am happy to meet you and hope that I can provide helpful information to the millions suffering from this disabling and significant injury.   I encourage you to share your stories and help another on the Facebook closed group, "TFCC tears".  Please send me your questions to info@wristwidget.com.   

Happy Healing. 

From our family in Hawaii to yours.