"A Revolutionary way to treat TFCC tears"

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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.

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.  

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.  Simply described, imagine the ulna head as a piano key.  The examiner would press on the ulna head and if painful, would indicate a positive Piano Key Sign.  A stable wrist would cause the ulna head to spring back like a piano key without pain.  You can read all about the test all over medical text books as an indicator of a TFCC tear or DRUJ (distal radial ulna joint) instability. 

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.  

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.   Dr. Richard Berger describes this beautifully in his work with UT tears.  https://www.youtube.com/watch?v=0HjFr5QieXU 

It is well known in the medical community that MRI’s have many false negative and false positive results. Add to this the variety of MRIs themselves.  MRI machines are not all the same. 

For the consumer, this is difficult to navigate.

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. 

Anatomical Variations of the Human Wrist. 

Not every human body is the same.  Surprise!  There are all kinds of “anatomical variations” in the nervous system, boney structures, and tendons.  Not all Ulna heads are the same.  Over the past 10 years, I have looked at so many Ulna bones!  The variations are fascinating to me.

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. 

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.