Wrist Pain - TFCC Tear

[Matt O]

A couple months ago, pre-Covid craze, I developed some pain in my left wrist that basically shut all shooting down. I went and saw my doc who recommended an X-Ray which determined I had apparently fractured my wrist at some point previously (un-united ulnar styloid I think?), but showed little else. He gave me some PT exercises and that was about it. Finally followed up a month or two later as it had gotten better, but not gone away and had an MRI done which apparently shows a central TFCC tear.

Anyone else out there experienced wrist pain due to a TFCC tear and able to comment on efficacy of treatment (hopefully non-surgical) and resulting recovery? At this point my doc is recommending a steroid injection and I have a preliminary appointment set up for next week, but just trying to get some info in advance of then as I'll likely have to make a yay or nay decision on that treatment in the moment.

[Doc_Glock]

I am a SME on this topic FYI.

Wrist pain has a lot of causes. Many do not show properly on xray (or even MRI). Central TFCC tears are extremely common on most humans over 40 and many times pathology is attributed to them when they are simply normal wear and tear and not the actual source of symptoms. A non union of the ulnar styloid is also completely benign and common. In this case the MRI may be over calling pathology that just isn't clinically relevant.

First I would see a wrist specialist of some sort (aka Hand Surgeon). I don't know what sort of doc is currently ordering your tests. You need a good examination from someone who knows wrists.

If your wrist is stable and only slightly tender I would ignore it. If it is stable and the pain is interrupting your life a series of steroid injections can often settle things down to the point you can live with it. If that doesn't work or the wrist is currently unstable, you need a surgery to get it stabilized and under control.

Hope that helps. Here is a link to find a good Hand Surgeon. There are plenty of good surgeons who are not in the ASSH, but members are usually high quality.

https://www.assh.org/handcare/fahs

[Slalom.45]

I am a PT and owner of my own TFCC tear. I guess that makes me a SME as well.

An arthrogram with dye is commonly used to locate the tear. At least is was roughly 12 years ago when I tore mine. Surgery was offered as an option, but the post op recovery was either a week in a splint if only a debridement was done or 6 weeks in a cast if it was repairable. I could not be out of work for 6 weeks at the time so I elected to go conservative.

Over time the pain resolved. It is basically not an issue for everyday life. I have to be cautious if I go bowling (which happens every 5-10 years like clockwork) and volleyball was a no-go. It did take months for the pain to fully resolve. Pain was based on position more than load. Documentation was by hand back then and holding a pen to write was exquisitely painful.

My suggestion would be to protect it and give it some time. If not improved and/or tolerable to your life activity then consult the surgeon. Good luck!

[Matt O]

Thanks Doc_Glock, that's very helpful info overall. I am absolutely no doubt reading into the MRI more than is perhaps necessary; I just haven't had the chance to meet with my doctor (regular family physician with sports-medicine focus) yet and ask for the download in more layman's terms. He is the referring physician for the MRI.

I have some pain in my wrist depending on activity and use, but it does't bother me unless I stress it in certain positions. For example, gripping a pistol hard in dry fire is a no go with that (support) hand after a few reps and I have to be careful how I pick my kids up, etc.

The MRI did mention that there is some inflammation and fluid in the wrist, so my hope is that perhaps the TFCC tear was present long before this and I've just somehow aggravated my wrist and if the fluid build-up is addressed, the discomfort may go away? I'm willing to live with the pain as is if it'll get better and would actually prefer to avoid the steroid shots in that case if they're just to minimize discomfort. The biggest question is if this falls within the realm of injuries that will resolve itself on its own as I'd, obviously, like to get back to shooting and using this hand more actively.

I noticed that there are several docs from OrthoVirginia on your list and I have used them for a knee repair surgery last year due to a severely torn meniscus. I'll likely go that route after my visit next week just to get some additional piece of mind from a more dedicated specialist.


I am a SME on this topic FYI.

Wrist pain has a lot of causes. Many do not show properly on xray (or even MRI). Central TFCC tears are extremely common on most humans over 40 and many times pathology is attributed to them when they are simply normal wear and tear and not the actual source of symptoms. A non union of the ulnar styloid is also completely benign and common. In this case the MRI may be over calling pathology that just isn't clinically relevant.

First I would see a wrist specialist of some sort (aka Hand Surgeon). I don't know what sort of doc is currently ordering your tests. You need a good examination from someone who knows wrists.

If your wrist is stable and only slightly tender I would ignore it. If it is stable and the pain is interrupting your life a series of steroid injections can often settle things down to the point you can live with it. If that doesn't work or the wrist is currently unstable, you need a surgery to get it stabilized and under control.

Hope that helps. Here is a link to find a good Hand Surgeon. There are plenty of good surgeons who are not in the ASSH, but members are usually high quality.

https://www.assh.org/handcare/fahs