Page 12 - Demo

IN HAND VOLUME 2 ISSUE 1 2018
There is no difference between dominant and non-dominant wrists. It is largely based on height,
age and bone
density. There are drops
in weight bearing tolerance that occur
normally as we
age. Menopausal women see a drop in bilateral weight bearing tolerance. Patients with diagnosed osteopenia have lower than normal weight bearing
tolerance. People, like gymnasts, who load their wrists regularly, have an unusually high weight bearing tolerance. The highest I have witnessed is 140 lbs (64 kg). People typically need 45 lbs (20 kg) of weight bearing to function around the house - lifting laundry baskets, pots and pans, opening jars, turning door knobs, etc. People who need to load their wrists with exercise like weight lifting, or tennis, or golf, need 60- 65 lbs (27-29 kg) of weight bearing
tolerance. Anyone with lower than 45 lbs (20 kg) of weight bearing tolerance, typically have pain in their wrists with all functional tasks. Less than 45 lbs (20 kg) is what I consider an unstable wrist, one that demands your full attention. It’s
tears of the central portion of the TFCC, there is a significant loss of grip strength AND weight-
bearing tolerance is about 20-30 lbs (9-13 kg).
there is significant loss of grip strength
When taped, again without compression of the ulna, their weight bearing increases to 80% of normal. Wow! In peripheral tears, as the injury heals, the weight bearing improvement is more progressive, increasing about 7 lbs (3 kg) a week.
Central tears are thought to be avascular and unresponsive to
surgery. The question I had early on was, “Do they have the potential to heal?” The central portion of the TFCC does have the capacity to heal. This is important to know. Peripheral tears also heal beautifully with conservative management.
The challenge with this injury is early and accurate diagnosis. We know the many pitfalls of MRI’s. This incredible
important to understand that body weight does not affect weight-bearing numbers.
In patients with TFCC
tears, they lose the ability to tolerate weight through
their wrist. This can be measured well with the weight-bearing test. The patient is instructed to push down on the scale just to the edge of pain and stop. What is even more interesting is when you tape the wrist without compression to the ulna head and there is a TFCC tear, you witness an immediate and significant increase in weight bearing tolerance. Taping the wrist with two pieces of non-elastic tape, each on
“The challenge with this injury is early and accurate diagnosis”
either side of the ulna, is effective only for TFCC tears. If you tape a normal wrist, weight- bearing tolerance decreases. If you were to tape on top of the ulna head, pain would increase
and
tolerance
decrease.
tears, this change can be dramatic. In complete
weight-bearing would In central
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