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IN HAND VOLUME 2 ISSUE 1 2018
As a community of educated practitioners, let’s help define normal weight bearing in the adult human wrist. I have created a TFCC support group on Facebook where over 800 people are having discussions about their wrists. I would encourage you to participate in the discussion. What I have learned after all of these years of work: this injury demands our attention and care. We can collectively make a difference in the lives of people who suffer from this treatable injury. Feel free to email me any questions or difficult cases. Together we can make a difference in the future understanding of the “black box of the wrist.” u
sheath tears present with normal weight bearing tolerance. I see this often in baseball players. They
are told that they have a TFCC tear but their
weight bearing tolerance is normal. When
evaluated by a hand surgeon with an ultrasound, the confirmation of a ECU sheath tear can be confirmed.
important time and place for strengthening once the wrist can tolerate
load. The type of
strengthening exercises matters as well. Bicep
strengthening should be avoided until 100%. No
strengthening in pronation or supination until weight bearing is 100%. I have seen a high incidence of pronator tightness, subscapularis weakness or tightness, weak posterior capsule of the shoulder, and a tight C5- 7. I do not recommend push-ups or pull-ups until 100%. I recommend a program of stretching the elbow, the shoulder (internal rotation: placing the back of the hand up the spine), neck stretches and breathing
exercises. These are really important. Once the wrist is stable and the entire extremity balanced, I recommend strengthening of the triceps, rhomboids, lats, and neck extensors.
The TFCC is involved in 50% of all wrist fractures.
It is wise to consider your splinting and ensure that the ulna is not compressed. Squeezing the wrist and testing the effects on grip
is a really good practice to have in your clinics since the weight-bearing test is unreliable in wrist fractures. If the TFCC is supported while the fracture heals, the TFCC heals faster than if left alone.
I am often asked about exercises. I do not recommend any strengthening of the wrist until the weight bearing is 60 lbs (27 kg). This came as a surprise to me. Strengthening often does more harm to the ECU. There is an
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Although I cannot present all of the details of my work in a few pages, I am hopeful that you can participate in a global effort to collect weight- bearing data. You can perform the test and enter your data here. https://bit.ly/ww-wbtr