Hi folks
I'm Bob Schrupp, physical therapist.
Brad Heineck, physical therapist. Together we are the most famous physical therapists on the internet in our opinion of course Bob. Today Brad we're going
to talk about the TFCC that's the triangular fibrocartilage complex
And if you've tore it or you've had a repair done, or if you've injured it
We're going to show you the stretches and exercises you need to do. It happens to be a wrist injury
It is a wrist injury
It's the wrist injury that's more on the non thumb side it's on the pinky side
That's where you feel it, but before we go any further. Do you mind if we say this right now?
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All right, let's start talking about this Brad. What is it first? Let's bring up Napoleon here
I actually have it on this one Brad. Oh you took it
Okay, so he's sitting here with the hand out. The thumb is actually right here
This is his thumb, so right here at the end of the ulna, this long bone right here
there's actually a little bit of cartilage there like you'd find in your knee and
So we're talking about right in this area
Yep And that serves and helps
Provide a little bit of a joint right there when using the wrist, but in addition to that
In addition to this
there's ligaments that are covering this all up, ligaments hold bone to bone, and there's even a little capsule Brad
A covering all the way around the whole thing and that
holds some synovial fluid
Yeah, just like a knee right, so you got some lubrication so your wrist works in all these directions
So if you fall, one way to do this, one thing if you're older it can deterioate
Just like any other thing. I mean it can deteriorate from arthritis
But a common injury is to fall on your hand like this
Your hand is stretched. It's stretched out like this, your arm is straight
And you fall right on your hand and that's a good way to injure this
It's a good way to break the bone too sometimes, but if you didn't break it
You might have injured the ligaments. I have a patient right now that has this
He's a younger man, and he plays football, and he hurt it doing exactly that, he fell right on it
So one thing. I'm gonna show you how you can test for it, I'll show you on Brad
So that's the ulna styloid
right there, there's a little kind of a gap right in there, lot of times if you push right in there there's
point tenderness, right in here and there was on him, but you can also hold the hand like this
I'm taking this one, I'm kind of squeezing it. I'm pushing it down like this. You can see the compression there.
I'm pushing the bones together, and now I'm rotating
So that would be hurt yeah, that would hurt produce some pain
And it did on him
Okay
So the other thing I found is a lot of times
Like if you measure your hand how far it goes this way and this way
His went further this way on this hand, the injured hand, than it did on the other hand because I think his ligament is tore
A little more relaxed which is not a good thing sure so
You know typically what they might do is they may put it in a cast or they may put it in a brace
you may try a brace like this and
We've got this link before. This is a nice brace what'd we call it, the Coreflex right?
I'll put a link down below, it actually on our website
Is where it is, easy to get on, nice velcro, and it's got a nice system to yeah
Brad show they're you know they can see that
It's gonna be hard to see black on black, but there's some
nice cords there, and you simply go over, and it works well, so while he's in the brace
You can do elbow range of motion. I probably don't want to do this one and this one
Yeah, no you can do this one, and you can make sure the fingers
keep the fingers moving, touch them to each other and doing the claw and
All those, so things don't tighten up, right so things don't tighten up. If you've had surgical repair
They're gonna have a protocol for you to follow
You'll be doing all these exercises
But they're going to let you know when you can do that and usually these protocols go week one
Start range of motion
No strengthening yet week two and then they have it all listed out, if you're recovering
without surgery you can try these and if it doesn't hurt
basically
you can kind of progress, that's pretty much a common rule with rehab after a
Surgery or an injury is that it's pain free
exercises, you're not going to irritate it, make it worse, so we're gonna start off with
Active range of motion once you got the brace off instead of the cast off you're gonna start with
wrist flexion
And wrist extension now you can do this off the end of a table, that works out really nice doesn't it Brad?
So if I'm doing it like this
Yeah, and then you're gonna also do
Ulnar deviation radial deviation so he's going back and forth like that, you can see Brad doing back and forth like that
Okay now usually
This one which is called pronation and supination
So you're turning your wrist this way you get your elbow on your side
You're opening the palm up, now palm down, This is the one that they
hold off a little bit onto because it just puts a lot of stress on that area, a lot of stress on those bones
You know what's good for range of motion Bob? What's that?
I'm not being real serious here, but you know when you take the flashlight
and you make the shadow on the wall and you can make
Yeah it'd be good range of motion
Always have fun with your rehab, all right the thing that you might use along with this
And we're just gonna bring this out because the reason I am using this with my patient right now
I sent one of these home with him, okay
And this is the Thermatex infrared and the reason I liked it with him is the Thermatex as opposed to regular heat
Which hardly ever even penetrates it only goes a millimeter past the skin
this goes
60 mm, 6 cms or actually 2.36 in so if you put this on
And they have a wrist unit, I'll put a link down below for that, too
They have one that you can use just for your hand especially if you have
arthritis or something, and you you're constantly having trouble
So this is going to penetrate all the way through the joint and help
get more blood flow to it, help it heal quicker, and then of course you can do
the hand motion with it on and then when you take it off you can do the rest of the wrist range of motion
If you don't have the wrist unit but you have the platinum unit which we really like, Brad and I, because you can use it for
pain anywhere in the body right, you can make it into a muff basically
It's got two straps, and you take the smaller strap, and you can just slide your hands in there
You can actually do both at the same time if you want. Yeah you know
it's winter time here right now
Feel my hands
It makes you feel good that way, so it's a win-win situation, but yeah so again
I'm having them do this and then I have them do
the range of motion exercise, the other thing you might try, again because the ligaments were damaged
They may have been stretched, and they're starting to heal and they're starting to lay down scar tissue
That scar tissue can hurt
I mean if it's just scarred down so we actually do have people rub
like this and this is what I'm having him do, cross friction massage. I'm gonna
go this way, and this way. Oh somebody answer the phone
Killing me yeah
So I'm having him do this now Brad. I'm having him try some rubbing, now
The key that you're looking for on this though is to start to feel better after around 30 seconds or so
It's should start to numb up, on him it didn't
It kept hurting so we're backing off on that a little bit right now, and then we're gonna have him do it later again, okay?
So you're rubbing on it, it might hurt at first, but if after 30 seconds it starts to feel good
Or feels like a numbish feeling that's the green light to keep going for a few more minutes
That's a great sign then and if not if it keeps hurting then it's the red light you stop and wait a few days
Yeah, so now we're gonna go to let's say everything's going well. You're not having any pain, you got some pretty good motion
We're now gonna do some strengthening
You can order one of the stretch bands, which we recommend it's actually the
the sanct bands, SANCT
And they have a lot of different levels of strength
we like these because I think they hold up the best of the bands,
they're strong and they're well made and
The peach is the smallest one or the least resistance, that's what I got right here
So you can do this, you can just wrap it around something. He's usually actually using one of the loops the sanct
band loops, this one is a band you can buy them at four foot lengths
I think they're five foot, so you're gonna go ahead, and you just put your hand like this
So I'm just going back like this, you can see how it's given resistance here
Or I can go up a little more like this, and it's giving me wrist resistance as I extend the wrist
So you can do ten of those, again It's not a lot, but
as you get as you get stronger you can double up the band
Or you can start going with a higher level band like a darker band. Be careful not to
We don't want to do this.
Stabilize the wrist, I like to grab the wrist with the other hand and that reminds me
Going into flexion here, one thing you do need make sure about the band is it you don't get across the sharp edge
because it doesn't matter who makes it if you get a sharp edge, it'll tear, so I went extension
flexion now I'm gonna go
radial deviation
So the thumbs going towards you and then you can also do ulnar deviations
So I'm going the other way towards the pinky now, which is this motion
So I could use this there you go, yeah, you could actually just hold onto it
We're inventing it as we go along here. I like these loop ones
Yeah, those loops are just real handy to do a lot of different exercises of them
And then eventually you're gonna want to go into
working on the strengthening for this supination and pronation
And what works really well for that is a hammer and you can start by gripping up
Near the top of the hammer and just working back and forth like this, it'll also give you a little bit of stretch
I'm sitting here for a reason Bob. I think it works good
if you have your forearm on a table
And it just allows you to have more stability, see like Bob was saying
It's easy here, and you'll be amazed after an injury
This might be all you can do, and as it gets stronger, then you know you can eventually
Go to this and there's a big difference between this and then you get that big maul eventually yeah that big sledge
Bigger, strong like bull I can make anything go so and usually repetitions of 10 to 15.
And then eventually you want to do some grip strengthening, too
You can just use a ball you can squeeze a towel if you want to
These nerf hard ones
They're not as good because it's basically isometric, it's nice to have something you can squeeze into
and you get these at any big-box store and just carry around and squeeze and get the strength back up again, so
There you go, give it a shot and remember Brad and I can fix just about anything this matches your shirt
Anything but that broken heart. But we're working on it day and night.
You