Triangular fibrocartilage

This is from Matt We- Weirich.

Uh, and also Jackson Holiday, left wrist, TFCC debridement with Dr. Steven Shin in Los Angeles.

So get well, get, get well guys.

I, I, I mean, I don't know.

Again, that instability is something if you don't train a lot and find yourself in a quite open position, you're going to open up the wrist, for instance, into more kind of injuries.

And that's why we see these TFCC type injuries or these sort of subluxation type injuries in the wrist.

In elite climbers, they're much more conditioned and we tend to find more overload, overuse type injuries where their circuit's really hardcore.

They're always traveling and training and all those external factors of travel, nutrition, sleep, these things take their toll.

And, you know, also sometimes they train really hard between competitions and that just adds load on load.

So a lot of the time working with these guys, because they're so resilient normally, is just... less is more, and with the less professional or more recreational climbers, it's thinking about generally conditioning up more and becoming more aware of how to make their body stronger in these strange positions that these holds are putting them in, you know?

And if you have to put a label on the pathologies, you said like TFCC injuries are more common in the recreational climbers.

What would be the overused injuries that you regularly see in elite climbers?

How many in the room do wrist arthroscopy somewhat regularly? It's almost everyone.

And I think most of us, when we're diagnosing TFCC tears, do a couple of things.

We try to rule out the ECU being the pathology.

We palpate in the fovea to assume and find pain.

And we check for DREJ instability, which is one of the unsolved problems in my mind because quantifying DREJ instability is impossible right now, and yet it's highly relevant.

But my pearl is that forced supination of the forearm is a great tell on TFCC pathology.

It doesn't have to be unstable, but if you, you can either grab the hand, but I think it's better to grab the forearm and just put the patient in supination and go a little further, and it causes sharp pain for those that have a TFCC tear.

So try it, and I'm going to

And then the momentum should carry you back into radial deviation again of your trail hand.

But it's that owner deviation is if you can't owner deviate through that cartilage complex, the TFCC, that's painful to you or there's a block there, you're not really going to be able to release the club very well and you're going to lose all speed and power.

That's it.

I see a lot of people trying to, like, on the downswing, put that right elbow in their hip and all that.

When you talk about it being like a baseball common injury, I've had one.

It was on my TFCC tendon, which is you know, just on the outside of your wrist.

So I don't know if that's where his was.

And I've had both of those scoped because of the amount of swings you take as a ball player.

[upbeat music] Welcome to this episode of Case Studies by Physio Network.

Today I'm joined by Dr. Ian Gatz to discuss a real case of a TFCC injury in a boxer.

Ian is an experienced sports physiotherapist and upper limb specialist with extensive experience working in elite boxing and Olympic sport.

His combination of clinical expertise and understanding of the demands placed on the hand and wrist in combat athletes make him an ideal guest to help us unpack this case.

In today's episode, we explore the TFCC, the differential diagnosis that you may want to consider when assessing ulnar-sided wrist pain, and how Ian approached the clinical reasoning behind this case.

We also discuss the framework he uses to link rehabilitation directly to function, helping treatment progress from early-stage recovery towards the specific demands of your patients and their sports.

More broadly, we explore how clinicians can make rehabilitation flow towards returning patients not only to sport, but to achieve the activities they personally deem most important.

And most importantly, Ian shares the key lessons from the case, including how to structure progression, make treatment meaningful, and use clear functional criteria to guide return to activity.

And I think...

Yeah, only this Tuesday was when I found out what I've actually done to myself, which is a TFCC tear, which is just like the classic climber injury.

But I did it in a weird way from what I understood from that session I had with the hand surgeon was that I tore from the inside out is what I understood from it.

Hmm.

What was fractured? Was it a carpal? Was it the radius? Was it the ulna? Was there anything else involved? There's a lot of ligaments that's in place.

Then all of a sudden you get the TFCC ligament that's in there and that becomes a bear.

If there's the scaphoid, if that's fractured, then you got to look at necrosis.

There's a lot of moving details that that uh correlate and not not to mention he's a rookie he doesn't have a lot of reps and it's going to be like well when are you going to actually like feel comfortable putting him in your lineup again because he looked really good prior to the injury in the preseason in uh also in uh the first game of the season but it's very unfortunate to see that he had this you know pretty pretty complex injury there for his wrist

Yeah, Weege, I saw those comments and I saw the press conference and he's talking about his left wrist.

So the left wrist was injured at Ironman and he specifically said the TFCC.

So that's the ligament in your wrist that's more towards the pinky finger side of your wrist and it provides stability within the wrist joint.

So it's a fairly large ligament.