TFCC, To surgery or not to surgery....

Hello!

Yes I know there are about 1,000 threads relating to a TFCC tear and what not but I am specifically hung up on this whole idea of spending all this time and money (cause goodness knows my insurance will not cover an elective surgery) to get a surgery that may or may not even work.

Background, I messed up my wrist a few years ago while teaching a special education class when I student grabbed on a jammed my wrist backward. Since then I just ignored the little bits of pain here and there and kept climbing. Fast forward to this summer when I was crack climbing and my feet slipped by my hand stayed exactly where it was (ouch).

I stayed off of it, took it easy from climbing and tried to be nice to my body.

Since then (about 5 months ago) I have seen a hand surgeon (who diagnosed the SMALLEST little tear on the inside of my tfcc via MRI), had a steroid shot, gone to two months worth of OT, and even tried 10 sessions of acupuncture. 

I was given a green light to "climb without pain" but after trying some very easy V1s and V2s felt sharp shooting pain and nearly fell off my darn wall.

Last week I had a follow up appointment with the doc and he is saying I stop climbing (HA), learn to live with the pain because it is not effecting the structure of my wrist or the only way to MAYBE remedy the pain is to go in for a scope debrining of sorts. 

Cherry on top? I work at a climbing gym and it is the middle of winter. So I am pretty much tortured every. single. day. by new problems I can't climb.

Anyone had a similar experience? Was surgery worth it? What about PRP treatment? 

TLDR; Should I get surgery on my minor TFCC tear if it might not even remedy the problem.

If any doctor told me to "stop climbing and learn to live with the pain" I would get a second opinion. 

I had a TFCC repair about 12 years ago, I was 21 years old or so. First surgeon I saw wouldn't do surgery on me because  I was so young, even though I could not supinate my hand further than 50%, could not do a push-up or even palm a steering wheel to turn it. 

I went to a second surgeon, who had done the same surgery on a friend of mine, and he had absolutely no problems performing the surgery on me. 

Things have to be pretty bad for me to go to the doctor, or even take a pill of any sort-- and I can say, in my condition it was one of the best things I ever did. 

Even around 12 years later, I have zero pain and have about 90% of my range of motion compared to my other wrist. The only issues I have is grabbing a straight barbell with weight on it and doing a curl, which causes some discomfort in the wrist. Other than that, my wrist feels great, and was totally worth the procedure.

I still climb fairly hard, I guess, whatever the hell that means... but I initially injured my wrist bouldering actually, and till this day, I pretty much don't do any bouldering (but mainly because bouldering is silly anyway and is for children). Best of luck.

Had a TFCC tear and a scapholunate tear that I got repaired together. TFCC was a routine debridement surgery, and post-op I've been doing quite well. I can't talk too much about climbing performance, but pre-surgery I was hesitating before opening doors and holding a cast iron in the affected hand. Post-surgery it's been pretty good!

Had surgery for TFCC tear a while ago (5 years? lost count). Took a while after surgery to recover but since surgery I've climbed harder and pulled on smaller holds harder than I ever had before surgery. Glad I got it, even if it was expensive, in the lifetime scale of things the money is trivial.

That said, my TFCC problems are due to a natural laxity, I've since minorly (which I'll define as: not bad enough to consider surgery) injured both wrists more than once.

Won't be doing regular pushups ever again, or mountain biking, or walking on my hands, or climbing anything hard, but meh. We get older, we end up with a bunch of things that need "managing".

Edit: As an aside, the surgery itself was pretty tame, had the op in the morning, went back to my desk job in the afternoon. The 6 weeks or so after before I could start physio weren't much of a problem either. Most annoying thing was wiping my ass with the other hand, and trying to roll up/stuffsack a self-inflating thermarest.

You sound like a good surgical candidate. You've tried months of conservative treatment (as did I) without a real permanently good outcome. Surgery was a great choice for me and resolved virtually all of my problems after about 9-12 months. (I still have to be careful and have suffered a few issues from time to time which made me really nervous, but so far so good.) Surgery gave me my life back.

I had 3 orthopedic opinions (four if you count my first doc I visited, who was my general ortho). First hand doc told me to quit climbing forever and find something else to do. He felt my ligamentous laxity issues would cause continual recurrence. He recommended NO surgery as he felt I would not heal properly due to my connective tissue abnormalities. He encouraged me to see another doc for a second opinion. Second surgeon said he thought I should have surgery and he believed I would climb again although he couldn't say at what level. By the time I finally found a third surgeon who would see me and break the tie (I wasted 2 extra months waiting to see my "first" third doc who ended up rejecting me as a patient once he saw my previous medical notes), I was ready for surgery. The "second" third doc concurred and off we went. No regrets even though my recovery wasn't as rapid and painless as I had hoped it would be.

One thing I recall my radiologist saying was that my tear was also "small" when he viewed the MRA. He remarked that he found it strange how some people can have very large tears and almost no pain and other people can have tiny little tears and tons of pain. So I don't think the size of your tear matters. How you are able to function in life matters. Whether conservative treatment has helped or not matters.

I am surprised this would be considered an elective surgery (and not covered) if you are unable to use your hand and wrist normally in day to day life, have regular pain, etc. Anyway, I would encourage you to go for surgery, but also get another medical opinion. It's just me, but I wanted a doctor to perform the surgery who thought I actually needed it. Also, you should be clear whether you need a debridement or a repair. A repair is much more involved and the recovery is far longer. I had a debridement. Far less downtime and pain. 

Thanks for all the accounts of surgery 2018.  I do not mountain climb but I adore cycling and pilates.  I fell in march and the tear is only diagnosed now.  I am having surgery on July 13th this year.  I need all the positive stories I can get, thanks everybody.   Mary

Update:

My insurance is not willing to cover my surgery expenses therefore I have to postpone surgery indefinitely (or until I get killer insurance). I will however say that taking Tumeric with black pepper (such as these https://www.gaiaherbs.com/products/detail/83/Turmeric-Supreme-Extra-Strength), has reduced pain immensely! Placebo or not it works for me so I highly recommend giving it a go for anyone still feeling wrist pain. I modify some of my climbing as well (no big left and pulls or gastons). Thanks everyone for your helpful information and support!

Alyssa, sounds like I had a very similar TFCC situation to you - TFCC injury a while back that was aggravated by climbing, cortizone shot followed by OT with little to no improvement in the pain department.  I really wanted to avoid surgery and luckily found a great PT who gave me a program that has had me pain free for a couple of years now.  In addition to the lighter weight stuff focusing directly on the wrist we really focused on activating and getting my pectoral and lats stronger - the stregnth and stability gains in the upper arm/shoulder really took a ton of pressure off my wrists.  We're all different but it may be worth giving a try - good luck!

Hey Alyssa if you haven't tried the wrist widget while climbing, i highly recommend it for tfcc related injuries. My tfcc injury was chronic overuse, i took two months off then found the wrist widget, after wearing the wrist widget for a few weeks i started climbing with it and have been relatively wrist pain free for the past year. I always were the brace while climbing and will also wear it when ever my wrist is cracking a lot. Check it out if you haven't already and good luck. Also they are expensive but totally worth it.

I have a complete tear of my scapholunate ligamament.  I am exploring the idea of surgery, but see mixed reviews.  Wondering if PRP would be a good option as i have read some good results.  Not sure if it helps complete tears heal.  Also, wondering a good brace to use while climbing.  It hurts most crack and offwidth climbing which are my favorite types.  Any info would be helpful.

Wrist widget, try taping in that fashion if it feeels like it helps I’d recommend buying the brace, it’s a bit pricey but a game changer for me, my pain was more overuse related and not tramatic though. 

Wrist widget definitely helps for TFCC tears, I don't think it's technically slated for scapholunate ligament tears.

Having had the surgery to repair a full scapholunate ligament and debride the TFCC, I still get some TFCC pain (rice bucket helps, Wrist Widget is great for climbing and everyday use). However, the wrist widget is pretty annoying when doing fist and hand cracks as it gets in the way whenever the wrist gets into the crack.

I don't know anything about PRP (seems to have helped Kobe Bryant), but my surgeon definitely told me that a full tear would not heal by itself, though I guess you'd expect him to say that. I'm definitely not an avid crack climber, but my wrist does not like pushing, and being bent into weird configurations, so straight in cracks are generally ok, but awkward angles are not fun. My range of motion is definitely not where it used to be, and that might be part of the problem. I don't think I did the best job with physical therapy as well so YMMV.

Alan Zhan wrote: Wrist widget definitely helps for TFCC tears, I don't think it's technically slated for scapholunate ligament tears.

Having had the surgery to repair a full scapholunate ligament and debride the TFCC, I still get some TFCC pain (rice bucket helps, Wrist Widget is great for climbing and everyday use). However, the wrist widget is pretty annoying when doing fist and hand cracks as it gets in the way whenever the wrist gets into the crack.

I don't know anything about PRP (seems to have helped Kobe Bryant), but my surgeon definitely told me that a full tear would not heal by itself, though I guess you'd expect him to say that. I'm definitely not an avid crack climber, but my wrist does not like pushing, and being bent into weird configurations, so straight in cracks are generally ok, but awkward angles are not fun. My range of motion is definitely not where it used to be, and that might be part of the problem. I don't think I did the best job with physical therapy as well so YMMV.

What is your rice bucket routine? 

For those of you who had surgery, how many had debridement only and how many had a full repair? I would love to hear what people's experiences have been like with both!

I know I'm a little late to the party but wanted to give some input. I apologize in advance for the rambling length of this and scatter brained nature.

I tore my TFCC 3 years ago bouldering. At the time I was in Canada and went to one of the best hand surgeons in the country to get it diagnosed. She misdiagnosed me for months. I then went back home to Australia to my physio (ex-AFL physio who understands you don't just quit doing what you love) who has correctly diagnosed without MRI all 5 specific cartilage tears I have now and then been proven correct with an MRI every single time. It took him all of two minutes to identify my TFCC tear. His input was as follows: the wrist widget that I'd tried to the molded wrist brace that ran the length of my forearm that the Canadian doc had molded me were useless and simply placebo effects if they had felt better. Cartilage does not heal. It cannot regenerate. Once it's torn you either leave it or debride it. I was so strongly leaning towards surgery. I had my appointments with the physio's recommended Aussie surgeon booked. I had before that tried the cortisone shots to no avail not even temporary relief.

At the time I was bouldering and really trying to push myself and my body - low body fat percentage, normal gym weightlifting 2 hrs in the morning and bouldering gym at night for 2 hrs 5 days a week. I pushed through all wrist pain through my training - really wanted to get my first outdoor V8 even when my physio kept telling me to take it easy and take a few weeks off. The nice thing was if I wanted surgery, he'd drive me to the surgeon and if I elected to work around my injury, he had the training plan drawn up. He gave me my full options and side effects of everything and let me make the decision I wanted.

Then the best thing that could have happened to me happened. I moved to Durango, CO with a tiny bouldering gym and lunatic route setter that set very technically and I got punted off V0s and was barely projecting his V4s. I got very turned off bouldering because I felt useless and like I'd wasted my training and didn't climb hard for a few months and started to outdoor climb more and sport climb particularly. I was a V8 climber that couldn't climb 5.9 outside.

I started focusing on endurance and less power focused. I improved my technique and I worked through a LOT of weaknesses - weak shoulders, weak wrists, weak knees, weak butt, weak core. I improved the crap out of my technique thanks to that bouldering gym. I can no longer do 20 pull ups. But I can climb 5.12 outdoor. I can no longer onsight harder than V6 in a bouldering gym and I don't enjoy bouldering anymore but I am such a better well rounded climber than I have ever been and looking back now that I'm not a grade chaser anymore can tell you that I've truly learnt what loving this sport is and can truly appreciate and enjoy a good route regardless of the grade. And my wrist. Yes it hurts. But only maybe once a month. And I can tell you straight up every time before I do something if it will hurt. Left hand undercling? Pain. Weird over side pull with the left? Pain. And that is only ever in a climbing gym. I swear bouldering gyms and bouldering is made to break your body.

I have yet since progressing outdoor and sport climbing been turned away from a climb or had wrist pain on a climb. I think a huge part of that is my increased overall body strength. I'm not trying to crimper pull up through all the holds because I'm not using my feet and core. Right now, I think it's crazy I ever considered surgery. My wrist isn't even a thought anymore and it sure as hell doesn't slow down anything I do. There's two climbs in any gym with a hold that would hurt my wrist that I simply won't do - and it's just not worth it.

My advice to you would be to take as much time and you can off climbing hard - I say can because it's a very mental battle when I feel like we equate so much of our self worth to how hard we can climb. Don't put yourself in situations where you're desperately flailing. Focus on your technique and climb easy routes thinking through every move. Gym weights train where you can isolate every motion and do only those that don't hurt. At least for a month of climbing if you must pull straight down keeping your fingers aligned with your forearm for every hold you grab with the injured wrist.

In hindsight my wrist coming out of 3 months of a splint was anemic and had no muscle support. And then I climbed and trained and pushed myself really hard on it and didn't give it the time it needed to stop being so inflamed and painful. And if I had surgery, I'd have had that rehab time that I needed to take off climbing anyway which is exactly what I got with baby climbing sport outdoor. The surgery is no guarantee. There are plenty of scientific journals out there showing TFCC injuries not healing after surgery in gymnasts and the like. It's important to read body intensive sport recovery journals. My physio has taught me that what we do to our bodies as climbers is extreme. Looking to equate your recovery to climbing? Look at the gymnasts recovery time and results.

I have five cartilage tears where I have considered surgery on all. Knees, hip and wrist and I'm 24yo. I'm a mess and it's my fault because every one of those tears was pushing through pain because the strength to do what I wanted wasn't there. It took me 5 tears to realise that if I started surgery it'd be an endless journey and I'd climb for 6 months a year and spend 6 months rehabbing only to tear something new. My body is not balanced in the slightest because I neglect my weaknesses until something breaks. Now starting to address that and strengthen my whole body for all forms of climbing instead of my crimper pullup strength to land the dyno on my V8 project.

Sorry for this being so long. Maybe this has absolutely nothing to do with what you end up doing. But if there's the slightest chance this helps you. The most important lesson my physio taught me is how weak my body is at a time when I thought I was at my prime. You're only as strong as your weakest part. Taking time off and changing your style of climbing might be one of the best things you ever do for yourself - it was for me.

I probably could have summarized this a little better and thought out the points I wanted to hit had I not word vomited on here off my phone. My apologies. 

Marleys Wonderland wrote: I know I'm a little late to the party but wanted to give some input. I apologize in advance for the rambling length of this and scatter brained nature.

I tore my TFCC 3 years ago bouldering. At the time I was in Canada and went to one of the best hand surgeons in the country to get it diagnosed. She misdiagnosed me for months. I then went back home to Australia to my physio (ex-AFL physio who understands you don't just quit doing what you love) who has correctly diagnosed without MRI all 5 specific cartilage tears I have now and then been proven correct with an MRI every single time. It took him all of two minutes to identify my TFCC tear. His input was as follows: the wrist widget that I'd tried to the molded wrist brace that ran the length of my forearm that the Canadian doc had molded me were useless and simply placebo effects if they had felt better. Cartilage does not heal. It cannot regenerate. Once it's torn you either leave it or debride it. I was so strongly leaning towards surgery. I had my appointments with the physio's recommended Aussie surgeon booked. I had before that tried the cortisone shots to no avail not even temporary relief.

At the time I was bouldering and really trying to push myself and my body - low body fat percentage, normal gym weightlifting 2 hrs in the morning and bouldering gym at night for 2 hrs 5 days a week. I pushed through all wrist pain through my training - really wanted to get my first outdoor V8 even when my physio kept telling me to take it easy and take a few weeks off. The nice thing was if I wanted surgery, he'd drive me to the surgeon and if I elected to work around my injury, he had the training plan drawn up. He gave me my full options and side effects of everything and let me make the decision I wanted.

Then the best thing that could have happened to me happened. I moved to Durango, CO with a tiny bouldering gym and lunatic route setter that set very technically and I got punted off V0s and was barely projecting his V4s. I got very turned off bouldering because I felt useless and like I'd wasted my training and didn't climb hard for a few months and started to outdoor climb more and sport climb particularly. I was a V8 climber that couldn't climb 5.9 outside.

I started focusing on endurance and less power focused. I improved my technique and I worked through a LOT of weaknesses - weak shoulders, weak wrists, weak knees, weak butt, weak core. I improved the crap out of my technique thanks to that bouldering gym. I can no longer do 20 pull ups. But I can climb 5.12 outdoor. I can no longer onsight harder than V6 in a bouldering gym and I don't enjoy bouldering anymore but I am such a better well rounded climber than I have ever been and looking back now that I'm not a grade chaser anymore can tell you that I've truly learnt what loving this sport is and can truly appreciate and enjoy a good route regardless of the grade. And my wrist. Yes it hurts. But only maybe once a month. And I can tell you straight up every time before I do something if it will hurt. Left hand undercling? Pain. Weird over side pull with the left? Pain. And that is only ever in a climbing gym. I swear bouldering gyms and bouldering is made to break your body.

I have yet since progressing outdoor and sport climbing been turned away from a climb or had wrist pain on a climb. I think a huge part of that is my increased overall body strength. I'm not trying to crimper pull up through all the holds because I'm not using my feet and core. Right now, I think it's crazy I ever considered surgery. My wrist isn't even a thought anymore and it sure as hell doesn't slow down anything I do. There's two climbs in any gym with a hold that would hurt my wrist that I simply won't do - and it's just not worth it.

My advice to you would be to take as much time and you can off climbing hard - I say can because it's a very mental battle when I feel like we equate so much of our self worth to how hard we can climb. Don't put yourself in situations where you're desperately flailing. Focus on your technique and climb easy routes thinking through every move. Gym weights train where you can isolate every motion and do only those that don't hurt. At least for a month of climbing if you must pull straight down keeping your fingers aligned with your forearm for every hold you grab with the injured wrist.

In hindsight my wrist coming out of 3 months of a splint was anemic and had no muscle support. And then I climbed and trained and pushed myself really hard on it and didn't give it the time it needed to stop being so inflamed and painful. And if I had surgery, I'd have had that rehab time that I needed to take off climbing anyway which is exactly what I got with baby climbing sport outdoor. The surgery is no guarantee. There are plenty of scientific journals out there showing TFCC injuries not healing after surgery in gymnasts and the like. It's important to read body intensive sport recovery journals. My physio has taught me that what we do to our bodies as climbers is extreme. Looking to equate your recovery to climbing? Look at the gymnasts recovery time and results.

I have five cartilage tears where I have considered surgery on all. Knees, hip and wrist and I'm 24yo. I'm a mess and it's my fault because every one of those tears was pushing through pain because the strength to do what I wanted wasn't there. It took me 5 tears to realise that if I started surgery it'd be an endless journey and I'd climb for 6 months a year and spend 6 months rehabbing only to tear something new. My body is not balanced in the slightest because I neglect my weaknesses until something breaks. Now starting to address that and strengthen my whole body for all forms of climbing instead of my crimper pullup strength to land the dyno on my V8 project.

Sorry for this being so long. Maybe this has absolutely nothing to do with what you end up doing. But if there's the slightest chance this helps you. The most important lesson my physio taught me is how weak my body is at a time when I thought I was at my prime. You're only as strong as your weakest part. Taking time off and changing your style of climbing might be one of the best things you ever do for yourself - it was for me.

I probably could have summarized this a little better and thought out the points I wanted to hit had I not word vomited on here off my phone. My apologies. 

Hi Marleys Wonderland,

Thanks for your response. Was your TFCC completely or partially torn?

Hey Meghan!
Full tear to the center of the complex.

hey all, looking for advice/etc on an ulnar shortening osteotemy. "stats" here, "story" below:

I have Ulnar positive variance (left = 1.9mm, right = 1.4mm).

MRI results (verbatim from the MRI sheet, mostly I don't know anything googling couldn't tell me about this):

Left:
- partial tear of the dorsal periphery of the TFCC and possible full thickness tear
- partial tear of the articular disc ulnar-sided surface
- moderate distal radial ulnar joint effusion
- mild tendinopathy extensor carpi ulnaris

Right:
- probably mild partial tear of the dorsal periphery of the TFCC and articular disc
- mild tendinopathy with moderate peritendonitis extensor culip ulnaris at the level of the ulnar styloid
- mild partial tear of the scapholunate ligament

Here's sorta the story:

Left wrist started hurting mid august after some hard climbing, wasn't too bad. I started taping it following talking to PT, who told me "don't do things that hurt, but you can keep climbing". Right starts hurting a little at that time too, so I started taping it. things seemed okayish. In late september I ended up spraining my ankle pretty bad and couldn't climb but continued doing yoga and hangboarding, some exercise every day — usually 3 days between hangboarding but a lot of yoga. At that point, wrist pain got debilitating, couldn't type without pain, open doors, etc, and I saw a hand specialist (Dr. Master at Boulder Orthopedic). I started to modify yoga so there's literally no weight going into my hands, don't open doors with my wrist anymore, etc. I ended up getting an MRI on both wrists and cortisol shots in both. The cortisol shot pretty much cleared pain up in my left wrist, but didn't do a ton in the right.

Per dr, I started climbing again (with wrist widgets) about once a week maybe 3 weeks ago, moved up to 2x/week with a minimum of 48 hours between sessions. No underclings, avoid slopers. Still pulling hard on crimps and stuff. Hangboarding about once a week.

Right wrist pain never went away, but wouldn't be getting worse, but now my left wrist pain's back.Typing hurts.

Basically my entire life revolves around my wrists — work is typing (computer science grad student), creative outlet is typing (writing), physical outlet is climbing and yoga. And right now, that's.... my whole life, plus or minus some running.

It's not realistic to me to continue at this level of pain — it's not bringing me to tears, but it already stops me from doing everything I don't need to do.

At this point, I'm trying to figure out if I should do surgery (the ulnar shortening osteotemy), which I'd have to wait until I think January to do. I guess I'm wondering about what your guys' experience with it was? It seems like I'll be able to type pretty quickly after the surgery, is that true? do you continue to climb?

Hunter Wapman wrote: hey all, looking for advice/etc on an ulnar shortening osteotemy. "stats" here, "story" below:

I have Ulnar positive variance (left = 1.9mm, right = 1.4mm).

MRI results (verbatim from the MRI sheet, mostly I don't know anything googling couldn't tell me about this):

Left:
- partial tear of the dorsal periphery of the TFCC and possible full thickness tear
- partial tear of the articular disc ulnar-sided surface
- moderate distal radial ulnar joint effusion
- mild tendinopathy extensor carpi ulnaris

Right:
- probably mild partial tear of the dorsal periphery of the TFCC and articular disc
- mild tendinopathy with moderate peritendonitis extensor culip ulnaris at the level of the ulnar styloid
- mild partial tear of the scapholunate ligament

Here's sorta the story:

Left wrist started hurting mid august after some hard climbing, wasn't too bad. I started taping it following talking to PT, who told me "don't do things that hurt, but you can keep climbing". Right starts hurting a little at that time too, so I started taping it. things seemed okayish. In late september I ended up spraining my ankle pretty bad and couldn't climb but continued doing yoga and hangboarding, some exercise every day — usually 3 days between hangboarding but a lot of yoga. At that point, wrist pain got debilitating, couldn't type without pain, open doors, etc, and I saw a hand specialist (Dr. Master at Boulder Orthopedic). I started to modify yoga so there's literally no weight going into my hands, don't open doors with my wrist anymore, etc. I ended up getting an MRI on both wrists and cortisol shots in both. The cortisol shot pretty much cleared pain up in my left wrist, but didn't do a ton in the right.

Per dr, I started climbing again (with wrist widgets) about once a week maybe 3 weeks ago, moved up to 2x/week with a minimum of 48 hours between sessions. No underclings, avoid slopers. Still pulling hard on crimps and stuff. Hangboarding about once a week.

Right wrist pain never went away, but wouldn't be getting worse, but now my left wrist pain's back.Typing hurts.

Basically my entire life revolves around my wrists — work is typing (computer science grad student), creative outlet is typing (writing), physical outlet is climbing and yoga. And right now, that's.... my whole life, plus or minus some running.

It's not realistic to me to continue at this level of pain — it's not bringing me to tears, but it already stops me from doing everything I don't need to do.

At this point, I'm trying to figure out if I should do surgery (the ulnar shortening osteotemy), which I'd have to wait until I think January to do. I guess I'm wondering about what your guys' experience with it was? It seems like I'll be able to type pretty quickly after the surgery, is that true? do you continue to climb?

Hi Hunter,

I'm actually in a very similar position right now - positive ulnar variance in both wrists my whole life (have been diagnosed with Madelung's deformity which leads to positive ulnar variance since high school), tore my tfcc in a bike accident mid-August (MRI found the tear early November) and haven't been able to climb/do yoga/support any real weight on my wrist without pain/discomfort since the fall. However, I did pretty intense PT for the month of October, and have gotten my wrist back to the point where I can get through my daily activities without pain. But like you, even if I can open a door I still can't do the intense activities that I love anymore. I also got a cortisol shot about 3 weeks ago that didn't make much of a difference in terms of pain.

I've seen two hand surgeons and both told me that I could go back to climbing and my other activities without surgery and I wouldn't injure my wrist further, but I would have to learn to live with the pain as it currently is because it's not likely to heal any more than it already has at this point.

After speaking to the surgeons, I am opting to go forward with both an arthroscopy to debride/repair the TFCC as well as an ulnar shortening osteotomy. As the doc explained it, the TFCC arthroscopy is to address the pain directly in my TFCC, and to repair it so that it can heal. The osteotomy would be to address the long-term health of my hand/wrist. Because I have positive ulnar variance, my distal radioulnar joint (right where the TFCC is) will continue to receive a greater load whenever I put weight on it, and I will continue to be at risk for the chronic wrist pain I have felt my whole life. Undergoing an ulnar shortening osteotomy in theory will free the joint of that disproportionate load and lead to less pain in the future.

Another thing the doc said that I found really helpful was that while he has never done this surgery on someone as young as me (I'm 23 y/o), he often sees patients diagnosed with Madelung's come to him in their 40s and 50s who need the osteotomy anyway, and have developed arthritis in their wrists as well. It was this point that swayed me to opt for the osteotomy - based on my wrist anatomy it seems this type of pain isn't going away and has the potential to get worse over time, so I see this as a preventative move to avoid arthritis/chronic wrist pain for the next 20-30 years before needing the surgery anyway.

I am not a medical professional, but based on my conversations with the docs I'd definitely recommend going back to the hand specialist and asking whether they see you as a good candidate for the osteotomy in addition to the arthroscopy due to the potential for greater pain down the line.

Because you asked about recovery from an ulnar shortening osteotomy, I'll also share what the doc told me:
- Returning to a typing job - as early as a couple days with some discomfort, you will be in a cast above your elbow for the first 3 weeks so will not have great range of motion
- Returning to biking (how I get around but more broadly a statement about putting some downward pressure on wrists) - 6-8 weeks from surgery
- "Back to normal"/point at which you can start strengthening and using your wrist as you did before injury - ~4 months from surgery (only 3 months if you opted for just arthroscopy and not osteotomy).
- Doc said it could be many more months before I'm back to my peak strength in climbing

Hope this helps! Happy to try to help answer any other questions if you have them, I have one more appt with the doc before surgery in a few days so I can bring some questions you have to him if you want.

To everyone on this forum - has anyone undergone an osteotomy in addition to an arthroscopy? What was the recovery like? How long after the full surgery were you actually able to return to climbing?
Did anyone elect to only get an arthroscopy and not the osteotomy? If so, why?

Hey everyone,

I'm two days post op for a TFCC debridement and repair plus removal of an avulsed piece of my ulnar styloid. Pain hasnt been as bad as i expected but learning to avoid using the recovering hand is certainly frustrating (typing w/ one hand is slow!!!). i will post updates as they arise for anyone that's interested. wish me luck!