Help: Torn wrist ligaments (TFCC and SL)

I have been diagnosed with a torn TFCC and a full thickness tear to my scapholunate ligaments ( SL) central portion with an additional damage to the dorsal aspect of the SL. There does not appear to be much migration (extra space) between the scaphoid and lunate.  I am in need of direction as to how to proceed at this point. I have had 3 MRI arthrograms at this point and the diagnosis is relatively certain. 

I am mosty functional. I can use my wrist to some degree. The injury was 9 weeks ago. It wasn't super acute, but did swell and was certainly painful. I have not even considered climbing in the past 2 months as any open handed hanging or crimping feels like my hand is ripping off. It does appear to be improving slightly but am super doubtful as to the long term effects of doing nothing.

I  understand there is a time sensitivity to SL injuries but unfortunately have only just become aware of this due to my own research and not through the orthopedics I have seen. 

I have been climbing for 25 years, I am 40, have been getting after it super regularly for the last 4 or 5 years, (60-70 days/year in the desert with lost of other climbing in the summer and winter too), and have been sending 5.12 trad and sport. 

What surgeon/hand specialist can anyone recomend? I have lost all faith in my orthopedic and am in search of a competent doctor. I have never had any surgery and this prospect seems super grim for a climber. The demands of a climbing wrist seem to outweigh the parameters of surgical repair, and I am super afraid of just reinjuring my wrist if I can ever start pulling down on  it again. 

Has anyone had SL surgery with success? Was it the procedure with pinning, a splint, then a hard cast at 1-2 weeks for 8 weeks or so? Are you crushing again? Anyone climbing with a fused wrist?

Has anyone had a torn TFCC or SL and just given it time, and if so how much time?

Any information and or guidance would be greatly appreciate at this point, especially in regards to finding a professional who understands the unique demands of climbing on the wrist. 

Thanks, 

Ed

A previous thread that may help: https://www.mountainproject.com/forum/topic/106457407/wrist-tfcc-tear

I self-diagnosed a tfcc tear and https://www.amazon.com/WristWidget-Patented-Adjustable-Triangular-Fibrocartilage/dp/B001BVNSRO/ref=sr_1_1_a_it?ie=UTF8&qid=1522690588&sr=8-1&keywords=the+wrist+widget was pretty helpful for recovery.

Obviously consult with a doctor yadda yadda yadda but I think those wrist widgets get pretty good praise for tfcc tear recovery.

I appreciate the responses. I have searched the web exhaustively regarding distal radio-ulna/wrist injuries, especially as they relate to climbing. Those threads were insightful but certainly leave me with more questions. 

I was given one of the wrist widgets 6 weeks ago, but it doesn't seem to help much. It certainly doesn't seem to help enough to the point where I can climb or train. I don't know if the widget helps with recovery or simply helps mask symptoms, which depending on your situation, may  hinder recovery.  I do appreciate the advice though. 

There are lot's of people out there who you see climbing with taped wrists. Now I know why!

It was quite a while for me ( mountainproject.com/forum/t…) and it was ~4 months after injury and mostly with immobilization / support (eventually moving to a wrist widget) before I eased back into climbing. Take your time. I recall the consensus being "wait and see" in my case wouldn't make surgery outcomes worse if I got to that point, with the idea being that I may not get to that point. I've been climbing on it for years since now and have no issues with it (and don't need to tape or any other sort of ongoing support).

Just sharing one more anecdotal experience:

I had a wrist injury last year. The cause of injury and feeling I experienced precisely matched what Dave Macleod describes in his book for TFCC injury.

Went to the hand specialist at a local hospital, twice. She said most likely it was a TFCC injury, but a scan would be only way to know for sure. Both times her advice was basically, "wait and see if it gets better, because it might." (This was significantly due to my having told her we had a high deductible plan, so scan would basically be out of pocket. And even if we did a scan and figured out what it was, I still might choose not to pay for surgery.)

I wore a wrist brace 24/7 and used that hand for basically nothing at all, to the extent possible. (Definitely no climbing with it.) Wrist widget didn't do anything for me.

The pain was pretty bad for about 3.5 months. Then it just went away relatively suddenly over a period of about 10 days.

I've now been doing regular PT for my wrist for about a year. It's not where it was pre-injury, but it's getting close (especially on any route that doesn't involve slopers).

My orthopedic has not recommended immobilization at any point, I wore a wrist brace at night for the first 6 weeks or so as it seemed like a good idea to at least get 8 hours of quality rest for the ol' wrist. I am definitely working with a puncture to the central portion of the TFCC (the part without any blood flow) with associated tearing along the sides of it. This is not a great situation, but is most likely something that I have been living with for years until the classic "one move too many" happened. I have fallen hard off bikes and boards countless times.The full thickness tear to the central portion of the scapholunate ligament is more concerning to me as it can apparently lead to a total wrist collapse. Maybe I was ignoring symptoms leading up to this injury but I feel that it was out of the blue without any single move or slip that could have caused it. I  just climbed hard 2 e days in a row  trying to get ready for an attempt on Moonlight in the spring. It was sore driving home from the desert. I woke up the next day slightly swollen and definitely injured. 

Ed L wrote:

What surgeon/hand specialist can anyone recomend? I have lost all faith in my orthopedic and am in search of a competent doctor. I have never had any surgery and this prospect seems super grim for a climber. The demands of a climbing wrist seem to outweigh the parameters of surgical repair, and I am super afraid of just reinjuring my wrist if I can ever start pulling down on  it again. 

The correct answer for any Coloradan for "where should I go for ortho?" is The Steadman Clinic in Vail. I haven't had any wrist issues (just had ACL surgery there) but it's truly a world-class clinic in our state. The in-house PT clinic at Vail Health (Howard Head Sports Medicine) is also the shit. 

I injured my tfcc last year as well. I went to two doctors - both said to "wait and see". I had 3-4 months off from any activity involving the wrist - no climbing, biking, lifting, etc.

Hi Ed,
I recommend Dr. Conyers at Boulder Centre for Orthopedics.  He fixed my wrist as well as my husband's.  My husband had a partially torn scapholunate ligament and was immobilized (including the elbow) for 8 weeks (if i recall correctly).  I'd be happy to tell you more about it over a PM.  
I'm not an wrist expert, but I don't think you should feel that your climbing prospects are grim.  I'm sure there are specific wrist-intensive moves that may shut you down, at least for a year or so, but I would imagine there are lots of hard moves that you will still be able to do.  You'll find the limitations of your wrist and learn how to work around them.  I agree that finding a doctor that wants to get you back to doing whatever it is you love doing is important.  Good luck.
Sarah

Hi Ed.  Sorry for your injury and good luck with both your research and recovery.  Sounds like you've learned that the clock is ticking, with more options quite early in the post-injury process rather than later.  I feel completely recovered after surgery for a complete SL tear.  Here's a brief note I put in a relatively recent related thread mountainproject.com/forum/t…  
Feel free to get in touch directly if you'd like (surgeon's name, more details, etc); I'm happy to share any info about my experience.  

Interesting thread. Here's a quick version of my story which might be helpful to some.  About 4 years ago I suffered a partial SLL tear, and then maybe 6 months later a complete SLL tear.  I saw 4 different hand surgeons, who told me that essentially climbing or hard climbing was over.  Several were keen to operate.  I researched the plethora of surgical repair options, which frankly tend to have not-so-great outcomes. Some kind folks on MP shared their experiences with me.  I spent a lot of time on PubMed, and talking with surgeons, hand therapists, and others.  After much work in PT to try to rehab the wrist, and not great outcomes, I found a surgeon in San Francisco who had just come up with a new alternative surgical repair.  I met with her, and was one of her very earlier surgeries.  Essentially, it mimics ACL repair, but done in the wrist with smaller cannulated screws.  I've now got 2 pieces of cadaver tendon going from the scaphoid, to the lunate and the triquetrum.  Much PT followed surgery.
The wrist is stable, painfree, and I have almost complete range of motion.  I'm training, hangboarding, campusing, and climbing a lot.  I'm back to where I was pre-injury I'd say in terms of climbing performance (occasionally flashing 12d and redpointing to 13+, and falling off easy boulder problems). So I'm certainly stressing my wrist on a regular basis, and have been back going hard for about 2 years now. YMMV, but I think her surgery (which is still quite new) is definitely a better option than what was previously available.  I'm happy to share the surgeon's contact info if you send me a message, or a poster she put together at an early stage where she had done some cadaver tests with her surgery vs. other more common options.  I think quite a few handsurgeons are now using her technique, but I'm definitely not up on that.  SLAC is out of the picture, and I don't feel limited ever by my wrist.  Before the surgery, I really thought I was done with climbing, which was quite a bummer.  Now I've got my life back.

ugggh the SL is such a bear. just here to lend my sincere 'i hope you find a good doc and heal up well, and soon!!'

Thanks everybody for your words of encouragement. I have requested an appointment with the Steadman clinic to see Dr. Viola and hope to get up there in the not too distant future.

As far as splinting the wrist, I have been curious as to it's efficacy for my situation as neither of the orthopedics I have seen yet have even broached the topic. There is however a little voice in the back of my head saying, "it should have been splinted for the past two months, you idiot!"

I am simply judging my progress by how long I can hold my favorite cast iron pan with my left hand. I look forward to a more scientific approach from Dr. Viola.

Starting my orthopedic residency this summer, so take my words with a grain of not yet a surgeon salt. Brace it if it feels good, but not all the time. Realize that when you immobilize a joint you create a host of problems with stiffness and adhesions. If you put a brace on that wrist 24 hours a day for 2 weeks you will be in a world of pain when you try to move it next. I would immobilize at night if it helps. Regarding the TFCC and the SL ligament, you won't heal those with bracing, and most likely will need repair surgically if you want a functional wrist in the future. If you don't get them fixed and can bear the discomfort, you have a high chance of developing premature arthritis in the wrist.

Will you be right back to climbing if you get them fixed? No way to say. Will you be back to climbing 12s if you don't get them fixed? equally hard to say but probably no. I'd say go for it, you're 40 and have a long time to get maximal use out of that wrist. Good luck!

Michael

Thanks for the honest response. I am still trying to get into see a doc who is capable of making an informed evaluation of my injuries. This is proving to be quite difficult.

I had a small tfcc tear a few months ago from a weightlifting accident in the gym. It did heal thankfully. I waited a month after the injury to see if it would get any better on its own, and it didn't.  I started physio right away.  I did 8 weeks of physio once a week  which included: laser therapy on my wrist, 6 different wrist strengthing exercises, heat and cold therapy, and a mix of IMS needling and interferential therapy.  I did the same exercises at home when I wasn't at physio. and even bought myself a little infrared heating pad that I used once a day for 15 min directly on the wrist after my exercises to improve circulation and blood flow.  During my 8 weeks of physio I wore my wrist widget every single day, all day and night.  Im not sure if this will help you, or if you are already beyond all this stuff, but it did heal my injury :) I also laid off anything that put pressure on my wrist. GOOD LUCK

Just saw this thread.  I had a scaphoid/lunate/capitate (I think that's right) fusion way back in '88.  They took bone from my hip to replace the cartilage.    Yes, pins and 8 weeks in a cast.  But I led a 10c crack in Lumpy about a month after getting the cast off.  There's certain things I can't do as well, like right-handed mantles and thumbs down jams, but I just learned to compensate.  I don't even think about it most of the time when climbing.  

My surgeon is also a climber, so discussing the options and outcomes was really clear.  Unfortunately for you, he's retired now but I ran into him at the gym a few months ago and he asked me how the wrist was.  He chuckled and said it's not often you get 30-year feedback on your work.

Anyway, I'm climbing harder now than when I got injured.   The wrist is strong, even if it's not very flexible.  If you go this way, buy some roller-blade wrist guards and wear them whenever you do something (not climbing) where you might fall and hit the ground: skating, biking, etc.    When I ski powder, I don't bother wearing them, but on hard-pack I do and just ski the bumps without poles (fun!).  

It's not the end of your climbing career to get a fusion.  I don't know if ligament reconstruction in the wrist has greatly improved (blood-flow seems to be the issue), but a fusion is quite livable.

Was just diagnosed with central tear of SL and the lunotriquetral, curious to see how people are faring now and what their attack plans were.  Thanks

I fully tore my TFCC in my left wrist about 5 years ago while tearing my ACL in my right knee in the same accident.. that sucked! This is before I started climbing. I know how annoyingly painful that TFCC tear can be. I went to Dr. Master who is now at Boulder Orthopedics. However, I didn't get an MRI initially on it and didn't know the severity of my tear at first. He put me in a cast for about 6 weeks, but it didn't make a difference. Upon getting the MRI, his words "this is the worst TFCC tear I've ever seen..."

Having to wait for several months for surgery (because the ACL came first) the wrist just continued to nag with pain no matter how little I used it. So I opted for the surgery which was really just cleaning out the torn ligament. For me, surgery was great! it was a really painless operation, did PT for about six weeks, and stayed away from hard activity for about another six weeks. Had no loss of motion, and I don't get any pain from using my wrist these days. The only thing I can feel is a little pain if I push into the side of my wrist with a finger or maybe on cold mornings but it doesn't get aggravated from use like it did before the surgery. In my situation surgery made all the difference for the better. I would highly recommend Dr. Master in Boulder as he is very patient with his patients, and if possible would prefer non-surgical methods, but in my case surgery seemed to be the best option. Wrist hasn't affected my climbing once, but then again I only climb 5.10... Best of luck with yours!

Michael Allen wrote: Starting my orthopedic residency this summer, so take my words with a grain of not yet a surgeon salt. Brace it if it feels good, but not all the time. Realize that when you immobilize a joint you create a host of problems with stiffness and adhesions. If you put a brace on that wrist 24 hours a day for 2 weeks you will be in a world of pain when you try to move it next. I would immobilize at night if it helps. Regarding the TFCC and the SL ligament, you won't heal those with bracing, and most likely will need repair surgically if you want a functional wrist in the future. If you don't get them fixed and can bear the discomfort, you have a high chance of developing premature arthritis in the wrist.

Will you be right back to climbing if you get them fixed? No way to say. Will you be back to climbing 12s if you don't get them fixed? equally hard to say but probably no. I'd say go for it, you're 40 and have a long time to get maximal use out of that wrist. Good luck!