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


Original Post
Alyssa Chamberlain · · Unknown Hometown · Joined Apr 2017 · Points: 0

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.

Josh Janes · · Unknown Hometown · Joined Jun 2001 · Points: 8,770

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

Phil York · · Winston-Salem, NC · Joined Jun 2009 · Points: 155

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.

Alan Zhan · · Seattle, WA · Joined Jul 2013 · Points: 65

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!

r m · · Unknown Hometown · Joined Apr 2015 · Points: 0

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.

Aerili · · Los Alamos, NM · Joined Mar 2007 · Points: 1,970

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. 

Mary Murphy · · Unknown Hometown · Joined Jun 2018 · Points: 0

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

Alyssa Chamberlain · · Unknown Hometown · Joined Apr 2017 · Points: 0
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!
wgc75 · · Unknown Hometown · Joined Oct 2010 · Points: 0

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!

Jack Sparrow · · denver, co · Joined Jun 2010 · Points: 1,505

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.

Guideline #1: Don't be a jerk.

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