Treatment Recommendations
It is essential that YOU can measure your wrist reliably and track your progress. The numbers will tell you how you are doing every week. Remember that the weight bearing test is strenuous to the TFCC and should only be performed at the beginning and end of the treatment. You will know when you have completed the treatment when your wrist has full, pain free weight bearing tolerance. You can print this spreadsheet for your reference. Yes- 8-12 weeks is a very long time but well worth your efforts AND you can continue to function with the WristWidget on! For those people whose weight bearing is 80% of normal, your treatment does not necessarily need to be all day and night. You may choose to wear it only when you perform strenuous exercises. Note that I have highlighted the forth week. This is a tough week where many people think they are healed and consider discontinuing the WW-- don't do it! Hang in there until the weight bearing is normal- not 80%. The recurrance of this injury is high in all patients who choose any treatment plan.
Therapist and Physician notes
Must use non digital analog scale. Must keep elbow STRAIGHT. If patient is painful with wrist extension, test the unaffected wrist at 45 degrees and duplicate test on affected wrist and compare. Do not push beyond pain. This is important.
WWB is largely defined by age and height.
WWB is typically between 60 and 120 lbs.
WWB - no difference between right and left, dominant and non dominant
WWB- If TFCC is torn, you will see painful and diminished weight bearing tolerance AND a clear and objective improvement with the WristWidget immediately.
WWB is typically 15% less than grip except in cases where heavy use of forearms- elite athletes, carpenters, weight lifters etc.
Often Abductor Digiti Quinti is the cause of clicking. Test resisted abduction. If painful, tape pinky to the ring finger during the day. The patient complains of pain with typing, mousing or writing.
Often Flexor Policis Longus is involved and causes slightly volar ulnar pain. Simply stretch FPL and resist flexion of DIP- if painful- will respond beautifully to stretching exercises. These patients report pain with mousing and typing- a complaint atypical for TFCC only problems.
ECU only tendonitis presents with pain free and normal weight bearing tolerance. Often though, both TFCC tears and ECU tendonitis present together. If ECU is painful to touch at the insertion at the base of the 5th metacarpal and 6th dorsal compartment, it really helps to splint patient at night in a wrist cock up which does not compress the ulna head. If wb is over 60 lbs, night time use of WristWidget is not required but recommended. Wear this wrist cock up splint over the WristWidget.
45 lbs of wrist weight bearing is necessary for function. If below, patient will have simple functional pain
65 lbs of wrist weight bearing is requires for heavier tasks. Patient can return to heavy activities when weight bearing is over 65 lbs. Patients need to wear WristWidget a24/7 until weight bearing is over 65 lbs. In patients who are not active and their normal is 65 lbs, they typically are not loading the wrist functionally beyond 50. In this case- the ww can be removed at night.
Goal is 100% of weight bearing tolerance. Most patients will stop treatment prematurely because they do not know their 100%.
Cortisone injections skew weight bearing tolerance- falsely negative- or pain free. Do not test weight bearing tolerance for 10 days after cortisone injection
High correlation between ulnar sided wrist pain and stomach weakness. Data gathered based on Chinese Medicine reports and worth noting.
| wrist_log.xls |