Triangular Fibrocartilage Complex (TFCC) diagnosis and the non-digital scale

I remember this patient well, "My wrist hurts by the pinky and I can't do anything without pain."  Most patients who come my way have had a disabling hand injury for over 6 months and have had several X-Rays, MRI's and opinions. Since 2006, more than 40,000 of them have come to me.  

There is a shortage of Hand Surgeons in the USIn America today, there is a shortage of Hand Specialists.  In 2014 there were 28,000 hand surgeons in the US serving 318 million people.  Most hand surgeons carry a grueling schedule of over 60 patients a day. They are more interested in urgent trauma cases: fractures, burns, etc. Their offices are filled with people waiting for 5 minutes of their time.  Yes, 5 minutes.  

 

 

I found the non-digital scale, also called a mechanical or analog scale, incredibly accurate in assessing the wrist.

Digital scales are not used because they take a simple "snapshot" during the weight-bearing - you don't know if it was at the beginning of your press, the middle, or the end.  Digital scales measure weight. 

With a non-digital scale, you can visibly see and determine your exact pressing ability.    

A non-digital scale can accurately determine a TFCC injury. A digital scale cannot. A non-digital scale, you know, the one that is still in your grandma's bathroom? The scale does not require a battery.   This simple tool is available in every country.  It is cheap.  It is reliable.  The test does not require a prescription or insurance to perform.  There are few tools available to people to assess the function of the wrist.  We have blood pressure cuffs available, blood sugar tests, ph tests, pregnancy test, urine tests, but nothing for the wrist.  Well actually, it has been sitting there for years, waiting for someone to push their hand on it.

 

 

You can get excited when you press more than your spouse or friend.   

HOW TO TEST YOUR PRESSING ABILITY WITH THE WEIGHT BEARING TEST

 
Use a NON-digital scale (also called dial, mechanical, or analog scales). They are available for less than $10 USD, OR perform the test on the scale in the store. For your convenience, we've added them to our inventory.  Shop here

 

Place scale on the floor, or the seat of a solid chair.  Place palm in the center of the scale, fingers pointing towards the dial, elbow over the wrist. When pressing on the scale, remember NO Pain. You are simply determining your ability.

1. Test the healthy wrist first (record the results)

2. Test the injured wrist – slowly 
Stop at the edge of pain – any pain! (record the results) 

3. Put on the WristWidget®, or tape the wrist as shown in the video. (Watch the video for important instructions.)

4. RETEST the injured wrist taped or wearing the WristWidget®. (record the results)


Typical pressing ability in an adult wrist is anywhere from 60 lbs to 140 lbs per wrist.  The highest I have ever seen was 140 lbs.  One gentleman reported 160 but I did not see that reproduced, to his dismay. Weight-bearing tolerance is defined by age, height, and bone density.  There is NO difference between dominant and non-dominant wrists.  I have just finished an extensive research project to determine the pressing ability in adults.

Grip strength (which requires a dynamometer-a sophisticated device. https://en.wikipedia.org/wiki/Dynamometer)  is generally 15% less than your weight-bearing (pressing) ability. 

WHY IS THE TEST IMPORTANT?

Let's say you fall on a Friday night, Christmas Eve, or any of the many inconvenient times to fall, and simply won't go to the ER. Your wrist is not swollen or bruised.  It just hurts to do most things.  So you wait until Monday to see your regular doc.

He/She takes an Xray and sends you to a hand specialist.  Xray comes out normal. Most family docs prescribe anti-inflammatories and a wrist splint and send you home to rest.  Now it has been 14 days and you still can't do much with your wrist.  Brushing your teeth hurts, turning doorknobs hurt, washing dishes is hard, cooking impossible, and heaven forbid you have to carry anything palm up.  

You phone the specialists and you have to wait 3-4 weeks for a consultation.  Why don't you simply perform the test?  Go slowly and do not exceed pain.  

Now you have an objective tool to measure your progress over time.    

Try a few things.   You can try taping it.  You can try splinting it.  Tape is cheap. Splints are cheap.  The taping technique is easy.  Take 2 pieces of non-elastic tape, each 1/2 inch in width and 13 inches in length.  Retest your weight-bearing tolerance.  If it goes up-yippee!  You have a Triangular Fibrocartilage Complex (TFCC) injury. 

If it doesn't, then try a resting hand brace or wrist cock-up splint.  This splint keeps the wrist in neutral.  Wait patiently for your visit to the Orthopedist and make sure you take cookies.  Be prepared for a 5-minute assessment.

Wrist Pain solution

This test in no way describes all of the variables of injuries to the wrist.  But it does help define if you have a TFCC tear.  The Triangular Fibrocartilage Complex (TFCC) is an important structure.  It serves as a stabilizer of the wrist.  When it is not healthy, you can't do much as it allows you to grip, rotate your wrist, and bear weight on your wrist. 

Hopefully, you don't want this injury or any injury, but the next time you hurt your wrist, at least, you will have something to help you know what to do.  Go visit Granny and borrow her scale.  Better yet, buy one for yourself.  Your wrist will thank you!

 The Weight Bearing Test is oftentimes more reliable than an MRI and much, much less expensive.
The Weight-bearing test must be performed by every patient with a diagnosis of a TFCC tear.  In 100% of the cases I have seen, every TFCC tear presented with painful and diminished weight bearing tolerance.  They all show changes with the tape or WristWidget®.  

This is not the case for tendonitis, fractures, UT tears and much more.  The Weight-bearing test is reliable, affordable and specific.
- Wendy