III. TFCC: a four letter word

The X-ray below depicts a person’s left hand (from above), and shows how the TFCC resides  on the “ulnar side” (the outside) of the wrist…

I’ve been learning about a new body part over the last 3 months. It’s called the Triangular Fibrocartilage (TFC), and is part of a larger grouping of anatomy in the wrist, called the Triangular Fibrocartilage Complex (TFCC). The TFCC consists of  several ligaments as well as cartilage arranged in a triangular shape.  The TFCC stabilizes the bones of the wrist, joins the ulna and the radius, separates  these same bones from the carpal bones (the base of the palm), and functions as a shock absorber for impacts to the hand and arm.  Until my 55th year, I knew nothing of this intricate piece of anatomy.  But when the TFCC starts protesting, it will be heard.

The picture to the right shows (in blue), the various

parts of the TFCC (of the wrist of the left hand).  And it specifically calls out the TFC, which is at the bottom of the TFCC, where it

attaches the ulna and the radius.

Swimmers are often concerned about the wear and tear that

they are putting on their shoulders, and rotator cuff problems can be the darkest fear of swimmers, pitchers, and tennis players.  But hey, the TFCC deserves some attention, too.

 

Last October I was swimming long course, splitting the lane with someone, I know not who. As we approached each other our left hands collided, and my hand was bent down and out (towards the outside of my arm–towards the ulna). It hurt at the time, and continued hurting for about a week, but then the pain subsided. October to December is my slack time in the pool, so I was not really over-exerting my wrists. Come January, the goal of swimming across Lake Siljan sprung to life, and my yardage jumped up significantly. Within a week my left wrist had swollen up, and was painful. It was evident that the light injury I’d sustained to my wrist in October was making itself known.

The TFCC on my left hand had  swollen  up quite a  bit, and it  was painful when I swam.   I iced my left wrist after my longer workouts, and I was feeling very protective of my  left wrist when I was sharing a lane with one or more  hoopleheads (e.g. non-swimmers and/or recreational swimmers). I  went to a physical therapist for a while, and I  got some  advice from a local  chiropractor also.  Eventually I went to see an orthopedic surgeon who  specializes in  the hands and wrists.  He examined my hand, and he had a couple of X-rays taken.  The X-rays indicated that there was no obvious contributing factor to my  problem  (like a “burr” on the end of the ulna for instance).  The doc’s feeling was that I did  not have a problem with any of the ligaments associated with the TFCC,  but  rather  there was a small  tear in the cartilage where  it attaches to the ulna.

The  doctor indicated that an  MRI could  tell us  more about  the nature of  the  cartilage tear.  (I declined.) He further  indicated  that  a long-term solution would  involve me not swimming  for 2-3  months (I took this  to mean  he was suggesting  surgery, but  I am not sure if  that  is  what he  meant.   Personally I’d  never go in  for  surgery unless I  exhausted every other treatment and was desperate  for  a “last ditch”  effort.)  The doctor  also  said that use of the  wrist was not going to further damage the TFC, and that I was free to  “swim  away”.  He noted that a squirt of cortisone  in my wrist was an option to reduce  inflammation (which was now the permanent condition of my wrist).  I opted for this treatment, taking a couple of  blasts of  cortisone from a hypodermic needle.  I  wish  I had a picture of this, because  a needle in a wrist  seems very unnatural.   But  I  was busily averting my eyes while  he  gave me  the shots,  and wasn’t thinking about documenting the shots when  they were being  given.

So,  what ensued was a full  day of an oddly swollen left wrist,  and increased pain.  Then the swelling and  pain subsided,  and for the  last fourteen  days I  have  been pain-free, and am  no longer  aware of my  wrist.  I  have a greater appreciation for a previously-unknown-by-me part of my body that is a necessary contributor  to  pulling  myself  across Lake  Siljan  in July.  Also, I am  doing exercises with  a device (suggested by  local  chiropractor Sandy Sachs) called a DFX Powerball, to strengthen my hand, wrist, and forearm.  Read more here.

Here’s one last image of  the TFCC:

trifibcc

So, at this point I am  thinking that I may have dodged a bullet; I’m paying  attention to my  wrists in any case; training is going forward as planned.

END

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