Wrist Injuries: Recovery, Treatment Options, and Rehabilitation

Regarding wrist injury issues?

Hello Dr.
Lee,
I injured my wrist in June of this year, and it has been five and a half months since then.
Initially, an orthopedic doctor at the clinic diagnosed me with possible injuries to the scapholunate ligament and the triangular fibrocartilage complex (TFCC) using X-rays and ultrasound.
I underwent some rehabilitation, but it wasn't very intensive.
Overall, I feel about 70 to 80% better, but there are still some uncomfortable areas.
In early November (about five months after the injury), I had an MRI at the hospital, and the doctor confirmed a TFCC injury.
The doctor mentioned that if it doesn't improve, we may need to consider arthroscopic surgery to suture the cartilage and allow it to heal on its own.
I would like to ask the doctor:
1.
Since the doctor advised me to limit wrist activity, I am currently using a soft wrist brace with a thumb support that I can adjust with Velcro.
I was wondering if I could go to the rehabilitation department at the hospital to ask the doctor to make a splint for better immobilization to accelerate healing.
Would the doctor be willing to help me with that?
2.
Would injecting PRP (Platelet-Rich Plasma) be effective at this stage? Is it preferable to have the PRP injection guided by ultrasound for better accuracy?
3.
What rehabilitation exercises are suitable for a TFCC injury? Is manual therapy appropriate? What aspects can manual therapy primarily improve?
4.
If ultrasound or shortwave therapy is applied and the temperature energy is not controlled properly, could it worsen the injury?
5.
Does taking UC-II or glucosamine have any benefits for cartilage healing?
Thank you for your responses!

A Yan, 30~39 year old female. Ask Date: 2021/11/19

Dr. Li Yanheng reply Rehabilitation

1.
It is fine to have a splint made at the rehabilitation department, but a fixed splint may significantly limit mobility.
It is recommended to continue using a Velcro wrist brace, and both can be used alternately.

2.
You can go to the rehabilitation outpatient clinic for evaluation.

3.
It is necessary to train the muscles of the upper arm and forearm to improve wrist stability; manual therapy can consider relaxing the hand and forearm muscle groups.

4.
Generally, this is not very common.

5.
This is subjective and varies from person to person.

Reply Date: 2021/11/19

More Info

Dear Patient,
Thank you for reaching out with your questions regarding your wrist injury and the ongoing recovery process. It sounds like you've been through a challenging time since your injury in June, and I appreciate your proactive approach in seeking further information about your treatment options. Let’s address your concerns one by one.

1. Custom Splinting: It is a good idea to consider a more supportive splint if you feel that your current soft brace is not providing enough stability. You can certainly visit a rehabilitation specialist or an orthopedic doctor who can assess your wrist and potentially create a custom splint or orthosis for you. A well-fitted splint can help immobilize the wrist, allowing the injured structures to heal more effectively. Most rehabilitation clinics are equipped to provide this service, and they should be willing to assist you.

2. PRP Injections: Platelet-Rich Plasma (PRP) therapy has gained popularity in treating various musculoskeletal injuries, including those involving cartilage and ligaments. There is evidence suggesting that PRP can enhance healing by delivering growth factors directly to the injured area. If you are considering PRP injections, it is advisable to have them performed under ultrasound guidance. This method allows for precise placement of the PRP into the injured tissue, which can improve the effectiveness of the treatment and minimize the risk of complications.

3. Rehabilitation Exercises: For a triangular fibrocartilage complex (TFCC) injury, rehabilitation typically focuses on restoring range of motion, strength, and functional use of the wrist. Physical therapy may include gentle range-of-motion exercises, followed by strengthening exercises as tolerated. Manual therapy techniques, such as mobilization, can also be beneficial in improving wrist function and reducing pain. The goal of these therapies is to enhance flexibility, reduce stiffness, and promote healing of the injured structures.

4. Thermal Modalities: When using modalities like ultrasound or shortwave diathermy, it is crucial that the temperature and energy levels are monitored closely. If the settings are too high, there is a risk of exacerbating the injury or causing further inflammation. Always ensure that these treatments are administered by a qualified professional who can adjust the parameters based on your specific condition and response to treatment.

5. Nutritional Supplements: Regarding the use of UC-II (undenatured type II collagen) or glucosamine/chondroitin supplements, there is some evidence suggesting that these may support joint health and cartilage repair. While they may not directly heal the injury, they can potentially provide nutritional support for the cartilage and overall joint function. However, it’s important to discuss any supplements with your healthcare provider to ensure they are appropriate for your specific situation.

In summary, it is essential to continue working closely with your healthcare team to monitor your recovery and adjust your treatment plan as needed. If your symptoms persist or worsen, further imaging or intervention may be necessary. Always communicate openly with your doctors about your concerns and progress.
Wishing you a smooth recovery and improved wrist function in the near future.

Best regards,
Doctor Q&A Teams

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