1. Rehabilitation: Post-Surgical TFCC arthroscopy Differential Diagnoses:
Josh Bush
Georgia College & State University, Milledgeville GA
Objective:
Treatment:
Uniqueness:
To present the case of a 21 year old, female softball player at Mercer University presenting a post-surgical TFCC arthroscopy.
To explain the process of rehabilitation and its effects on functionality and time to return to play.
Athlete has an anatomical misalignment of her radius and ulna; ulna is longer than usual. Radius and ulna are straight across instead of having that natural curve to allow for space in the TFCC.
Injections after follow up with doctor: Cortisone and Toradol and a Medrol dose pack.
Doctor thought nothing of the misalignment until further issues arose
Post Surgical (after a month of general wrist strengthening)
(2 weeks)
Complete mobilization
Ball squeezes
Finger ROM (extension, flexion, AB/Adduction
(2-4 Weeks)
Modalities
Parrafin wax
Pulses ultrasound (2 times a week)
Heat on some days
Stim and ice after each session
Exercises (ROM)
Can hangs for increased extension
Towel stretches
CPM
Isometric strengthening (manual resistance)
Continued ball squeezes
(4-6 weeks- Christmas Break)
Take Home Sheet**
(6-8 weeks)
Modalities:
Thermal ultrasound to 4 degrees
Stim and Ice after each session
Exercises
Strengthening wrist exercises
Bat pronation/supination radial/ulnar deviation
Therabar flexion and extension
Began trampoline tosses (throwing mechanics)
(desired progression but presenting pain)
Regression to lighter exercises
No more throwing
T-band
Doctors follow up
Doctor noticed Misalignment but didn’t address till now
Patient Background:
Height: 5’11”
Weight: 160 lbs
Age: 21
Ethnicity: Caucasian
Sports: Softball: Starting catcher
Golf as a hobby
School: Mercer University
Past Injuries: ganglion cyst on the radial side of the dorsal portion of her hand.
Training level: 5 days a week, weekend tournaments.
Original Evaluation: Ganglion cyst was original complaint. It was referred pain from the tear in the TFCC but the tear was unknown until after MRI. Joint mobes and ROM testing caused pain. Swinging a bat and throwing a ball caused pain. Ulnar deviation caused most pain during ROM.
Conclusions:
Although the athlete presents pain occasionally with wrist it has decreased enough for her to participate during the rest of the season.
Athlete is currently able to do everything at practice as tolerated after being on an original hitting count.
Differential Diagnoses:
Ganglion Cyst
TFCC tear
Lunate dislocation
Scaphoid fracture
Misalignment of Radius and Ulna