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Rhythmic Physician: Wristful Thinking

Drummers who regularly hit hard are susceptible to a number of injuries to the wrists and hands. They will often develop pain over the little-finger side of the wrist, but this is often disregarded or neglected and felt to be a minor sprain or strain-type injury. However, the more violently the drumhead is struck, and when a significant simultaneous forceful twist of the wrist occurs, the triangular fibrocartilage complex (TFCC) of the wrist is at risk for injury.

The TFCC is a small piece of cartilage attached by ligaments on the little-finger side of the wrist, located between the end of the forearm bone (ulna) and the wrist bone (carpals). This cartilage is a tough, resilient tissue that acts as a cushion between the joint surfaces.

TFCC injuries will usually cause a painful clicking or catching sensation on the little-finger side of the wrist that accompanies movement. A persistent localized swelling over the same area of the wrist can also develop.

A physician may suspect triangular fibrocartilage tears when a patient presents with wrist pain or pain with a clicking sensation. The definitive diagnosis is often be made by performing an MRI arthrogram of the wrist. However, surgical arthroscopy may become necessary to diagnose a tear when imaging studies fail to provide the necessary information needed to make a diagnosis.

The treatment of TFCC injuries includes using protective supports including splints or a cast to minimize movement of the wrist, applying ice to the painful wrist for 15 minutes three to four times a day to diminish pain and inflammation, non-steroidal anti-inflammatory medications, corticosteroid injections into the wrist, and by performing wrist- and forearm-strengthening exercises. However, complete tears or tears that don’t respond to conservative treatment may require surgical treatment consisting of arthroscopic debridement or possibly repair.

It is safe to return to normal activities including drumming when the injured wrist and hand exhibit pain-free range of motion. In my final article on the hand and wrist coming in the next issue, I will discuss methods to compensate for an injury as well as methods to prevent some of the injuries from occurring.

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