Injury Breakdown: Carl Crawford's Wrist Watch

By Abby Sims
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Carl Crawford, All-Star Red Sox left fielder, evidently had injections to cope with left wrist pain during the 2011 season. He recently complained of issues once again, reporting soreness when swinging a bat. Accounts of Crawford's subpar 2011 season now attribute his decline to what was likely a nagging wrist injury. Crawford underwent arthroscopic surgery in January and, for some reason, was already throwing, hitting off a tee and working on his questionable bunting skills in spring training when he complained of a flare-up in his wrist. What was the rush?

One would think the Red Sox would have been a bit more conservative in protecting their star center fielder from a setback in his recovery - if for no other reason than he earns the big bucks. Crawford is in the second year of a seven-year 142 million dollar contract. As with traffic lights and stop signs, often installed only after enough accidents occur, it is only after doing too much, too soon that Sox management is cutting Crawford back and putting him on anti-inflammatory meds.

Even when an athlete is "feeling good" during recovery from an injury or surgery and insists on playing, common sense, caution, and management intervention should prevail, limiting activity as medical needs dictate. It is easy to "feel good" with rest and rehab if recovery is without complication and is progressed appropriately; Add the demands of baseball activities too soon or too aggressively and, well, the result is obvious.

The nature of Crawford's wrist problem? The TFCC

The TFCC, or Triangular Fibrocartilage Complex. is located on the pinky side of the wrist. This complex is comprised of a disc (like a meniscus at the knee), ligaments connecting the base of the two bones of the forearm (the radius and ulna) to each other at the wrist, as well as ligaments that connect the ulna to the small bones (carpals) of the wrist below.  The complex also includes the sheath of a tendon that helps to extend the wrist. The TFCC separates the joint between the radius and ulna from that formed by the radius and carpals.

The TFCC is the primary stabilizer of the wrist and the joint between the radius and ulna (radioulnar joint). It also supports the first row of carpals at the wrist. As with fibrocartilage in other areas of the body, the TFCC has a poor blood supply, which limits it's ability to heal when injured.

How does the TFCC get hurt?

The TFCC is most likely to suffer traumatic injury due to loading and shearing forces with a rotational component, or twisting, particularly when the hand is angled toward the pinky side (known as ulnar deviation). This might occur when breaking a fall. Impingement of the ulna on the carpals is a major cause of degenerative TFCC tears.  Forced ulnar deviation, which occurs when batting, puts tremendous stress on the TFCC. This might explain Crawfords injury, since there was no mention of prior trauma in the reports of his condition.

The nature of Crawford's surgery

Crawford had a simple debridement, or cleaning out of the area.  TFCC repairs are often undertaken when there is a tear in the rim of the cartilage (the area that does have some blood supply), or when a portion of the boney attachment is torn off (known as an avulsion).

Post-op

As after any serious injury or surgery, it is imperative to allow for the affected tissue to heal.  This initial healing response is generally thought to take approximately six weeks. Simple fractures may heal as quickly as four weeks. It is only then that rehab can be ramped up gradually while continuing to minimize inflammation. Work to restore range of motion (which is often an issue following the immobilization required during the early phase), improve muscle flexibility, and re-build strength & muscular endurance is crucial. A foundation must be set in order to meet the demands of progressive sport-specific activities without suffering a setback. As for Crawford's timetable – you do the math…

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