Randon Hall, MD
Didi Gregorius' Wrist Cartilage Tear
Didi Gregorius tore cartilage in his wrist sliding into home for Saturday's game-winning score. Based on the mechanism of injury he likely had his wrist bend backwards and toward the pinky side of his wrist. The forceful extension of the wrist typically can lead to a bony injury such as a fracture to the distal radius or scaphoid bone. On the other hand, the trauma can lead to a soft tissue injury such as a wrist sprain or, as in the case of Gregorius, an injury to the cartilage in the wrist. The classic injury is to an area called the triangular fibrocartilage complex tear (TFCC). Most individuals will have pain on the back side of the wrist just beyond the tip of the ulna (see below). Other symptoms may include clicking or catching of the wrist as well as issues with grip strength. An x-ray is was probably done first in order to detect the presence of an ulna styloid fracture or disruption of the distal radioulnar joint. An MRI is the optimal test which likely confirmed the diagnosis of the TFCC tear which can be seen below as well.
MRI Showing TFCC Tear
After confirmation of the tear on MRI a "cortisone" shot was performed at the wrist in an attempt to reduce the swelling an pain. I can only go off reports that it was in fact a cortisone shot, but it may have been more appropriate to attempt an injection with a biologic such as platelet rich plasma to theoretically expedite the healing process. He will be immobilized for a few days and re-evaluated to see if he has improved. Unfortunately, TFCC injuries do not improve dramatically within a few days. Even with the injection TFCC injuries are generally treated with 4 weeks of immobilization with an attempt to allow the TFCC injury to heal. If it doesn't heal he will need a scope of the wrist to remove the damaged cartilage.
Return to Play
We have got about 2 weeks from the time of injury to the start of the post-season, so it is unlikely he will be 100%. However it is feasible that the TFCC injury is only painful in certain positions depending upon the extent of the tear. Therefore Didi Gregorius could potentially return to fielding if it does not actually bother his wrist. The bigger issue will be batting as swinging the bat puts the wrist in an ulnar deviated position cause compression and further injury to the TFCC. If his injury can be successfully treated without surgery then, look for him to return in the 4 week range where he will be closer to 100%.