From the Guidelines
The treatment for triangular fibrocartilage complex (TFCC) injury typically begins with conservative management, including rest, immobilization, and anti-inflammatory medications, with surgical intervention reserved for cases that fail conservative treatment after 3-6 months or have complete tears. The initial approach to managing TFCC injuries involves a combination of rest, immobilization with a wrist splint or cast for 4-6 weeks, ice application for 15-20 minutes several times daily, and anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to reduce pain and swelling 1.
Conservative Management
- Rest and immobilization are crucial in the initial stages to allow the injury to heal.
- Ice application helps in reducing pain and swelling.
- Anti-inflammatory medications are used to manage pain and inflammation. Physical therapy focusing on wrist strengthening and range of motion exercises should follow immobilization to improve wrist function and reduce the risk of future injuries.
Diagnostic Imaging
For cases where the diagnosis is unclear or when planning for surgical intervention, diagnostic imaging such as MR arthrography or CT arthrography may be considered. MR arthrography has been shown to have a higher sensitivity and specificity for the detection of scapholunate ligament injury, lunotriquetral ligament injury, and TFC injury 1.
Surgical Intervention
Surgical intervention is considered for cases that fail conservative treatment after 3-6 months or for complete tears. The options for surgical intervention include arthroscopic debridement, repair, or reconstruction, depending on the tear location and tissue quality. Recovery from surgery requires immobilization for 4-6 weeks followed by gradual rehabilitation for 3-6 months. The decision to proceed with surgical treatment should be based on the severity of symptoms, the extent of the injury, and the patient's overall health and activity level 1.
Importance of Appropriate Treatment
TFCC injuries require appropriate treatment because this complex is crucial for wrist stability and rotation, particularly on the ulnar side where it cushions and stabilizes the distal radioulnar joint during forearm rotation and wrist movements. Prompt and effective treatment can significantly improve outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Treatment Options for TFCC Injury
- Conservative management: This approach includes modification of daily activities, temporary splint or cast immobilization, non-steroidal anti-inflammatory medication, and physical therapy 2, 3, 4. Conservative management has been shown to be effective in treating TFCC injuries, especially those with stable distal radioulnar joint 4.
- Arthroscopic treatment: Arthroscopic debridement, repair, and other procedures have been used to treat TFCC injuries 5, 2, 6. Arthroscopic treatment has been shown to lead to satisfactory functional outcomes 5.
- Surgical treatment: Open and arthroscopic TFCC repair are surgical options for treating TFCC injuries 2, 6. The choice of operative treatment is guided by the type and extent of injury.
Specific Treatment Techniques
- Arthroscopic debridement: This procedure involves removing damaged tissue from the TFCC 5, 2.
- TFCC ligament to capsule suturing: This procedure involves suturing the TFCC ligament to the capsule 5.
- TFCC foveal reinsertion with a suture anchor: This procedure involves reinserting the TFCC into the fovea using a suture anchor 5.
- Ulnar unloading procedures: These procedures, such as shortening or Wafer procedure, may be used to treat TFCC injuries associated with degenerative changes 2.
- Strength training exercises: These exercises have been used as a conservative management approach to rehabilitate TFCC injuries 3.