Management of TFCC Calcification
Initial Approach: Conservative Management First
For TFCC calcification, conservative management should be the first-line treatment, as it has demonstrated similar outcomes to surgical intervention in patients with stable distal radioulnar joint (DRUJ). 1
The distinction between TFCC calcification and other TFCC pathology is critical—calcification may represent calcium pyrophosphate deposition (CPPD) disease rather than a traumatic or degenerative tear, which fundamentally changes the management approach.
Determining the Underlying Cause
If CPPD Disease is Suspected or Confirmed
- Apply ice or cool packs, provide temporary rest, and consider joint aspiration with intra-articular injection of long-acting glucocorticosteroids for acute symptoms 2
- Prescribe oral NSAIDs with gastroprotection or low-dose oral colchicine for systemic treatment when intra-articular injection is not feasible 2
- Use low-dose oral colchicine or low-dose oral NSAIDs with gastroprotection for prophylaxis against recurrent attacks 2
- Screen for and treat associated metabolic conditions including hyperparathyroidism, hemochromatosis, or hypomagnesemia 2
If Mechanical TFCC Pathology is Present
- Initiate conservative treatment consisting of immobilization, activity modification, and forearm/grip strength exercises for 8-12 weeks 1, 3
- Conservative management achieves pain scores averaging 0.1/10, with 99-100% range of motion recovery and 88% grip strength compared to the contralateral side 1
- This approach is particularly effective when DRUJ stability is maintained 1
When Conservative Treatment Fails
Surgical intervention should be considered only after 3 months of failed conservative management with persistent or worsening symptoms. 1
Surgical Options Based on Pathology
- For peripheral tears with foveal disruption (Palmer 1B): Arthroscopic foveal repair with suture anchor is preferred, as it restores anatomic TFCC attachment critical for DRUJ stability 4, 5
- For central tears or degenerative lesions: Arthroscopic debridement of the torn tissue 6, 7
- For TFCC tears with ulnar positive variance: Ulnar shortening osteotomy (average 3mm) addresses the underlying mechanical cause 7
Post-Operative Protocol
- Immobilize forearm rotation for 4 weeks in neutral rotation with wrist in neutral position 4
- Begin gentle active wrist motion at 4 weeks post-operatively 4
- Progress to strengthening exercises at 8-12 weeks 4
- Allow return to heavy tasks and sports at minimum 3 months 4
- Obtain radiographs at 3 weeks post-operatively and at immobilization cessation to confirm healing 4
Diagnostic Imaging Considerations
- MR arthrography provides better diagnostic accuracy than standard MRI for TFCC tears when surgery is being considered 4
- 3.0T MRI without contrast has sensitivity of 63-100% and specificity of 42-100% for TFCC tears 4
- CT arthrography is superior to MRI and similar to MR arthrography for TFCC lesions 4
Common Pitfalls to Avoid
- Do not rush to surgery—conservative treatment achieves similar outcomes to arthroscopic debridement in stable DRUJ cases 1
- Do not overlook metabolic causes—TFCC calcification may represent CPPD disease requiring medical rather than surgical management 2
- Do not use intravenous colchicine if treating CPPD, due to high risk of serious toxicity 2
- Be aware that dorsal sensory branch of ulnar nerve neuroapraxia occurs in approximately 10% of surgical cases, though full spontaneous recovery is expected 4
- Immobilization-related complications occur in 14.7% of cases but are generally minor 4