From the Guidelines
Treatment for triangular fibrocartilage complex (TFCC) injuries should begin with conservative measures, including rest, ice, and anti-inflammatory medications, and may progress to surgical intervention if necessary, with diagnostic imaging such as MR arthrography or CT arthrography playing a crucial role in guiding treatment decisions 1. When considering treatment for TFCC injuries, it's essential to prioritize a step-wise approach, starting with non-invasive methods to manage pain and promote healing.
- Resting the wrist and applying ice for 15-20 minutes several times daily can help reduce pain and swelling.
- Over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily) can be used to reduce pain and inflammation.
- A wrist splint or brace should be worn for 4-6 weeks, especially during activities that cause pain, to provide support and stability to the wrist.
- Physical therapy focusing on wrist strengthening and range-of-motion exercises is often recommended once pain subsides to improve wrist function and prevent further injury. For persistent symptoms, a corticosteroid injection may provide relief, and in cases where conservative treatment fails, surgical intervention may be necessary, either through arthroscopic repair or open surgery 1. The choice of diagnostic imaging, such as MR arthrography or CT arthrography, is critical in guiding treatment decisions, with MR arthrography providing better diagnostic accuracy for the determination of scapholunate interosseous ligament tears and TFCC injury 1, and CT arthrography demonstrating high sensitivity and specificity for triangular fibrocartilage complex tears and articular cartilage abnormalities 1. In terms of diagnostic imaging, MR arthrography is recommended for suspected intrinsic ligament injury, TFC complex injury, cartilage abnormality, or surgical planning, with a sensitivity and specificity for TFC tears ranging from 63% to 100% and 89% to 97%, respectively 1. Similarly, CT arthrography is supported for the assessment of clinically suspected scapholunate instability and cartilage defects, with a sensitivity, specificity, and accuracy between 92% and 94% for triangular fibrocartilage complex tears 1. Ultimately, the treatment approach should be individualized based on the severity of the injury, patient symptoms, and diagnostic imaging findings, with the goal of minimizing morbidity, mortality, and improving quality of life 1.
From the Research
TFCC Treatment Options
- Conservative treatment is a sufficient and reliable option for TFCC lesions with stable distal radioulnar joint, as demonstrated by a study published in 2021 2.
- A comparative study between conservative and surgical treatments of TFCC injury of the wrist with distal radius fractures found no statistically significant differences in clinical outcomes between the two groups 3.
- Surgical treatment may be necessary for TFCC disruptions that result in distal radioulnar joint instability, with repair of the articular disk and adjacent ligaments being a common approach 4.
Treatment Considerations
- The management of TFCC injuries in professional athletes requires a detailed understanding of the pathology and the athlete's specific needs and goals 5.
- Conservative measures are often used as first-line treatment for TFCC injuries, with arthroscopic procedures planned when indicated to allow for early diagnosis and treatment 5.
- The Palmer classification is typically used to define injuries to the TFCC, with the critical distinction being between injuries that produce instability of the distal radioulnar joint and those that do not 6.
Surgical Strategies
- Surgical strategies for TFCC injuries include débridement, acute repair, and subacute repair, with most procedures being performed arthroscopically 6.
- Open ligament repair may be needed in the setting of distal radioulnar joint instability 6.
- Arthroscopic repair is used for peripheral lesions, while central lesions are treated with arthroscopic debridement 5.