From the Guidelines
Management of TFCC injuries should prioritize conservative treatment, including immobilization and physical therapy, with surgical intervention reserved for cases with unstable tears or those that fail conservative management, as supported by the most recent evidence from 2024 1. The treatment approach for TFCC injuries depends on various factors, including tear classification, location, and stability.
- Conservative treatment is recommended for most cases, including:
- Immobilization with a wrist splint or cast for 4-6 weeks
- NSAIDs like ibuprofen (400-600mg three times daily) for pain and inflammation
- Activity modification to avoid wrist loading
- Physical therapy focusing on wrist strengthening and range of motion exercises should follow immobilization.
- For persistent symptoms, corticosteroid injections may provide temporary relief.
- Surgical intervention is indicated for patients who fail conservative management after 3-6 months or have unstable tears.
- Arthroscopic debridement is preferred for central tears, while peripheral tears often require repair to restore stability.
- Post-surgical rehabilitation includes immobilization for 4-6 weeks followed by gradual return to activities over 3-4 months. The use of imaging modalities such as MR arthrography 1 and CT arthrography 1 can aid in the diagnosis and assessment of TFCC injuries, with MR arthrography providing better diagnostic accuracy for the determination of scapholunate interosseous ligament tears and CT arthrography demonstrating high sensitivity and specificity for triangular fibrocartilage complex tears.
- MR arthrography has a higher sensitivity and specificity for the detection of scapholunate ligament injury, lunotriquetral ligament injury, and TFC injury 1.
- CT arthrography allows direct visualization of full thickness ligament tears and visualization of partial thickness tears of the appropriate compartment 1. Early diagnosis and appropriate management are crucial to prevent chronic wrist instability and degenerative changes, as highlighted in the 2023 update of the ACR Appropriateness Criteria for chronic hand and wrist pain 1.
From the Research
Management of TFCC Injury
- The management of TFCC injuries can be divided into conservative and surgical treatments 2.
- Conservative management includes modification of daily activities, temporary splint or cast immobilization, non-steroidal anti-inflammatory medication, and corticosteroid injections, often used in conjunction with physical therapy 2.
- Surgical treatment is considered if conservative management fails to provide relief, or in cases presenting with frank instability of the DRUJ or unstable and displaced fractures 2.
- The choice of operative treatment is guided by the type and extent of injury and may include debridement, repair, and ulnar unloading procedures like shortening or Wafer procedure 2.
Arthroscopic Management
- Arthroscopic management can be instituted successfully in most TFCC injuries, with the current understanding of arthroscopic anatomy of the wrist and availability of instrumentation 2.
- A study on the effectiveness of platelet-rich plasma (PRP) injection as an adjunct treatment to arthroscopy for TFCC injury found that PRP injections did not improve function over repair alone 3.
- Another study on the use of a novel brace as a non-surgical intervention for TFCC tears reported significant improvements in functional status and upper extremity use 4.
Surgical Repair
- Open TFCC reinsertion has been shown to improve function and reduce pain in patients with TFCC injuries, with clinically significant improvements reported in 80% of patients three and 12 months postoperatively 5.
- Surgical repair of acute TFCC injury can be performed using open or arthroscopic techniques, with both offering improvements in objective measures and patient-centered outcome scores 6.
- Recently developed knotless arthroscopic techniques may limit morbidity, but require further study 6.