Small changes in ulnar length have been shown to have substantial effects on the amount of load to the ulna. If a TFCC injury is severe, it may require surgical intervention. Often times patients will do a trial of hand therapy to see if this can improve symptoms before surgery. The goal of TFCC therapy is to reduce pain and inflammation along with improving wrist mobility while maintaining stability and strength (Rehab Solutions, 2018). If the TFCC injury is recent, hand therapists may create a muenster splint to limit supination and pronation or wrist mobility while the TFCC injury heals for the first 6-8 weeks (Barlow, 2016). During the wrist immobilization stage, the client should be instructed on the importance of gentle ROM of the digits to increase blood flow and decrease edema. Typical therapy regimes may include the following. On exam, palpation of the TFCC is best with the wrist in pronation. It is between the flexor carpi ulnaris, ulnar styloid, and os pisiform. Several physical exam tests can suggest the diagnosis of TFCC injury. These include: Rehab Solutions. What is the TFCC? How do you treat it? Retrieved from https://rehabupracticesolutions.com/tfcc-treatment/ An injury or tear to the TFCC can cause chronic wrist pain. Sometimes called a wrist sprain, TFCC can be very painful and cause loss of motion. With TFCC, turning your wrist, pushing open a door, and pushing up from a chair, can cause your wrist to hurt.

Leger AB, Milner TE. , Muscle function at the wrist after eccentric exercise, Medicine and Science in Sports and Exercise, 2001;33:612–20. Limited range of motion in supination and pronation. If TFCC injury is severe, a client may present with limited wrist flexion and extension Treatment varies dependent on the severity of your injury but may involve wearing a splint, undergoing treatments such as electrotherapy to decrease pain and swelling, and performing stretching and strengthening exercises. When you do return to normal activity, your physiotherapist will be able to advise you on and provide you with protective equipment such as a wrist brace or strapping, if required, to prevent further injury. More recently Atzei 16 and colleagues have proposed as new classification system for peripheral TFCC tear with algorithm to decide appropriate treatment for each class of peripheral TFCC lesion. Their algorithm of treatment is based on clinical assessment of DRUJ instability by ballottement test classified as negative (stable), mild instability (hard end point, sever instability (soft end point),radiographic presence of ulnar styloid fracture (tip or basilar). The third component in evaluation and classification is by arthroscopy (both radio-carpal and DRUJ) and it findings are summarized according to the following four parameters:The TFCC is load-bearing, meaning that it remains under stress and has to bear weight often. It stabilizes the wrist and allows your wrist to bend in six different directions. This is why it’s frequently used.‌ Some types of splints will help stabilise the wrist, which will lead to an improvement in hand function. [17] Injury: The force of falling on your hand or wrist can tear your TFCC. A fall or other injury that fractures your radius can also tear your TFCC. A sudden twist of your arm that over-rotates your wrist can also cause a TFCC tear. Post-operative complications like infections, hypertrophic scar, tendon injury, nerve injury, reflex sympathetic dystrophy, and joint stiffness can occur with arthroscopic management. Another major risk is of iatrogenic instability following aggressive debridement and during wafer’s procedure.

Examination of a suspected TFCC injured patient requires careful palpation and application of few provocative tests. The patient must be seated in a relaxed environment and should be explained to report any discomfort or reproduction of symptoms during the process of examination. All tests must be performed on the uninjured limb first, this serves in two ways. One, it acts as a control for comparision, two, it alleviates apprehension in an anxious patient. The best outcomes with TFCC injuries will occur when other etiologies of ulnar-sided wrist pain are ruled out with initiation of conservative treatment. Recovery after surgery varies, but typically four to six weeks should be expected for arthroscopy and approximately three months for an open approach. Patients will undergo physical therapy after the procedure. The exact time to begin physical therapy and the length of physical therapy depends on the type of surgery performed and the surgeon’s preference. [2] A small longitudinal incision is made on the ulnar side of the wrist just anterior to extensor carpi ulnaris tendon, and blunt dissection is used to protect any branches of the dorsal ulnar sensory nerve within the field. The dissection is further carried down to the retinaculum.

Ulnar extensor or flexor muscle tendonitis: Movements that cause the muscle to fire will provoke the pain. Pain may radiate along the muscle belly depending on the degree of inflammation. For degenerative (type 2) TFCC tears surgery may be directed at shortening the ulna bone, if it is abnormally long, and tightening the ligaments. Shortening the ulna bone means cutting it with a saw, removing a few millimetres of bone, and then fixing the bone ends together using a plate and screws. Because the ulna bone is relatively close to the skin and often rests against surfaces (eg tables, desks, computer keyboards) it is common that the plate and screws are removed once the ulna has healed. Arthroscopic techniques to clean inside the joint and to remove a few millimetres of the tip of the ulna may also be used for type 2 TFCC tears. The last proactive test is called the “pressed” test. The client sits on a chair with hands grasping the edges of chair. The client is directed to weight bear on extended wrists as they push themselves up off of the chair. If pain in ulnar region occurs, the test is considered positive. The dry arthroscopy technique of joint exploration can be utilized to reduce soft tissue infiltration and swelling by the continuous leaking of saline through the portals. Supination test: Patient grabs the underside of a table with the forearms supinated; this causes a load on the TFCC and dorsal impingement, which will cause pain if there is a peripheral, dorsal tear.

During an arthroscopy, a surgeon will make a number of small incisions on the outer edge of the wrist, which allows them to repair the damage to the TFCC. Sometimes, they may also shorten the ulna to alleviate symptoms.

Neoprene Short Wrist Brace

There are some elements of the history which can occur in conjunction with individual sports, for example, baseball-specific acute injury can be due to forced wrist extension while doing a head-first slide or when a hitter attempts to hit an inside pitch and gets “jammed.” If there is a large tear to the central area of the TFCC then surgery is more likely to be required, as the central area has no blood supply and so has a much reduced capacity to heal. If non-surgical treatment is not successful then surgery is done arthroscopically (using a small telescope that is inserted inside the joint) and the tear is cleaned up (“debrided”). For management purposes we follow the Palmer classification. Initial treatment of all types of TFCC injury includes rest, activity modification, splint, physical therapy, and corticosteroid injections. In case of failure of conservative treatment to give relief or in tears with joint instability early surgical intervention is recommended. Choice of treatment is based on type of lesion and may include open or arthroscopic repair, arthroscopic debridement, ulnar shortening, and the Wafer procedure. Hagert E., Proprioception of the Wrist Joint: A Review of Current Concepts and Possible Implications on the Rehabilitation of the Wrist, Journal of Hand Therapy, 2010 Jan-Mar 23, 2-16 Initially, your physiotherapist can assess your wrist and the extent of the damage. This may require referral for an X-ray, CT or MRI scan, or referral to an orthopaedic surgeon. From this assessment, they can usually provide you with an estimation of how long the injury is expected to take to heal and devise an appropriate treatment plan.

Unlike many of our Body Helix products, the TFCC Wrist Brace needs to be hand washed and air dried to insure that the brace will remain stiff enough to offer the stabilization needed for the TFCC while it heals.This small but complex structure can tear easily as a result of a sudden impact or twisting injury. TFCC tears also happen more often in older adults, as the tissues that make up your TFCC break down and become thinner with age. This degeneration leaves your TFCC more vulnerable to tears. What causes a TFCC tear? In particular, unilateral isometric exercises are beneficial as they have been found to increase voluntary muscle activation bilaterally. This may be because the motor cortex is stimulated, resulting in greater neuromuscular control. [27] [28] In addition, controlled isometric activation of pronator quadratus in supination and neutral wrist position will help to stabilise the distal radioulnar joint (DRUJ). This can be used pre- and postoperatively in patients with TFCC injuries. [29] Isometric exercises should be included to help strengthen the area and reduce the risk of instability. [25] [26] Therapists are more likely to give eccentric grip strengthening exercises, because this will have an influence on the co-activation pattern of the wrist-flexors, which help stabilise the wrist. [20] [21] [22]