Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint

Abstract

Purpose Triangular fibrocartilage complex (TFCC) lesions have high clinical relevance. Although multiple studies have been done in the past, there is a lack of data after conservative treatment and controversy remains regarding management. The purpose of this study was to compare the outcome of symptomatic TFCC lesions after conservative treatment and arthroscopic debridement. Methods Between 2012 and 2017, 33 patients were included. 16 patients were treated conservatively and 17 patients with arthroscopic debridement. The average age was 41 years (range 18-63). The mean follow-up was 22.2 months (range 6-74). Evaluation included pain, range of motion (ROM), grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Modified Mayo Wrist Score (MMWS), and Purdue Pegboard test. Results Pain averaged 0.1 (range 0-1) in the conservative group compared to 1.3 (range 0-6) in the arthroscopic group. The mean ROM was 99% for wrist extension, and 100% for flexion and pro-/supination in the conservative group, and 96% for extension and flexion, and 100% for pro-/supination in the arthoscopic group compared to the contralateral side. Grip strength was 88% (range 63-100) in the conservative group versus 89% (range 33-100) in the arthroscopic group. The conservative group reached a DASH score of 16.8 and MMWS of 94.3 compared to 22.1 and 87.2 in the arthroscopic group. The differences were not statistically significant. Conclusions Our study demonstrated similar results of conservative compared to arthroscopic treatment. Because conservative treatment was a sufficient and reliable option, we propose it as first-line treatment for TFCC lesions with stable distal radioulnar joint.

Increase of weight-bearing capacity of patients with lesions of the TFCC using a wrist brace

“…9 In patients with stable DRUJ, a conservative treatment with splinting and pain medication showed comparable results to the arthroscopic treatment. 10 From our experience, pain during axial load is a major cause for inability to work in patients with either traumatic or degenerative lesions of the TFCC. Conventional wrist splints decrease initial pain sufficiently but also prevent any movement during recovery.…”

The Natural History of Non-operatively Treated Traumatic Triangular Fibrocartilage Complex Tears: A Systematic Review

“…The search strategy identified eight studies [10][11][12][13][14][15][16][17] which were appropriate for inclusion and analysis.…”

“…There was one randomized controlled trial, 13 four comparative studies, 12,[15][16][17] and three noncomparative studies. 10,11,14 Five studies 12,[14][15][16][17] had retrospective data collection, while three studies 10,11,13 outlined their study focus prior to performing prospective data collection. The in-depth study characteristics and results are summarized in ►Table 2.…”

Rehabilitation in Triangular Fibrocartilage Complex Injuries: Treatment Algorithm

“…A partir de la sexta semana , se introducen ejercicios de carga completa: 24 prensa y apoyo palmar específico. Como la sintomatología se prolongue por más de tres meses, puede ser el momento de plantearse la posibilidad de intervención quirúrgica.…”

“…By the sixth week , we introduce full-load exercises 24 specific for apprehension and palmar support. If symptoms last more than three months, it may be time to consider surgical intervention.…”