Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain

Abstract

The purpose of this study was to evaluate treatment results following arthroscopic triangular fibrocartilage complex (TFCC) debridement for recalcitrant ulnar wrist pain. According to the treatment algorithm, 66 patients (36 men and 30 women with a mean age of 38.1 years (15 to 67)) with recalcitrant ulnar wrist pain were allocated to undergo ulnar shortening osteotomy (USO; n = 24), arthroscopic TFCC repair (n = 15), arthroscopic TFCC debridement (n = 14) or prolonged conservative treatment (n = 13). The mean follow-up was 36.0 months (15 to 54). Significant differences in Hand20 score at 18 months were evident between the USO group and TFCC debridement group (p = 0.003), and between the TFCC repair group and TFCC debridement group (p = 0.029). Within-group comparisons showed that Hand20 score at five months or later and pain score at two months or later were significantly decreased in the USO/TFCC repair groups. In contrast, scores in the TFCC debridement/conservative groups did not decrease significantly. Grip strength at 18 months was significantly improved in the USO/TFCC repair groups, but not in the TFCC debridement/conservative groups. TFCC debridement shows little benefit on the clinical course of recalcitrant ulnar wrist pain even after excluding patients with ulnocarpal abutment or TFCC detachment from the fovea from the indications for arthroscopic TFCC debridement.

A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear

“…13,15 (Table 3) The pre-operative radioulnar deviation was 43° (ones study). 13 The mean post-operative extension/flexion arc was 146° ± 18° with a range of 117°–163°, 7,12,13,15,22,25 the mean post-operative pronosupination arc was 161° ± 11° with a range of 152°–178° 7,12,13,15,22 , and the mean post-operative radioulnar deviation arc was 53° ± 5° with a range of 46°–58°. 7,12,13,19,22 These radioulnar deviation data are inclusive of all studies that presented post-operative arc of motion.…”

“…The mean pre-operative extension/flexion arc was 120° ± 3° with a range of 118°–122° 13,15 and the mean pre-operative pronosupination arc was 140° ± 14° with a range of 132°–152°. 13,15 (Table 3) The pre-operative radioulnar deviation was 43° (ones study).…”

“…5,6,16,19,20 Several studies included in this review used magnetic resonance imaging (MRI, 35%) to diagnose TFCC tear before performing arthroscopies. 13,15,21–24 However, the exact reason for MRI use was not reported in those studies.…”

“…13,14 Conversely, Nishizuka et al reported that TFCC debridement for stable central tear did not significantly improve grip strength and patient reported outcomes (PROs) at 18 months. 15 It was also reported that only 40% of patients with a degenerative TFCC tear associated with ulnar positive variance were satisfied. 16 …”

Conservative Treatment Is Sufficient for Acute Distal Radioulnar Joint Instability With Distal Radius Fracture

“…22 In addition, previous studies have reported that conservative treatment or arthroscopic debridement for damaged TFCC provided unsatisfactory clinical outcomes, or resulted in persistent symptoms, in more than half of the cases. 30,31 In contrast, a long-term follow-up study after conservative treatment for distal radius fracture reported that TFCC injury did not affect the final outcome. 32 Therefore, it appears that no study has accurately identified the recovery period that is needed to resolve a TFCC injury that caused DRUJ instability.…”