Journal Club Discussion #19: Triangular Fibrocartilage Complex Injury

Hey readers! This week’s Journal Club Discussion is a little different. I was recently asked some advice on what to do for an injury to the triangular fibrocartilage complex (TFCC). I guess as an OT student, people think I have answers to this kind of question! I decided to make this the topic of our discussion this week, because I’d love to be able to offer some *unofficial* advice to this person. So, if any practitioners (especially Certified Hand Therapists!) have knowledge regarding treatment for a TFCC injury, please comment below!

Unfortunately, I had a difficult time finding a reliable journal article about occupational therapy intervention for the TFCC. So, I resorted to searching Google for the answers. Here is what I found:

The TFCC

The TFCC is a collection of ligaments and cartilage that connect the radius, ulna and carpal bones. This allows and restricts motion at the wrist. Here is a photo of a common TFCC injury (sprain or tear). Injuries can be traumatic or degenerative. In the case of the person who asked for my advice, his injury is most likely traumatic resulting from lifting heavy boxes while moving. TFCC injuries likely result in pain and/or weakness on the ulnar side (pinky-side) of your wrist and pain with ulnar deviation and heavy lifting.

Photo via Lex Medicus

Treatment Methods

Splinting

The Muenster Splint is likely to be the most effective for this kind of injury. Since the TFCC is located between the radius and ulna at the distal radial ulnar joint (DRUJ), we want to prevent pronation and supination from occurring there, as these motions cause the radius to rotate around the ulna and likely pull on these ligaments. We also want to prevent other motions such as radial and ulnar deviation, flexion, and extension at the wrist. From my research, I believe that you should immobilize the TFCC for 6-8 weeks following injury. This allows time for the ligament(s) to heal.

There are lots of prefabricated splints online, but none that really do what a Muenster Splint would do. We want to immobilize the DRUJ and the elbow, but most of the splints that I found online only do one of these jobs. You can probably try a prefabricated splint, but seeing an OT who can make you a custom orthosis that fits you perfectly and does what it is supposed to do is your best bet.

Strengthening

It is also important to strengthen the forearm, wrist, and hand once the injury is healed. You can do this using exercises with and without putty. You should also work on pinch strength.

Range of Motion

Since the Muenster Splint immobilizes the elbow, we want to resist stiffness and maintain ROM at the elbow. This will be very important in maintaining function. Once the injury is healed, you will also want to slowly start stretching the wrist and hand to preserve ROM there as well for functional activities.

OT’s Role

The best thing that anyone with a TFCC injury can do is see a professional OT, specifically a CHT if possible. Once diagnosed with this injury, the person likely needs a custom orthosis made to resist motion at the DRUJ and elbow. Then, an OT can prescribe strengthening and ROM exercises to regain function in the hand and wrist.

Question of the Week: Calling all CHTs! What is your advice for this person?

Citations: Lex Medicus (n.d.). Triangular Fibrocartilage Complex Injury. Retrieved from http://pathologies.lexmedicus.com.au/pathologies/triangular-fibrocartilage-complex-injury

Orfit (n.d.). Splint in the spotlight – Orthoses to prevent full forearm rotation: The muenster orthosis and the sugar tong orthosis. Retrieved from https://www.orfit.com/blog/splint-in-the-spotlight-orthoses-to-prevent-full-forearm-rotation-the-muenster-orthosis-and-the-sugar-tong-orthosis/

Disclaimer: I am not a professional occupational therapist or certified hand therapist. I found this information online and drew conclusions that way. Do not do any of these suggestions without consulting a doctor and/or OT first.

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