DRUJ/TFCC Injuries and Treatment-Case-TFCC Learning Module

Case-TFCC Learning Module

Pdf Summary

This case study discusses a 60-year-old right-handed male who experienced a painful "pop" in his right wrist while lifting a heavy box two weeks ago. He presents with persistent ulnar-sided wrist pain and a clicking sensation. The physical examination reveals positive "piano key" and foveal signs, increased palmar translation of the ulnar head, and pain with tabletop push-off. The patient undergoes three months of conservative management, including wearing a munster splint full-time for six weeks and then at night for six weeks. At the three-month mark, he still has persistent pain and clicking, so he is sent for an MRI. The MRI findings show a partial thickness tear involving the ulnar aspect of the TFCC. The options for treatment include open or arthroscopic repair. A diagnostic scope is performed, and the tear is debrided arthroscopically. However, due to the presence of instability on the exam, the decision is made for open repair. During the open repair, a radial-based flap is created, and the TFCC is repaired using Fiberwire. Capsular and retinacular closure is performed to supplement the repair. After the surgery, the patient undergoes rehabilitation, starting with gentle active range of motion exercises and wearing a splint. The splint is gradually discontinued, and strengthening exercises are started at eight weeks. The study concludes that conservative management is appropriate for most TFCC tears, and peripheral tears can be managed with arthroscopic or open repair with good outcomes. Radial and central tears are more commonly treated with arthroscopic debridement.

Keywords

TFCC tear

wrist pain

clicking sensation

ulnar-sided pain

MRI findings

conservative management

munster splint

arthroscopic repair

open repair

rehabilitation