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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.
Above: Functional rehabilitation exercises for the hand and wrist guided by a specialist physiotherapist DRUJ chondral lesions or osteoarthritis: Differentiate via radiographic evidence suggestive of a chondral lesion or osteoarthritis. The extensor carpi ulnaris relies on the TFCC for movement, and thus alteration of the motion of the extensor carpi ulnaris may lead to abnormal force through the TFCC, predisposing it to injury [2] Surgical options should be a consideration if conservative treatment fails or if there is DRUJ instability. Surgical treatment will depend on the Palmer classification of the injury [11]
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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.
In gymnastics the TFCC can be injured through overuse injury (both support skills and hanging elements). With repetitive weight bearing (both compressive and tensile), this area can become inflamed and tendonitis/tendonosis can develop in the anchoring wrist ligaments (often misdiagnosed as a wrist sprain). [7]
As with any health concern, it’s always recommended that you consult with your health care provider provider to find out why your wrist hurts and the recommended treatment. Applying ice and taking anti-inflammatory medication such as aspirin, ibuprofen, or naproxen can help with the pain and swelling. Resting your hand in a wrist brace or splint is important for healing and can help prevent further injury. Wrist Braces can be worn during the day and at night. In severe cases, surgery may be recommended. An X-ray is unable to detect soft tissue but may provide insight with fractures and abnormalities within the wrist and may correlate with a TFCC injury. TFCC stress test: applying a force across the ulna with the wrist in ulnar deviation reproduces symptoms Corticosteroid injections or platelet rich plasma therapy can also be utilized in recalcitrant cases. Physical therapy to prevent stiffness and gain range of motion is instituted once discomfort due to acute trauma or inflammation has subsided. Strengthening exesices are usually begun after 6 weeks of successful recovery.
The Palmer classification is the most recognized scheme for TFCC lesions ,It divides them into these two categories (with subdivisions, beyond the scope of this articles):Wrist with positive ulnar variance are vulnerable to TFCC injury. Palmer and Werner demonstrated that ulnar variance decreases with supination and increases with pronation. Substantial changes in amount of ulnar load have been observed small changes of ulnar length. 2 The extensor carpi ulnaris sub-sheath which is a component of the TFCC, is important as pulley for wrist ulnar extensors, and thus any deviation of vector of pull of extensor carpi ulnaris tendon can put abnormal forces across the dorsal aspect of the TFCC, predisposing same to injury. 3
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