Triangular Fibrocartilage Complex (TFCC) - Anatomy, Imaging, and Classifications with Special Focus on the CUP Classification.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare that they have no conflict of interest. 6. Hand Ther. 2021 Dec;26(4):123-133. doi: 10.1177/17589983211033313. Epub 2021 Jul 27. Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries. Chen Z(1). Author information: (1)Occupational Therapy Department, Singapore General Hospital, Singapore, Singapore. INTRODUCTION: Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. METHODS: Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the 'push-off' test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. RESULTS: Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen's D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. DISCUSSION: WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups. © The Author(s) 2021. DOI: 10.1177/17589983211033313 PMCID: PMC10584051