TFCC Tear/workers comp

[Mr. Night]

I have just been diagnosed with a TFCC tear and dealing with quite a bit of pain. Lucky for me, I'm right-handed. This injury occurred in an acute seforum.xxxe while at work so it is being filed with WC. Has anyone had similar experiences? Not quite sure what to expect...Just sitting in limbo. Any advice?

 

[Iqhwan]

TFCC Tear/workers comp

Welcome to the forums. Are you a therapist or a client? It may help us in knwing how to better help you.

 

[lightmn]

TFCC Tear/workers comp

I'm a therapist...6 years now

 

[Incense & Peppermints68]

TFCC Tear/workers comp

I don't have any advice as I've never injured anything at work. I've worked with WC patients/clients, but that's about it.

If I were damaged, I'd probably get a second opinion and definitely attend all of my rehab.

For anyone who doesn't know what a TFCC tear is: It is triangular fibrocartilage complex tear. The following is a little info I found in google, so it may help us discuss the injury with a little more knowledge.

I hope you get well soon! Since you are new to the boards, maybe it will give you extra time to read and comment on most everything at MassagePlanetL. We welcome comments to new and old threads!

TFCC Tear Etiology / Epidemiology / Natural History

• Generally occurs from fall on an outstretched arm with the wrist extended and the forearm pronated.

TFCC Tear Anatomy

• TFCC consists of: triangular fibrocartilage disk, dorsal and palmar radioulnar ligaments, the meniscus homologue, and sheath of the extensor carpi ulnaris. (Palmar Ak, J Hand Surg 1981;6Am:153)
• Origin = the junction of the lunate fossa and the sigmoid notch. Insertion = the base of the ulnar styloid.
• Central 80% of the articular disk is avascular. The remainder of the TFCC is vascular, being supplied by branches of the anterior interosseous artery, ulnar artery, and the medullary interosseous arteries that penetrate throught the ulnar head. (Bednar MS, J Hand Surg 1991;16Am:1101)

TFCC Tear Clinical Evaluation

• Pain +/- snapping localized to the radioulnar joint examassageplanetated by forearm rotation.
• The ulnar head is prominent dorsal, with the forearm in pronation, as compared to the normal side.
• Piano key sign=patient actively tries to force pisiform into the table using entire extremity. Distal ulna moves dorsally like a piano key indicating DRUJ instability +/- TFCC tear. Compare to uninjured side.
• TFC tenderness=with forearm in neutral palpate area proximal to pisiform between FCU and ulna styloid. Pain indicates TFC injury.
• Press-test : patient pushes themself up from a seated position with the affected wrist. Pain suggests that a lesion in the triangular fibrocartilage complex. (Lester B, Ann Plast Surg. 1995;35:41)
• Shuck test: With the patient’s forearm in supination, the examiner should holds the distal part of the ulna between the thumb and index finger and tests for dorsal and volar displacement of the distal part of the ulna. Increased laxity as compared to the normal side indicates DRUJ instability/peripheral TFCC tears.

TFCC Tear Xray / Diagnositc Tests

• P/A and lateral wrist xrays
• Fleck fracture at the base of the ulnar styloid/ulnar fovea indicates TFCC avulsion.
• Ulnar variance: determined on neutral rotation P/A view. Positive ulnar variance increases with power grip and pronation. Consider pronated grip view. (Tomaino MM, J Hand Surg 2000;25Am:352). Normal = neutral (articular surface of distal ulna and radius equal). Postive (ulna longer) associated with ulnocarpal impaction, lunotriquetral ligament injurie and TFCC tears. Negative (ulna shorter) associated with carpal instability, Keinbock's disease.
• MRI: 90% accuracy. (Golimbu CN, Radilogy 1989;173:731)
• Triple-injection arthrography (Levinsohn EM, Radiology 1991;179:231)

TFCC Tear Classification / Treatment

• Palmer's Classification (Palmar AK, J Hand Surg 1989;14A:594)
• Usually occur in the avalscular origin from the radius. Arthroscopid debridement is treatment of choice. Central 2/3 of articular disc may be removed without affecting stability as long as palmar and dorsal radiocarpal ligaments are intact. 73% complete resolution of pain (Osterman, Arthroscopy 6:120;1990)
• TFCC repair: dorsal incision through the fifth compartment. Reflect extensor digiti minimi radially and the extensor carpi ulnaris ulnarly, TFCC and visualizing the dorsal radioulnar ligament. Repair using nonabsorbable sutures. (Hermansdorfer JD, J Hand Surg 1991;16Am:340)

TFCC Tear Associated Injuries / Differential Diagnosis

• Distal radius fracture
• Ulnar styloid fracture

 

[Mary Boo]

TFCC Tear/workers comp

I had an MRI which confirmed the dr. diagnosis. Thanks for the info! I am hesitant to have any kind of procedure and aside from rest, nothing else was recommended. I see the doc again at the beginning of jan and will reassess then. The discomfort even after 3 weeks of rest is a bit of an annoyance....especially being off of work thru the holidays.