General Guideline Principles for Triangular Fibrocartilage
Complex (TFCC) Tears for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Triangular Fibrocartilage Complex (TFCC) Tears.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Triangular Fibrocartilage Complex (TFCC) Tears

Triangular fibrocartilage complex (TFCC) rips are common wrist injuries affecting the cartilaginous meniscus between the radius and ulna. The ulnar side of the wrist joint is frequently characterised as having symptoms.

Physical Exam of Triangular Fibrocartilage Complex (TFCC) Tears

A dorso-ulnar wrist joint that is not focally sensitive over an extensor compartment may be seen during the examination. Although it could be present with an acute, major tear, swelling is typically absent. In general, the examiner should try to simulate catching or snapping in the ulnar wrist joint.

Medical History of Triangular Fibrocartilage Complex (TFCC) Tears

Patients frequently express discomfort and clicking on the ulnar side. It’s critical to link the physical examination with the mechanism of injury because MRI studies indicate that TFCC rips are both common and appear to be frequently without symptoms. Axial loading with ulnar deviation often makes discomfort worse. A

With forearm rotation (supination/pronation), the “click” or “clunk” in the ulnar wrist joint can be mimicked. In occupational cases, symptoms often begin after a specific traumatic event, like a fall.

Ulnar wrist joint pain and a catching, cracking, or popping sensation in the wrist with movement should be mentioned in the history. These symptoms should be replicated during the physical examination.

Initial Assessment of Triangular Fibrocartilage Complex (TFCC) Tears

Finding out if the TFCC is extensively ripped and, if so, if it is symptomatic enough to call for intervention is the main goal of the patient history (s). The most typical strategy is often to follow the patient’s symptoms for healing without immediate surgical intervention. Some don’t heal, exhibit symptoms longer, and respond well to surgical correction or removal.

Diagnostic Studies of Triangular Fibrocartilage Complex (TFCC)

1. Diagnostic Studies of Triangular Fibrocartilage Complex (TFCC) Tears X-raysDiagnostic Studies of Triangular Fibrocartilage Complex (TFCC) Tears X-rays are recommended to determine if there are TFCC (triangular fibrocartilage complex) tears.

   Indications – TFCC tear suspected, or to rule out other potential causes of wrist pain

   Frequency/Duration – Typically, one set of x-rays is enough.

    

2. MRI
   MRI is recommended triangular fibrocartilage complex (TFCC) tears to be diagnosed

    

3. Arthroscopy
   Arthroscopy is recommended In certain patients with persistent wrist discomfort that is refractory to conservative treatment and in whom the MRI does not identify the cause.

Medications of Triangular Fibrocartilage Complex (TFCC) Tears

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients.
For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs. There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic TFCC Tears

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic TFCC Tears are recommended for the treatment of recent, recurring, or acute TFCC tears.

   Indications – NSAIDs are suggested as a treatment for TFCC tears that are acute, subacute, or chronic. First, try over-the-counter (OTC) medications to see whether they work.

   Frequency/Duration: For many patients, use as necessary may be acceptable.

   Indications for Discontinuation: the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

   Indications: the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

   Frequency/Dose/Duration: Misoprostol, proton pump inhibitors,

   Sucralfate and H2 blockers are advised. dosage and repetitions per manufacturer. Most people think there aren’t any significant distinctions. in their ability to stop gastrointestinal bleeding.

   Indications for Discontinuation: Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   The risks and advantages of NSAID therapy for pain should be considered with patients who have known cardiovascular illness or numerous risk factors for cardiovascular disease.

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as harmful cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

      

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

     To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

4. Acetaminophen for Treatment of TFCC Tears Pain

   Acetaminophen for Treatment of TFCC Tears Pain is recommended for the treatment of TFCC tear pain, especially in individuals who have NSAID contraindications

   Indications: All TFCC tear patients experience pain, including post-operative, chronic, and acute types.

   Indications for Discontinuation: pain, side effects, or intolerance are gone.

5. Opioids

   Opioids are not recommended for TFCC tears that are either chronic or subacute.

   Opioids is recommended for brief (no longer than seven days) usage as an adjuvant therapy to more potent therapies for postoperative pain control.Indications: A brief prescription of opioids is frequently needed for post-operative pain management as an addition to more effective medications (particularly NSAIDs, acetaminophen), especially at night.

   Frequency/Duration: As needed during the day, solely at night thereafter, and finally completely discontinued.

   Rationale for Recommendation: When NSAIDs are ineffective in relieving a patient’s pain, opioids should be used sparingly, especially at night. Opioids are advised for brief, selective usage in postoperative patients, with nighttime use being the main recommendation for achieving postoperative sleep.

Rehabilitation of Triangular Fibrocartilage Complex (TFCC) Tears

If rehabilitation (supervised formal therapy) is necessary as a result of a work-related injury, it should be concentrated on restoring the functional ability needed for the patient to engage in daily activities and return to work; insofar as possible, the goal should be to return the injured worker to their pre-injury status.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side. Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Over passive interventions, active initiatives should be prioritised.

To sustain improvement levels, the patient should be advised to continue both active and passive therapies at home as an extension of the therapeutic process.

To facilitate functional gains, assistive devices may be used as an adjuvant measure in the rehabilitation strategy.

Therapy: Active

Therapeutic Exercise

Therapeutic Exercise is recommended for select patients

Therapeutic Exercise is recommended Phase of Recuperation/Post-Operative

Rationale for Recommendation – In general, acute activity is not recommended; however, recuperation or post-operative stages may require exercise. Increased grip strength, critical pinch strength, range of motion, and the development of work skills should all be considered functional goals.

Frequency/Dose/Duration – With verification of continued objective functional progress, the total number of visits may be as low as two to three for individuals with minor functional deficits or as high as 12 to 15 for those with more severe deficits.

If there is evidence of functional improvement toward particular objective functional goals (e.g., enhanced grip strength, key pinch strength, range of motion, or improving capacity to execute work activities), more than 12 to 15 visits may be necessary to address persistent functional impairments.

A home exercise regimen should be created as part of the rehabilitation strategy and carried out alongside the therapy.

Therapy: Passive

1. RICE (Rest, Ice, Compression, Elevation)

   RICE (Rest, Ice, Compression, Elevation) is recommended Arelative period of rest for treating acute, triangular fibrocartilage complex, whether subacute or chronic (TFCC)

   Rationale for Recommendation – The necessity for surgery may be avoided by relative rest. With more severe symptoms in particular, ice and heat may be beneficial. Symptomatic alleviation may be facilitated by these treatments.

    

2. Cryotherapy / Heat

   Cryotherapy / Heat is recommended Using ice on oneself to treat acute, subacute, or chronic rips of the triangular fibrocartilage complex (TFCC).

    

3. Self-Application of Heat

   Self-Application of Heat is recommended for the treatment of triangular fibrocartilage complex (TFCC) rips that are either acute, subacute, or chronic

.
Immobilization

Immobilization is recommended Splinting is used to treat mild to severe acute or subacute rips of the triangular fibrocartilage complex (TFCC), especially to lessen forearm rotation.

Rationale for Recommendations – Wrist splints may aid in avoiding actions or activities that aggravate symptoms, making them more suitable for moderate-to-severe or acute injuries.

Surgery of Triangular Fibrocartilage Complex (TFCC) Tears

1. Surgical Repair (Arthroscopic or Open Surgical Repair)

   Surgical Repair (Arthroscopic or Open Surgical Repair) is recommended for a small number of patients who have instability, concurrent fractures, or symptoms that don’t seem to be getting better after 3 to 6 weeks of nonoperative care.

   Rationale for Recommendation – Although open repairs are also possible, arthroscopic procedures are more frequently done.

    

2. Ulna Shortening and Wafer Procedures for Chronic Triangular Fibrocartilage Complex (TFCC) Tears

   Ulna Shortening and Wafer Procedures for Chronic Triangular Fibrocartilage Complex (TFCC) Tears is recommended for certain chronic rips if non-surgical therapy is ineffective and there is a clearly visible ulna positive variation

   Reason for Recommendation In a few patients with ulna positive variance, this surgery is advised if significant or incapacitating symptoms have not abated or have not shown any signs of improvement.

What our office can do if you have Triangular Fibrocartilage Complex (TFCC) Tears

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

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