Early outcomes of a post-operative protocol allowing immediate forearm rotation and graduated wrist motion at 2 weeks, following dorsal peripheral TFCC repair

To provide a protocol of post-operative rehabilitation following dorsal peripheral TFCC repair that allows immediate forearm rotation and graduated wrist motion exercises from 2 weeks as guided by a hand therapist. This protocol allows greater proprioceptive input, improved scar mobility and earlier resumption of functional use.

X patients with a TFCC type 1B injury were arthroscopically repaired with a double strand (2/0 vicryl) dorsal peripheral repair between March 2023 and June 2024. Patients were treated post operatively in a forearm-based wrist immobilisation orthosis with forearm rotation commenced day 1 followed by a graduated wrist active range of motion (AROM) program at 2 weeks. Progression of wrist arom was guided by a trained hand therapist and increased by 15 degrees weekly, within patient comfort. Unrestricted AROM of the wrist and forearm, were approved at 4 weeks and a wean from orthosis wear at 6 weeks post operatively. Proprioceptive and targeted isometric exercises of distal radio-ulna joint stabilizers were commenced 1 week post operatively. Outcome measures included the verbal numerical rating score, arom, the Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), gross grip, weight bear, lateral pinch, and supination/pronation strength.

Preliminary results demonstrate an improvement across all outcome measures at 5 months post-surgery. All X patients achieved greater wrist extension and flexion and improved strength in comparison with pre-operative measures. Average self-rated performance measures, the DASH (X) and PRWE (X) demonstrated improved occupational participation with an initial measure of 65.83 and 60.647, respectively. All repairs were assessed by the surgeon as stable with nil failures reported.

Preliminary results show that TFCC peripheral repairs can be safely treated in a below elbow orthosis, allowing forearm rotation from day one post operatively, followed by graduated wrist active range of motion at 2 weeks. Full wrist and functional forearm rotation were achieved along with reduced pain and improved functional participation by X months post operatively.

Keywords: TFCC, therapy