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Outcome of conservative treatment for triangular fibrocartilage complex (TFCC) lesions in forceful hand-intensive tasks related injury: a case report

Triangular fibrocartilage complex (TFCC) is prone to injury when the wrist is forced into extension traumatically. Injuries and degenerative changes of the TFCC are a common cause of ulnar-sided wrist pain and disabilities and often are accompanied by swelling, clicking, decreased range of motion (ROM), supination-pronation pain, point tenderness and sometimes a palpable bump over the areas as well. The patient may also present with weakness in grip strength. Regarding management and evidence-based recommendations for the treatment of TFCC lesions, it remains controversial despite improvement in understanding and classification of these lesions. TFCC injury is common among athletes which can be injured in repetitive motion sports involving forced extension such as gymnastics, basketball, and martial arts. However, some epidemiological research associates the onset and severity of hand and wrist work-related musculoskeletal disorders with the performance of repetitive and forceful hand-intensive tasks. These disorders and injuries are worsened by the performance of such tasks in the presence of awkward or extreme wrist and forearm postures, cold temperatures, and vibration. In this case report, we will discuss a case of TFCC injury in a healthcare worker due to repetitive and forceful hand-intensive tasks in daily routine of operation theatre which was treated conservatively.

A 31-year old male, Operation Theare (OT) staff from a General Hospital in Selangor presented to the clinic with diffuse left ulnar sided wrist pain with limited ROM. He could not remember a particular injury that could have caused the initial pain, but it was getting worse upon transferring an obese patient during his duty in OT. The pain increased when he was trying to grip the patient upon transferring to stretcher. The press test positive over ulna side and ultrasound showed effusion at ulnar side of wrist joint. MRI Imaging revealed TFCC tear at foveal attachment. Patient was referred to physiotherapist and treatment consisted of grip strength exercises, active stretching and strengthening of the wrist and forearm.

After eight weeks of grip strength and wrist exercises, the patient reported no pain with all activities, including a full return to work duty in operation theatre. Grip strength was retested and increase in both right and left was present after the care plan period. The Fovea sign was negative for wrist pain.

TFCC injury associated with chronic wrist pain can be considered as part of work-related musculoskeletal disorders as they are caused by the chronic performance of highly repetitive hand-intensive tasks, especially those involving high levels of force especially in hospital setting. TFCC injury responded positively to a regimen of therapeutic exercise.

Triangular fibrocartilage complex (TFCC), work-related musculoskeletal disorders (WMSDs)