Download PDF
CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2022; 50(01): e49-e59
DOI: 10.1055/s-0042-1748854
Update Article | Artículo de Actualización

Rehabilitation in Triangular Fibrocartilage Complex Injuries: Treatment Algorithm

Article in several languages: English | español
Eva Guisasola Lerma 
1   Hand and Upper Limb Surgery Unit, Hospital QuirónSalud Valencia, Valencia, Spain
,
Francisco Javier Lucas Garcia
2   Hospital QuirónSalud Valencia, Valencia, Spain
,
Alberto Márquez Caraballo
3   Hospital QuirónSalud Valencia, Valencia, Spain
,
David Santosjuanes Royo
3   Hospital QuirónSalud Valencia, Valencia, Spain
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Injuries to the triangular fibrocartilage complex (TFCC) can lead to instability of the distal radioulnar joint (DRUJ). In fact, they are the most frequent cause of it. But, in other cases, depending on the type of injury, the DRUJ remains stable. This will condition different types of treatments, from conservative management to the different options of surgical treatment. Since a controversy persists regarding the management of these lesions, our purpose is to disclose the foundations of the rehabilitation treatment and propose an algorithm of treatment according to the different types of injuries and their repairs.

Keywords

distal radioulnar instability - neuromuscular control - dynamic stabilizers - exercise program - orthosis


Publication History

Received: 12 March 2022

Accepted: 22 March 2022

Article published online:
23 June 2022

© 2022. SECMA Foundation. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Atzei A. DRUJ instability: arthroscopic ligament reconstruction. In: Del Piñal F, Manthoulin C, Lucheti R. eds. Arthroscopic Management of ulnar pain. Berlin: Springer Verlag; 2012: 147-160
    Search in Google Scholar
  • 2 Carratalá Baixauli V, Lucas García FJ, Martínez Andrade C, Carratalá Baixauli R, Guisasola Lerma E, Corella Montoya F. All-arthroscopic triangular fibrocartilage complex. Ligamentoplasty for chronic DRUJ instability. Tech Hand Up Extrem Surg 2019; 23 (01) 44-51
    CrossrefPubMedSearch in Google Scholar
  • 3 Schädel-Höpfner M, Müller K, Gehrmann S, Lögters TT, Windolf J. [Therapy of triangular fibrocartilage complex lesions]. Unfallchirurg 2012; 115 (07) 582-588
    CrossrefPubMedSearch in Google Scholar
  • 4 Mirghasemi AR, Lee DJ, Rahimi N, Rashidinia S, Elfar JC. Distal radioulnar joint instability. Geriatr Orthop Surg Rehabil 2015; 6 (03) 225-229
    CrossrefPubMedSearch in Google Scholar
  • 5 William B. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 2007; 32 (07) 1086-1106
    CrossrefPubMedSearch in Google Scholar
  • 6 Moritomo H. The distal oblique bundle of the distal interosseous membrane of the forearm. J Wrist Surg 2013; 2 (01) 93-94
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Watanabe H, Berger RA, An KN, Berglund LJ, Zobitz ME. Stability of the distal radioulnar joint contributed by the joint capsule. J Hand Surg Am 2004; 29 (06) 1114-1120
    CrossrefPubMedSearch in Google Scholar
  • 8 Morrey B, An KN. Stability of the elbow oseous constraints. J Shoulder Elbow Surg 2005; 14 (1 Suppl S): 174S-178S
    CrossrefPubMedSearch in Google Scholar
  • 9 Manson TT, Pfaeffle HJ, Herdon JH, Tomaino MM, Fischer KJ. Forearm rotation alters interosseous ligament strain distribution. J Hand Surg Am 2000; 25 (06) 1058-1063
    CrossrefPubMedSearch in Google Scholar
  • 10 Spinner M, Kaplan EB. Extensor carpi ulnaris. Its relationship to the stability of the distal radio-ulnar joint. Clin Orthop Relat Res 1970; 68 (68) 124-129
    PubMedSearch in Google Scholar
  • 11 Stuart PR. Pronator quadratus revisited. J Hand Surg [Br] 1996; 21 (06) 714-722
    CrossrefPubMedSearch in Google Scholar
  • 12 Esplugas M, García-Elías M. Terapia de Mano basada en el razonamiento y la práctica clínica. Biomecánica del antebrazo y aplicaciones prácticas. 2020. Sevilla: Universidad Internacional de Andalucia; 2020
    Search in Google Scholar
  • 13 Bonhof-Jansen EDJ, Kroon GJ, Brink SM, van JHUchelen. Rehabilitation with a stabilizing exercise program in triangular fibrocartilage complex lesions with distal radioulnar joint instability: A pilot intervention study. Hand Ther 2019; 24 (04) 116-122
    CrossrefPubMedSearch in Google Scholar
  • 14 Esplugas M, Llovet VA. Lesiones del complejo del fibrocartílago triangular. Tipos de reparación. Rev Esp Artrosc Cir Articul. 2014; 21 (01) 14-27
    CrossrefPubMedSearch in Google Scholar
  • 15 Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin 2011; 27 (03) 263-272
    Search in Google Scholar
  • 16 Bachinskas AJ, Helsper EA, Morris HA, Hearon BF. Nonsurgical treatment for acute posttraumatic distal radioulnar joint instability: a case series. J Hand Surg Global Online 2020; 2 (01) 35-41
    CrossrefPubMedSearch in Google Scholar
  • 17 Magnus CR, Arnold CM, Johnston G, Haas VDB, Basran J, Krentz JR, Farthing JP. Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial. Arch Phys Med Rehabil 2013; 94 (07) 1247-1255
    CrossrefPubMedSearch in Google Scholar
  • 18 Mesplié G, Grelet V, Léger O, Lemoine S, Ricarrère D, Geoffroy C. Rehabilitation of distal radioulnar joint instability. Hand Surg Rehabil 2017; 36 (05) 314-321
    CrossrefPubMedSearch in Google Scholar
  • 19 Hagert E, Hagert CG. Understanding stability of the distal radioulnar joint through an understanding of its anatomy. Hand Clin 2010; 26 (04) 459-466
    CrossrefPubMedSearch in Google Scholar
  • 20 Mesplie G. Stabilité de lárticulation radio-ulnaire distale: quid du carré pronateur kinesitherapie. Law Rev 2007; 68: 58-62
    PubMedSearch in Google Scholar
  • 21 LaStayo PC, Lee MJ. The forearm complex: anatomy, biomechanics and clinical considerations. J Hand Ther 2006; 19 (02) 137-144
    CrossrefPubMedSearch in Google Scholar
  • 22 Arora S, Button DC, Basset FA, Behm DG. The effect of double versus single oscillating exercise devices on trunk and limb muscle activation. Int J Sports Phys Ther 2013; 8 (04) 370-380
    PubMedSearch in Google Scholar
  • 23 Minami A, Kato H. Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. J Hand Surg Am 1998; 23 (05) 904-908
    CrossrefPubMedSearch in Google Scholar
  • 24 Sander AL, Sommer K, Kaiser AK, Marzi I, Frank J. Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint. Eur J Trauma Emerg Surg 2021; 47 (05) 1621-1625
    CrossrefPubMedSearch in Google Scholar