Taping as part of a conservative treatment approach to TFCC injuries for kinesiology tape wrist cartilage injury fixes
TRIANGULAR FIBROCARTILAGE COMPLEX (TFCC) TEARS are a common source of ulnar-sided wrist pain. The TFCC is composed of the triangular fibrocartilage, the ulnar collateral ligament, the radioulnar ligament and the sheath of the extensor carpi ulnaris. 1
It plays an important role in load bearing across the wrist as well as in distal radioulnar joint (DRUJ) stabilization. 2 A traumatic tear can occur from a fall forward onto an outstretched hand, such as in athletic activities, or a degenerative tear may develop with repetitive workloads.
Examination and diagnosis
A patient with a TFCC injury typically presents with ulnar-sided wrist pain that increases with supination/pronation of the forearm and ulnar deviation of the wrist. Examination reveals tenderness to palpation along the ulnar side of the distal radioulnar joint. A large joint effusion is not typical. A provocative test performed by the examiner involves applying an axial load to the wrist in an ulnar-deviated position. Although often normal, a radiographic finding of a widened space between the distal ulna and radius may suggest a TFCC tear. An MRI is needed to definitively diagnose a structural tear.
A number of unstable and chronic tears will require arthroscopic debridement or reconstruction. However, stable and acute tears may benefit from common non-operative treatment methods including: 2
Activity modification: Avoiding aggravating activities, such as loaded wrist extension and rotational movements, will help to remove strain on the ligamentous complex.
Immobilization: In one study, more than 50% of patients with a clinical diagnosis of a TFCC tear had complete pain relief with immobilization provided by a short-arm cast or a wrist brace. ⁴
Nonsteroidal anti-inflammatories (NSAIDS): NSAIDs are among the most common pain relief medicines. They can help mitigate both pain and swelling but can carry unwanted side effects.
Steroid injections: An intra-articular radiocarpal joint injection can provide local pain relief but requires a skilled practitioner to assure proper placement and desired outcome. Corticosteroid injections do not come without risk, though.
Physical rehabilitation: Exercises and modalities aimed at reducing pain and inflammation as well as increasing function may be helpful to some patients.
Another option for conservative treatment of a TFCC injury is elastic therapeutic taping. When applied appropriately, this modality can reduce pain and improve neurosensory feedback to heighten body awareness and motor control.
It is believed that by stimulating the mechanoreceptors in local tissue, nociception (the nervous system’s response to harmful stimuli) can be reduced. Studies have shown that this type of treatment provides superior pain relief when compared to minimal intervention. ⁵ Elastic therapeutic taping has also been shown to improve joint position and proprioception in multiple joints of the body. ⁶,⁷,⁸ Simply put, tape applied to the skin increases the conversation between the brain and the affected region of the body, resulting in more desirable movement patterns and body awareness.
In his book Fascial Manipulation for Musculoskeletal Pain, Stecco proposes that there is a helical pattern to the fascial network in the human extremities. This fascial pattern helps us understand rotational movements of the forearm. ⁹ Therefore, it is possible that a similar helical pattern of taping application can cue the patient to stay within a desired range of motion to allow for healing of a TFCC injury.
A taping application provides a few benefits over traditional casting, including a lower risk of stiffness and atrophy following immobilization, improved cleanliness and greater comfort for the patient. Elastic therapeutic tape offers pain relief that is non-invasive and generally well-tolerated. Likewise, it will not limit the ability to perform physical rehabilitation.
While many patients with TFCC injuries may require surgical intervention for full resolution of their symptoms, conservative treatment still remains a viable option. Elastic therapeutic tape applied in a helical pattern may be an alternative to traditional non-operative treatment of TFCC injuries.
SHANNON M. HAUSCHILDT, MS, PA-C, is an assistant professor and academic coordinator in the Missouri State University Physician Assistant Program. She has 15 years of experience in orthopedics and currently works at Mercy Hand Surgery in Springfield, Mo.