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Ravella KC, Yao J. Treatment of Hand and Wrist Cartilage Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:104-112. [PMID: 38978204 DOI: 10.1097/jsa.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Cartilage injuries of the hand and wrist can be debilitating in the athlete. Diagnosis is difficult given the broad spectrum of presenting symptomatology. History and physical examination is crucial to achieve the correct diagnosis, and advanced imaging can offer helpful assistance to the clinician as well. TFCC injuries and ulnar impaction syndrome are among the most common conditions in athletes with hand and wrist pain. Treatment of these injuries is initially nonoperative, but elite athletes may elect to bypass nonoperative treatment in favor of earlier return to sport. Surgical treatment varies but can include open and arthroscopic methods. The clinician should tailor treatment plans to each athlete based on level of competition, type of sport, and individual preferences and goals.
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Affiliation(s)
- Krishna C Ravella
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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Pace V, Bronzini F, Novello G, Mosillo G, Braghiroli L. Review and update on the management of triangular fibrocartilage complex injuries in professional athletes. World J Orthop 2024; 15:110-117. [PMID: 38464359 PMCID: PMC10921179 DOI: 10.5312/wjo.v15.i2.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024] Open
Abstract
Triangular fibrocartilage complex injuries are common in amateur and professional sports. These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist, particularly on the ulnar side and in association with rotations or radial/ulnar deviations. In order to treat professional athletes, a detailed specific knowledge of the pathology is needed. Moreover, the clinician should fully understand the specific and unique environment and needs of the athletes, their priorities and goals, the type of sport, the time of the season, and the position played. An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon. A compromise between conservative vs surgical indications, athletes' needs and expectations, and financial implications should be achieved. Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time. Conservative measures are often used as first line treatment when possible. Peripheral lesions are treated by arthroscopic repair, whilst central lesions are treated by arthroscopic debridement. Further procedures (such as the Wafer procedure, ulnar osteotomies, etc.) have specific indications and great implications with regard to rehabilitation.
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Affiliation(s)
- Valerio Pace
- Department of Trauma and Orthopaedics, AOSP Terni, Terni 05100, Italy
| | - Francesco Bronzini
- Department of Trauma and Orthopaedics, University of Perugia, Perugia 06100, Italy
| | - Giovanni Novello
- Department of Trauma and Orthopaedics, University of Perugia, Perugia 06100, Italy
| | - Giuseppe Mosillo
- Department of Trauma and Orthopaedics, Hand Unit, AOSP Terni, Terni 05100, Italy
| | - Luca Braghiroli
- Department of Trauma and Orthopaedics, Hand Unit, AOSP Terni, Terni 05100, Italy
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Sergent A, Shaw T, Richardson M. Conservative management of a suspected triangular fibrocartilage complex injury utilizing strength training exercises: A case report. J Bodyw Mov Ther 2023; 36:210-212. [PMID: 37949562 DOI: 10.1016/j.jbmt.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/01/2023] [Accepted: 07/04/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The purpose of this case report is to describe the conservative chiropractic management of a patient with a suspected triangular fibrocartilage complex (TFCC) injury. CLINICAL PRESENTATION A 36-year-old Brazilian Jiu-Jitsu black belt athlete sought care for left-sided diffuse ulnar pain (numeric pain scale 5/10) with a notable bump over the ulna and weakness when grappling. A working diagnosis of suspected TFCC injury was made. INTERVENTION AND OUTCOME The patient was treated with forearm and grip strength exercises to rehabilitate the pain and strength loss. Following 6 visits and a home exercise program for 8 weeks, his numeric pain scale decreased to 0/10. CONCLUSION In this case, it is evident that Triangular fibrocartilage complex injury was successfully treated conservatively without the need for surgical intervention or passive care modalities.
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Affiliation(s)
- Adam Sergent
- 4705 S Clyde Morris Blvd, Port Orange, FL, 32129, USA.
| | - Trevor Shaw
- 4705 S Clyde Morris Blvd, Port Orange, FL, 32129, USA.
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Swinging injuries in competitive baseball players. Skeletal Radiol 2022; 52:1277-1292. [PMID: 36542131 DOI: 10.1007/s00256-022-04261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Injuries are common in competitive baseball players and can occur in all facets of the game. The majority of the existing literature on injuries in baseball players has focused on injuries secondary to the overhead throw with very little attention given to injuries sustained while batting. The baseball swing is a complex, often violent, motion that predisposes batters to a variety of injuries affecting the spine, trunk, pelvis, and extremities. Knowledge of injury patterns that commonly occur during the baseball swing and radiologic findings important to the treating physician can help radiologists provide accurate imaging interpretations that appropriately guide patient management.
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Rios-Russo JL, Lozada-Bado LS, de Mel S, Frontera W, Micheo W. Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options. Curr Sports Med Rep 2021; 20:312-318. [PMID: 34099609 DOI: 10.1249/jsr.0000000000000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.
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Affiliation(s)
- Jose L Rios-Russo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - Lianette S Lozada-Bado
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - Sandra de Mel
- Ponce Health Sciences School of Medicine, Ponce Health Sciences University, Ponce, PUERTO RICO
| | - Walter Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
| | - William Micheo
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico, San Juan, PUERTO RICO
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Patel H, Lala S, Helfner B, Wong TT. Tennis overuse injuries in the upper extremity. Skeletal Radiol 2021; 50:629-644. [PMID: 33009583 DOI: 10.1007/s00256-020-03634-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Tennis is a popular sport with high levels of participation. This article aims to describe how upper extremity overuse injuries occur in relation to tennis biomechanics and to review their imaging characteristics and implications for management. In particular, we will review the imaging patterns of internal impingement, scapular dyskinesis, lateral and medial epicondylitis, ulnar collateral ligament insufficiency, valgus extension overload, capitellar osteochondritis dissecans, extensor carpi ulnaris tendinosis and instability, tenosynovitis, triangular fibrocartilage complex injuries, and carpal stress injuries. CONCLUSION Tennis is a complex and physically demanding sport with a wide range of associated injuries. Repetitive overloading commonly leads to injuries of the upper extremity. An understanding of the underlying mechanisms of injury and knowledge of these injury patterns will aid the radiologist in generating the correct diagnosis in both the professional and recreational tennis athlete.
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Affiliation(s)
- Hanisha Patel
- New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA.
| | - Sonali Lala
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA
| | - Brett Helfner
- Zwanger and Pesiri Radiology, 150 Sunrise Hwy, Lindenhurst, New York, NY, 11757, USA
| | - Tony T Wong
- Division of Musculoskeletal Radiology, New York Presbyterian Hospital - Columbia University Medical Center, 622 W 168th Street, New York, NY, 10032, USA
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Abstract
Triangular fibrocartilage complex tears are a common source of ulnar-sided wrist pain and distal radioulnar joint instability. Symptoms recalcitrant to conservative management or injuries in high-demand athletes may indicate surgical management. Both open and arthroscopic techniques offer improvements in objective measures, patient-centered outcome scores, and return to work, but may be complicated by nerve irritation, persistent wrist instability, and pain. Recently developed knotless arthroscopic techniques are not well studied but may limit morbidity.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, El Paso, TX, USA
| | - Michael M. Polmear
- William Beaumont Army Medical Center, El Paso, TX, USA,Michael M. Polmear, Department of Orthopaedic Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, TX 79920-5001, USA.
| | - Leon J. Nesti
- Walter Reed National Military Medical Center, Bethesda, MD, USA,Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Tedesco LJ, Swindell HW, Anderson FL, Jang E, Wong TT, Kazam JK, Kadiyala RK, Popkin CA. Evaluation and Management of Hand, Wrist and Elbow Injuries in Ice Hockey. Open Access J Sports Med 2020; 11:93-103. [PMID: 32425621 PMCID: PMC7196194 DOI: 10.2147/oajsm.s246414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/12/2020] [Indexed: 12/01/2022] Open
Abstract
Ice hockey continues to be a popular, fast-paced, contact sport enjoyed internationally. Due to the physicality of the game, players are at a higher risk of injury. In the 2010 Winter Olympics, men’s ice hockey had the highest injury rate compared to any other sport. In this review, we present a comprehensive analysis of evaluation and management strategies of common hand, wrist, and elbow injuries in ice hockey players. Future reseach focusing on the incidence and outcomes of these hand, wrist and elbow injuries in ice hockey players is warranted.
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Affiliation(s)
- Liana J Tedesco
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Hasani W Swindell
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Forrest L Anderson
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Eugene Jang
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
| | - Tony T Wong
- Department of Radiology, New York Presbyterian Hospital, New York, NY, USA
| | - Jonathan K Kazam
- Department of Radiology, New York Presbyterian Hospital, New York, NY, USA
| | - R Kumar Kadiyala
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Charles A Popkin
- Center for Shoulder, Elbow and Sports Medicine, Columbia University Medical Center, New York, NY, USA
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Sagar JH, Lohana ST. Hand-arm Vibration Syndrome in Farmers and its Correlation with Degenerative Triangular Fibrocartilage Complex Injury. Indian J Occup Environ Med 2019; 23:79-82. [PMID: 31619880 PMCID: PMC6783529 DOI: 10.4103/ijoem.ijoem_71_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/17/2019] [Indexed: 11/04/2022] Open
Abstract
Context Hand-arm vibration syndrome (HAVS) is an occupational disease that affects workers who are exposed to vibrations. Farmers are prone to various musculoskeletal and cumulative trauma disorders. These occur owing to overuse, degeneration, and excess physical efforts along with whole-body vibrations- owing to the use of farming equipment such as tractors and harvesters. Aims Aims of the study were to find out the prevalence of various symptoms of HAVS among farmers using tractors, harvesters, etc., and to find out the correlation of triangular fibrocartilage complex (TFCC) injury with HAVS. Subjects and Methods A prevalence study was conducted among farmers. Farmers were selected by random sampling method and were asked to fill-up a HAVS surveillance questionnaire. The handgrip strength was recorded with a hand dynamometer. Assessment of carpal tunnel syndrome was done, and correlation of HAVS with TFCC injury was assessed. Results Data from 100 farmers was obtained and analyzed. The musculoskeletal symptoms of HAVS, more specifically pain was prevalent (n = 65), followed by sensorineural symptoms (n = 70), and the vascular symptoms were less common (n = 43). HAVS accounts for a prevalence of 64% with 39% of farmers having TFCC injury along with HAVS (P value = <0.0001). Conclusions These findings reported in the study provide a better understanding of the impact and extent of HAVS in farmers. There is a significant prevalence of HAVS with mild symptoms of vascular component, mild to moderate symptoms of sensorineural component, and significant involvement of the musculoskeletal component. In addition, TFCC injury is correlated with HAVS.
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Affiliation(s)
- Javid Hussain Sagar
- Department of Cardiopulmonary Sciences, Faculty of Physiotherapy, Krishna Institute of Medical Sciences Deemed to Be University, Karad, Maharashtra, India
| | - Soniya T Lohana
- Intern, Faculty of Physiotherapy, Krishna Institute of Medical Sciences Deemed to be University, Karad, Maharashtra, India
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Robertson G, Ang KK, Maffulli N, Simpson CK, Rust PA. Return to sport following surgical management of triangular fibrocartilage tears: a systematic review. Br Med Bull 2019; 130:89-103. [PMID: 30943287 DOI: 10.1093/bmb/ldz013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION This review aims to provide information on return rates and times to return to sport following surgical management of triangular fibrocartilage (TFC) tears. SOURCES OF DATA A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, Medline, PEDro, Scopus, SPORTDiscus and Web of Science was performed using the keywords 'triangular', 'fibro-cartilage', 'complex', 'tear', 'distal radio-ulnar joint', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. AREAS OF AGREEMENT In all of the 10 studies included, conservative management for 6 weeks to 6 months was the first-line treatment. If symptoms persisted following this period, surgical management was advised. Arthroscopic debridement was recommended for central tears, and arthroscopic repair was recommended for peripheral tears. AREAS OF CONTROVERSY The optimal treatment modalities for TFC tears remain to be defined. GROWING POINTS Traumatic central tears can be treated with arthroscopic debridement alone. Arthroscopic repair with an all-inside repair can improve return rates to sport over an outside-in technique for ulna-sided tears. AREAS TIMELY FOR DEVELOPING RESEARCH Future prospective studies should aim to establish the optimal treatment modalities for TFC tears.
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Affiliation(s)
- Greg Robertson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Kok Kiong Ang
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Nicola Maffulli
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Claire K Simpson
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Philippa A Rust
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
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Outcomes of Operative Treatment of Triangular Fibrocartilage Tears in Pediatric and Adolescent Athletes. J Pediatr Orthop 2018; 38:e618-e622. [PMID: 30134350 DOI: 10.1097/bpo.0000000000001243] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) tears have been treated with increasing frequency in pediatric and adolescent patients over the past decade. There is little information on these injuries in young athletes and a scarcity of data regarding their ability to return to preinjury levels of athletic participation. The purpose of this study was to review the outcomes of pediatric and adolescent athletes with operatively treated TFCC tears with or without a concurrent ulnar shortening osteotomy and to determine their ability to return to their preoperative level of activity. METHODS A retrospective chart review was performed for all patients who underwent operative treatment of TFCC tears between 2006 and 2012 within one Upper Extremity practice. Patients were included if they were high-level athletes, unable to participate in their sport secondary to wrist pain and desired to return to their sport. All operative patients had imaging studies and clinical findings consistent with TFCC injury as the primary source of their activity-limiting pain and had failed nonoperative management prior to surgery. Patients without at least 3 months of documented postoperative follow up were excluded. RESULTS In total, 22 patients were included in the chart review with 20 patients willing to participate in a telephone survey and PODCI. Eighty percent of patients returned to their sport following operative treatment of their injury at an average of 4.8 months. Seven of the 22 patients underwent a concurrent ulnar shortening osteotomy for ulnar positive variance. All 20 patients reported satisfaction with the outcomes of their surgery and treatment. CONCLUSIONS Operative treatment of TFCC injuries in adolescent and pediatric athletes after failure of conservative treatment allowed return to sport at the previous level of participation. Concurrent ulnar shortening osteotomy in the setting of ulnar positive variance did not prohibit return to high-level athletic participation. LEVEL OF EVIDENCE Level IV.
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Prognostic Factors of Arthroscopic Debridement for Central Triangular Fibrocartilage Complex Tears in Adults Younger Than 45 Years: A Retrospective Case Series Analysis. Arthroscopy 2018; 34:2994-2998. [PMID: 30292592 DOI: 10.1016/j.arthro.2018.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/26/2018] [Accepted: 05/01/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to analyze factors that affect the treatment outcomes of arthroscopic debridement for central triangular fibrocartilage complex (TFCC) lesions in adults <45 years of age. METHODS A total of 71 patients (mean age, 39 years; range, 20-44 years) who had been arthroscopically diagnosed with central TFCC tears were treated with arthroscopic debridement. Demographic, clinical, and arthroscopic findings were examined and analyzed. The response to treatment, including pain numeric rating scale on an ulnar provocation test; Disability of the Arm, Shoulder, and Hand score; and satisfaction with treatment, was assessed at 12-month follow-up. RESULTS The mean pain numeric rating scale (6.6 ± 3.6 to 2.4 ± 2.0, P < .01) and Disability of the Arm, Shoulder, and Hand (59.3 ± 15.0 to 33.7 ± 14.1, P < .01) scores exhibited significant clinical improvement at 12-month follow-up. In terms of satisfaction, 43 patients (70.5%) were satisfied (enthusiastic or satisfied) and 18 (29.5%) were dissatisfied (noncommittal or disappointed). In the satisfied group, there were 24 flap and 19 wearing tears, whereas in the dissatisfied group, there were 4 flap and 14 wearing tears (P = .02). The extent of ulnar plus variance on preoperative radiographs also differed between the 2 groups (0.5 ± 1.2 vs 1.7 ± 1.1, P < .01). There were no significant differences in age, gender, hand dominance, or work level between the groups. After controlling for confounding variables, the wearing type tears (odds ratio, 3.4) and greater ulnar plus variance (odds ratio, 2.0) were associated with a higher likelihood of dissatisfaction after arthroscopic TFCC debridement. CONCLUSIONS Although clinical outcome scores showed significant improvement after arthroscopic debridement for central TFCC tears, wearing type tears and greater ulnar plus variance were associated with dissatisfaction and poorer postoperative outcomes after the procedure. LEVEL OF EVIDENCE Level IV, case series.
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Roh YH, Kim S, Gong HS, Baek GH. Prevalence and clinical characteristics of radiographic central triangular fibrocartilage complex tears in symptomatic and asymptomatic individuals younger than 50 years. Arch Orthop Trauma Surg 2018; 138:1173-1178. [PMID: 29855684 DOI: 10.1007/s00402-018-2969-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few studies have addressed the prevalence of central triangular fibrocartilage complex (TFCC) tears or their risk factors for symptom development. The aim of this study was to determine the prevalence of radiographic central TFCC tears in both symptomatic and asymptomatic individuals, and evaluate clinical characteristics of symptomatic individuals. METHODS In this retrospective case control study, 221 patients younger than 50 years who exhibited positive ulnocarpal provocation test and underwent MRI to identify abnormalities associated with TFCC were age- and sex-matched with 221 controls who had undergone hand or wrist MRI for tumorous lesions or pain in hand other than ulnar-sided wrist. Demographic and radiologic parameters including the degree of ulnar plus variance, the type of central TFCC lesions, the presence of ulna head or carpal bone enhancement, and cartilage degeneration of ulno-carpal or distal radio-ulnar joint were compared. Multivariable regression analysis was carried out to identify independent risk factors for symptom development in patients with central TFCC lesions. RESULTS The prevalence of central TFCC lesions was 68/221 in symptomatic patients, which was not significantly different from that (51/221) in asymptomatic controls. Patients in the symptomatic group had significantly greater ulnar plus variance (1.6 vs. 0.7). They were more likely to have type 1A tears and bony enhancement in ulnar head or carpus on MR images. Multivariable logistic regression analysis revealed that youth, female gender, and presence of bony enhancement were significant risk factors for symptom development in central TFCC lesions. CONCLUSION Based on the findings of this study, prevalence of central TFCC lesions detected on MRI in symptomatic patients seems to be similar to that in asymptomatic individuals. Younger age, female gender, and presence of bony enhancement on MR images seem to be risk factors for symptoms of central TFCC lesions.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Abstract
Injuries to the hands and wrist are common in athletes. Injuries include acute fractures, dislocations, ligamentous, and tendon injuries, as well as more chronic injuries such as sprains and strains. Complications in the treatment of sports injuries of the hand and wrist may be divided into 2 categories: incorrect or delayed diagnosis and iatrogenic injury related to treatment. This article highlights common sports injuries of the hand and wrist and their complications, and includes tips for successful management.
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Affiliation(s)
- Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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Abstract
Increasing numbers of people are playing golf. Golf is a unique sport in that the ability to participate at a high level is not limited by age. In addition, participants tend to play more rather than less as they grow older. Injuries can occur at any point during the golf swing, from takeaway through follow-through. Upper extremity injuries can affect the hands, elbow, and shoulder and are usually a result of the golf swing at impact. Injuries are also common in the lower back as well as the lower extremities. Most injuries are the result of overuse and poor swing mechanics. When treating golfers, it is important to have a good understanding of the biomechanics and forces of the golf swing to diagnose and manage the vast spectrum of injuries incurred in this sport.
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Hand and wrist injuries in golf. J Hand Surg Am 2013; 38:2029-33. [PMID: 24021743 DOI: 10.1016/j.jhsa.2013.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 02/02/2023]
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Recognition and Management of Triangular Fibrocartilage Complex Injury. INTERNATIONAL JOURNAL OF ATHLETIC THERAPY AND TRAINING 2013. [DOI: 10.1123/ijatt.18.3.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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