Outcomes of Nonsurgical Treatment of Ulnar-Sided Wrist Pain

Vollständiger Abstract

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Background: Ulnar-sided wrist pain (USWP) is a frequent complaint, and triangular fibrocartilage complex (TFCC) injuries are amongst its most common aetiologies. Nonsurgical management of USWP is heterogeneous with variable periods of immobilisation. This study describes the outcome of a structured multiphase, conservative program for USWP that was clinically diagnosed as TFCC injuries in a single centre. Methods: Thirty-two individuals with USWP, foveal tenderness ± distal radio-ulnar joint (DRUJ) laxity diagnosed as TFCC injuries participated in the structured multiphase therapy program from 2020 to 2023 and were followed up prospectively. Assessments included numeric pain rating scale (NPRS), wrist range-of-motion, grip strength, weight-bearing ability, Modified Mayo Wrist Score (MMWS) and Patient-Specific Functional Scale (PSFS). The program comprised 4 weeks of splint immobilisation, 3–4 weeks of dynamic DRUJ stabiliser strengthening and 4 weeks of neuromuscular retraining. Outcomes were reassessed at 3 months and 1 year. Results: Twenty-nine patients were evaluated; 14 completed therapy, 15 defaulted and 21 were reviewed at 1 year. Amongst these 21 patients, mean NPRS decreased by 4 points and PSFS improved significantly. Completers also showed significant improvement in weight-bearing ability and were more likely to achieve excellent/good MMWS at 3 months than defaulters. All completers returned to regular work/activities at 1 year, compared with 9 of 10 contactable defaulters. None required surgery within 1 year. Conclusions: A structured multiphase therapy program for USWP clinically diagnosed as TFCC injury improved pain, function and weight-bearing ability. Completers were more likely to achieve excellent/good MMWS at 3 months, and no patient required surgery within 1 year. Level of Evidence: Level IV (Therapeutic)