How long before my wrist returns back to normal?

PROGNOSIS

The prognosis or the time frame that you can expect your triangular fibrocartilage complex (TFCC) tear to take in the long term recovery from diagnosis to return to function depends upon the interaction of several important factors relating to the injury itself and its management. Whether your TFCC tear is the result of a trauma or degenerative changes and the extent of the damage affects it response to the compulsory conservative management you will receive. If your injury does not respond to conservative management then more invasive surgical procedure will be undertaken and the rehabilitation post-operatively will add to the length of time you spend in recovery and unable to participate in your occupation or sport. Factors external to the management strategies can also complicate your TFCC tear healing and act as poor prognostic indicators, these include:

• Infection
• Repair Failure
• Wrist Arthroscopy Complications
• Hardware failure
• Non-union
• Stiffness, decreased strength, continued pain

Another significant indicator for prognostic outcomes is the time from the initial injury (for traumatic) or when degenerative tears become symptomatic that the individual receives treatment for their TFCC tear. With individuals who began management greater than six months post injury or symptoms having a significantly increased rehabilitation period and greater need for more invasive management than individuals who received management for their tear within six months.


PROGNOSIS GUIDELINES


1. Conservative Management – ( 12 – 18+ weeks )

a. Immobilisation – Traumatic ( 4 – 6 weeks )
- Degenerative ( 3 – 4 weeks )

b. Splint Removal and Early Physiotherapy Rehabilitation – ( 4 – 6 weeks )

c. Continued Physiotherapy Rehabilitation – ( 4 – 6+ weeks ) – depends upon response to exercise program and patient’s goals

Surgical management must follow conservative interventions first, therefore the prognosis of recovery after a surgical intervention is on top of the period of time spent in conservative management which may not be the full 12 – 18 weeks.


2. Surgical Management – ( 16 – 20+ weeks )

a. Wrist Arthroscopy – Cast Immobilisation ( 2 weeks )
- Splint immobilisation ( 3 weeks )

b. Open Surgery - K-wire ( 4 – 6 weeks)
- Cast immobilisation ( 4 – 8 weeks) – this is simultaneous with K-wire

c. Ulnar-Shortening Osteotomy – Cast immobilisation ( 6 – 8 weeks ) – replicates normal bone healing time frames

d. Physiotherapy Rehabilitation – ( as required, at least 8 weeks )


Total surgical management time frame depends on the extent of injury, procedure used and individual response to physiotherapy. These figures are estimates that assume no complications, management began less than six months post-injury, physiotherapy response and adherence and non-significant damage to the TFCC.
The American College of Radiology (ACR) recommendations for short and long term goals for post surgical reconstruction of TFCC tears return to specific tasks are that for light duties (42 days post-surgery with extensive physiotherapy rehabilitation) and for heavy, manual tasks duties (180 days post-surgery with ongoing physiotherapy management). Overall however it is the motivation and adherence to the rehabilitation program prescribed by the physiotherapist that will determine how long post management interventions recovery will take. An individual with a TFCC tear has to achieve short term goals such as increasing ROM, reducing pain and stiffness and increasing strength and long term goals such as independence in functional activities and returning to work or sport. Such goals may take a greater or lesser time suggested by the ACR.