Current rehabilitation recommendations following primary triangular fibrocartilage complex foveal repair surgery: A survey of Australian hand therapists

Luke McCarron; Brooke K Coombes; Randy Bindra; Leanne Bisset

doi:10.1016/j.jht.2023.08.009

Current rehabilitation recommendations following primary triangular fibrocartilage complex foveal repair surgery: A survey of Australian hand therapists

J Hand Ther. 2023 Oct-Dec;36(4):932-939. doi: 10.1016/j.jht.2023.08.009. Epub 2023 Sep 28.

Authors

Luke McCarron¹, Brooke K Coombes², Randy Bindra³, Leanne Bisset⁴

Affiliations

¹ School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; Occupational Therapy Department, Bond University, Bond Institute of Health and Sport, Level 4, 2 Promethean Way, Robina, QLD 4226, Australia; Orthopaedic Department, Gold Coast Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia. Electronic address: luke.mccarron@griffithuni.edu.au.
² School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; Menzies Health Institute, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia. Electronic address: b.coombes@griffith.edu.au.
³ School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; Orthopaedic Department, Gold Coast Hospital and Health Service, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia. Electronic address: r.bindra@griffith.edu.au.
⁴ School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia; Menzies Health Institute, Griffith University, Gold Coast Campus, Southport, QLD 4222, Australia. Electronic address: l.bisset@griffith.edu.au.

PMID: 37777443
DOI: 10.1016/j.jht.2023.08.009

Abstract

Background: Following injury to the Triangular Fibrocartilage Complex (TFCC), foveal repair surgery may be indicated to restore joint stability and function. Protection of the repaired ligament is a clinical consideration during post-surgical rehabilitation, although no "gold standard" rehabilitation protocol currently exists.

Purpose: To describe the professional opinions of Accredited Hand Therapists (AHT) regarding post-operative rehabilitation recommendations following TFCC foveal repair surgery.

Study design: Cross-sectional descriptive study.

Methods: All Australian AHTs were invited to complete a quantitative, online, 10-item survey between December 2019 and March 2020. The survey included questions regarding clinical recommendations for wrist and forearm immobilization, range of motion and exercise methods, and timeframes. AHT characteristics and experience of patients sustaining a TFCC re-rupture were also collected. Categorical and nominal survey responses were reported descriptively and effects of AHT characteristics on survey responses were assessed using Pearson Chi², with significance set to <0.05.

Results: Survey responses were received from 135 AHTs or approximately 37% of the available population at the time of completion (March 2020). Recommendations for post-surgery immobilization ranged from "not required" to 8 weeks, 6 weeks representing the most common answer. Wrist and forearm range of motion commencement time ranged from "immediately" to "later than 8 weeks," with 6 weeks also the most common answer. When asked whether post-surgery rupture had been experienced in their respective patient groups, 15 therapists (11%) indicated "Yes." The most recommended thermoplastic orthosis was a Sugartong orthosis (41%) followed by a Muenster orthosis (30%), both of which immobilizes the wrist and forearm.

Conclusions: Rehabilitation varied widely between AHTs. Further prospective research is recommended to explore whether patient-related or rehabilitation factors influence outcomes following TFCC repair.

Keywords: Hand therapy; Ligament repair; Rehabilitation; Triangular fibrocartilage; Wrist.

MeSH terms

Arthroscopy / methods
Australia
Cross-Sectional Studies
Forearm
Humans
Triangular Fibrocartilage* / injuries
Wrist Injuries* / surgery
Wrist Joint