Conservative management of a suspected triangular fibrocartilage complex injury

Key points

1. 01A 36-year-old Brazilian Jiu-Jitsu athlete had left ulnar-sided wrist pain rated 5 out of 10 with a notable bump and grappling weakness.
2. 02Diagnosis of a suspected TFCC injury was based on history and positive orthopedic tests, not on the gold-standard MRA imaging.
3. 03Treatment was progressive grip strength, isometric wrist, and kettlebell exercises over 8 weeks across 6 visits plus a home program.
4. 04Pain dropped to 0 out of 10, the Fovea sign turned negative, and the patient fully returned to sport.
5. 05This is a single case report, so it cannot prove the exercise approach caused the recovery.

How it was conducted

Design

Single-patient case report

Participant

36-year-old male Brazilian Jiu-Jitsu black belt with 20 years of training, presenting with left ulnar-sided wrist pain

Diagnosis

Suspected TFCC injury based on history and positive press test, TFCC compression test, and Fovea sign; MRA not performed due to cost

Intervention

Progressive grip strength (Theraband ball then 50, 100, 150 lb grippers), isometric wrist flexion and extension, and kettlebell exercises (press, swing, Turkish Get-Up)

Duration

6 visits plus an 8-week home exercise program

Outcomes

Numeric pain scale, dynamometer grip strength, and Fovea sign

What they found

• Numeric pain scale fell from 5 out of 10 at presentation to 0 out of 10 after 8 weeks, with full return to Brazilian Jiu-Jitsu.
• Left (injured) grip strength on dynamometer increased from 130 pounds to 160 pounds (average of 3 tests).
• Right (dominant) grip strength increased from 165 pounds to 175 pounds (average of 3 tests).
• The Fovea sign was negative for wrist pain at retest, having been positive at presentation.

Limitations

• A single case report cannot establish cause and effect or generalize to other patients.
• The diagnosis was only suspected; MR angiography, the stated gold standard, was never performed, so the TFCC injury was not confirmed.
• The patient stopped competing in Brazilian Jiu-Jitsu during care, which the authors note could itself have contributed to pain reduction.
• One of the patients treated is also a coauthor of the report, which introduces potential bias.

Why it matters

For patients

If you have suspected ulnar wrist pain, a structured strength program may be worth discussing with your clinician before considering surgery.

For clinicians

This report supports trialing progressive loading and isometric exercise for suspected TFCC pain, but its single-case design means it should inform rather than dictate practice.

For readers

A promising anecdote that highlights the need for proper trials on loading-based rehab for TFCC injuries rather than firm evidence.