Treatment of Combined Central TFCC Tear, Scapholunate Ligament Tear, and Rotary Subluxation of Scaphoid

Diagnostic Confirmation

CT arthrography is the preferred diagnostic modality, achieving nearly 100% sensitivity and specificity for both scapholunate ligament tears and TFCC lesions, with superior accuracy for detecting partial tears compared to other modalities, as recommended by the American College of Radiology 1, 2
MR arthrography serves as an alternative, with high sensitivity (63-100%) for TFCC tears and ability to identify which specific segments of the scapholunate ligament are torn, critical information for surgical planning, according to the American College of Radiology 3

Arthroscopic foveal repair with suture anchor for peripheral tears with foveal detachment restores anatomic TFCC attachment critical for distal radioulnar joint stability, as suggested by Praxis Medical Insights 4

Immobilize forearm rotation for 4 weeks in neutral rotation and wrist in neutral position, as recommended by Praxis Medical Insights 4
Gentle active wrist motion begins at 4 weeks, strengthening exercises at 8-12 weeks, according to Praxis Medical Insights 4
Return to heavy tasks and sports at minimum 3 months, as suggested by Praxis Medical Insights 4

Obtain radiographs at 3 weeks post-operatively and at immobilization cessation to confirm healing and assess carpal alignment, as recommended by Praxis Medical Insights 4
Monitor for maintenance of scapholunate interval and absence of dorsal intercalated segmental instability pattern, according to Praxis Medical Insights 5

Dorsal sensory branch of ulnar nerve neuropraxia occurs in approximately 10% but fully recovers spontaneously, as reported by Praxis Medical Insights 4
Immobilization-related complications (skin irritation, muscle atrophy) occur in 14.7% but are generally minor, according to Praxis Medical Insights 4

Do not rely on standard MRI alone, as it has only moderate sensitivity (65-89%) for scapholunate tears and may miss the full extent of injury, as noted by the American College of Radiology 2
Ensure adequate immobilization duration, as premature mobilization leads to repair failure and persistent instability, as suggested by Praxis Medical Insights 4