Wrist Injury - Tae Kwon Do

Abstract

HISTORY: An 18-year-old right-hand dominant male, nationally-ranked Tae Kwon Do competitor presented with a 4 year history of left wrist pain. Four years prior to presentation, he was kicked on the ulnar wrist while sparring. At that time, he had tenderness over the ulnar styloid and distal physis, no tenderness at the ulnar-carpal articulation, and full wrist range of motion. Wrist X-Rays were read by radiology as negative for fracture, but interpreted by the sports medicine team as a possible ulnar Salter- Harris I injury in addition to a wrist contusion. He returned to sport after three weeks of relative rest and use of a wrist brace. He presented to clinic four years later due to worsening symptoms that inhibited his level of competition in Tae Kwon Do. He had not sustained any further wrist injuries in the interim. There was increased pain with active range of motion and he felt an occasional click in his wrist and intermittent tingling in his fifth digit. PHYSICAL EXAMINATION: Left wrist exam demonstrated no gross deformity, swelling, erythema, or ecchymosis. The limb was neurovascularly intact. There was tenderness to palpation of the hook of the hamate and the triangular fibrocartilage complex. Full wrist and hand range of motion. Mild weakness noted in fifth digit flexion and wrist flexion; strength otherwise intact. Wrist extension with ulnar deviation reproduced the patient’s pain. There was increased dorsal instability of the ulnar styloid at the distal radioulnar joint (DRUJ) (positive piano key sign). DIFFERENTIAL DIAGNOSIS: 1. TFCC tear 2. Post-traumatic arthritis 3. Hook of the hamate fracture 4. Flexor carpi ulnaris strain 5. Ulnar neuropathy at the wrist TESTS AND RESULTS: MR arthrogram: There is contrast extension into the distal radioulnar joint indicating disruption of the triangular fibrocartilage complex (TFCC). The TFCC appears irregular and demonstrates intermediate signal. These findings were interpreted by the Sports Medicine team to represent concomitant central and peripheral TFCC tears. FINAL DIAGNOSIS: Central and peripheral TFCC tears TREATMENT AND OUTCOMES: After consultation with orthopedic surgery, the patient is currently scheduled for arthroscopic debridement of the central tear and repair the peripheral tear of his TFCC.