Effectiveness of two orthotic designs on pain and hand function in patients with degenerative triangular fibrocartilage complex lesions: A preliminary randomized crossover study.

BACKGROUND: Degenerative lesions of the Triangular Fibrocartilage Complex (TFCC) cause ulnar-sided wrist pain and functional impairment. While orthoses are a common conservative treatment, evidence comparing the efficacy of different orthotic designs is limited. PURPOSE: To compare the immediate effects of a novel hinged ulnar gutter orthosis versus a conventional volar wrist immobilization orthosis on pain, hand function, grip strength, and weight-bearing tolerance in individuals with degenerative TFCC lesions. STUDY DESIGN: Preliminary randomized crossover study. METHODS: Twenty one adults with confirmed degenerative TFCC tears were assessed under four conditions in a single session: no orthosis, a placebo wrist band, a conventional volar wrist immobilization orthosis, and a novel hinged ulnar gutter orthosis. Primary outcomes included pain intensity (Visual Analogue Scale), hand function (Grip Ability Test), grip strength, and weight-bearing tolerance (push-off test). RESULTS: Compared with no orthosis, the hinged ulnar gutter orthosis significantly improved hand function (p = 0.005, mean difference: -1.6 s, 95% CI -2.66 to -0.54), weight-bearing tolerance (mean difference 1.27 N, 95% CI 0.15-2.40), and reduced pain (p = 0.005, mean difference -1.26, 95% CI -1.96 to -0.56). Neither orthosis improved grip strength. CONCLUSIONS: While both orthoses provide immediate pain relief, the hinged ulnar gutter orthosis is superior for improving immediate hand function and load tolerance in degenerative TFCC lesions. These preliminary findings provide proof-of-concept for functionally-permissive orthotic designs and justify the need for adequately powered longitudinal trials to confirm sustained clinical efficacy.