Triangular fibrocartilage complex injury in cardiopulmonary resuscitation providers: A case report

Cardiopulmonary resuscitation (CPR) is physically demanding and may result in work-related musculoskeletal injuries in healthcare providers. We report a case of triangular fibrocartilage complex (TFCC) and dorsal distal radioulnar ligament injuries sustained by an orthopedic resident during prehospital CPR events, to increase awareness of this underrecognized occupational hazard.

A 31-year-old orthopedic resident performed prolonged CPR twice in one shift and subsequently developed marked tenderness, instability, and pain in the left wrist with pronation, as well as a sensation of clicking subluxation. A second physician recalled persistent wrist pain after CPR in previous years.

Imaging demonstrated a tear of the TFCC and dorsal distal radioulnar ligament as well as joint effusion and extensor carpi ulnaris sheath edema in the affected wrist. The retrospective magnetic resonance imaging of the second physician indicated chronic TFCC change.

Conservative management with nonsteroidal anti-inflammatory drugs, plaster splint immobilization, and subsequent wrist bracing was implemented for the resident; self-treatment with nonsteroidal anti-inflammatory drugs and wrist brace was reported by the second physician.

The orthopedic resident achieved resolution of instability after 6 weeks with restoration of full wrist motion and strength by 2 years. The second physician's symptoms persisted for 2 years before mostly resolving.

Musculoskeletal injuries, including TFCC and distal radioulnar ligament tears, may occur in CPR providers but are often underrecognized and underreported. Early recognition, appropriate management, and preventive strategies such as alternating roles, prompt initiation of automated compression devices, and ergonomic device placement may mitigate injury risks. Encouraging timely reporting and self-care among healthcare professionals is essential for provider well-being and care quality.