EFFECT OF MCCONNELL TAPING ON PAIN, ROM & GRIP STRENGTH IN

PATIENTS WITH TRIANGULAR FIBROCARTILAGE COMPLEX INJURY

Dr. Shahid Mohd. Dar* MPT (Orthopaedic & Sports), Dr. R. Arunmozhi** MPT (Sports &
Rehabilitation), Babloo Sharma*** MPT (Sports)

ABSTRACT
STUDY OBJECTIVES: To find out the efficacy of McConnell Taping on Pain, Range of Motion and Grip
strength in subjects with Triangular Fibrocartilage Complex (TFCC) injury. DESIGN: An Experimental Study.
SETTING: All the Subjects were selected from various sports center from Dehradun and SAI Guwahati.
Methods: A total of 28 subjects were recruited for the study on the basis of inclusion and exclusion criteria after
signing the informed consent form. The subjects were divided into two Groups (A= Taping & B= Conventional
Therapy). OUTCOME MEASURE: Grip Strength, Range of Motion for Wrist and Forearm & Numerical Pain
Rating Scale. RESULTS: The result of the study shows that both McConnell Taping and Conventional Therapy
are effective in improving the Range of Motion, Grip Strength and reducing the Pain level. Both groups showed
significant improvement when comparison was made within the group. However, there is significant reduction in
pain level between the groups for Group A (p=0.000). CONCLUSION: The present study demonstrates that both
McConnell Taping and Conventional Treatment are effective in improving the Grip Strength, Range of Motion
and reducing the Pain level in subjects with TFCC injury. However, it can be concluded that McConnell Taping
is the better form of treatment in improving the Grip Strength, Range of Motion and reducing the Pain level in
subjects with TFCC injury.

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 ISSN: 2277-1700 ● Website: http://www.srji.info.ms ● URL Forwarded to: http://sites.google.com/site/scientificrji
KEY WORDS: TFCC, Taping, Grip Strength, Range of Motion, Numerical Pain Rating Scale, Conventional
Therapy.
INTRODUCTION
The triangular fibrocartilage complex (TFCC)
is a special structure at the ulno-carpal articulation.8
It is composed of semicircular biconcave
fibrocartilage or articular disc called the TFC, the
palmar and dorsal distal radioulnar ligaments, a
meniscus homolog, ulnolunate and ulnotriquetral
ligaments and the extensor carpi ulnaris tendon
(ECU) subsheath.7,17 Functionally, the
extends the radio-carpal articulation, permitting
8
pronation and supination. The TFCC
cartilaginous and ligamentous structure, important in
the stabilization of the distal radial ulnar joint and in
the absorption of load between the distal ulna and
the volar carpus.7,17 The articular disc of the TFCC
separates the ulna and the proximal carpal row, and
carries about 20% of the axial load from wrist to
forearm.17
Injuries to the TFCC occur with repetitive ulnar
loading (e.g., bench press, racquet sports) or acute
traumatic axial load with rotational stress (e.g.,
17
FOOSH). Most injuries to the TFCC have a
component of hyperextension of the wrist and
rotational load. Injury to the TFCC is the most
7
common cause of ulnar-sided wrist pain. Ulnar-
sided wrist pain made worse with ulnar deviation,
wrist extension, or heavy use is the common
complaint of an athlete who has a TFCC injury.
TFCC injuries are more commonly seen in such
sports as gymnastics, hockey, racquet sports, boxing,
17
and pole vaulting.
The problem that arises from soft tissue
injury of this important structure is distal radio ulnar
joint (DRUJ) instability. The DRUJ is a diarthroidal
trochoid articulation, which is an incongruent
articulation; only around 20% of its stability is
produced by osseous articular contact. Soft-tissue
structures of the TFCC play a critical role in intrinsic
joint stability.7
TFCC Wrist injuries are often complex and their
management will vary greatly; as such it is vital that
is a the correct diagnosis is made. If we look specifically
at the athletic population TFCC tears are more
frequently seen in gymnastics, hockey,
racquet/batting sports, boxing, and pole vaulting.
This is due to the repetitive high forces on the wrist
that will often be in extension or ulnar deviation, or
both (Parmelee-Peters & Eathorne, 2005).30 The
most common mechanism of injury to the TFCC
occurs with axial loading, ulnar deviation, and
forced extremes of forearm rotation. Injury may also
be associated with localized swelling, crepitus, grip
weakness and sense of instability.7
The initial treatment for TFCC injury may
include splinting, rest, anti-inflammatory
medications, cryotherapy, electrotherapy modalities
and physiotherapy techniques like manual and
exercise therapies.23 Biomechanical adjustments may
be required to comprehensively manage the injury
and reduce the incidence of recurrence.23 These
include on court stroke analysis and if necessary,
modifications to the athlete’s stroke mechanics, or
their equipment, such as adjustments of the grip size,
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 Scientific Research Journal of India ● Volume: 2, Issue: 1, Year: 2013
the over grip, the strings and string tension, the
weight balance of the racket, or the grip placement
(continental, eastern, semi-western, and western).23
Physiotherapists and Athletic Trainers often
use athletic tape methods to support and prevent
sport related injuries. Athletic tape is effective due to
its reported ability to provide stability, maintain
proper structural alignment, facilitate proprioception
and also its neuromuscular effects. The aim of taping
is to reduce healing time, to protect and support the
wrist, and prevent future injury.23
In response to the limited effective taping
options for wrist injuries involving the TFCC and/or
ECU tendon, Kathleen Stroia and Kathy Martin
applied the McConnell principles of “unloading” to
the wrist.23 Stroia and Martin experimented with
various tape applications and created a clinically
effective tape technique, consisting of 1) an unload,
2) a block, and 3) a re-direction tape for players who
sustained wrist injuries involving the TFCC and/or
ECU tendon.23 This tape technique is effective for
injuries involving both the TFCC and ECU as they
are in close proximity to each other, and due to the
co-morbid nature of ECU tenosynovitis and TFCC
pathologies.23 This tennis-specific wrist taping
technique protects and supports the injured
structures; however it restricts only the desired
motions (supination, ulnar deviation, and extension).
The technique meets the desired goal of allowing a
player to play with more support which improves
function, while restricting extreme range of motion.
It is designed to consider the anatomy and patho-
physiology of the injury and the biomechanics of the
two-handed backhand.23
3
METHODS
An experimental study design was conducted
on total of 28 subjects who were recruited from
various sports center in and around Dehradun and
SAI Guwahati based on the inclusion and exclusion
criteria. The subjects were divided into two groups
after the informed consent was signed. Subjects with
prediagnosed cases of TFCC injury were included in
the study. Group A (Taping + Conventional
Therapy, n=14) and Group B (Conventional
Therapy, n=14). Pre intervention measurements of
pain, range of motion and grip strength were taken
out using Numerical Pain Rating Scale, Universal
Goniometer and Hand Dynamometer. Both the
groups were received intervention for total of 8 days
with a rest period on the 4th day. Subjects were
excluded from the participation if they present with
any neurological deficit of the reference extremity,
ay other reason of wrist and hand pain of the
reference extremity, history of fracture or any other
musculoskeletal surgery of wrist, pain or movement
restriction more than 6 weeks and subjects with h/o
TFCC injury less than 48 hours.
Grip strength (pound)11,18, Range of Motion
(degree)15 for Wrist and Forearm and Numerical
Pain Rating Scale13,28 was taken as outcome measure
before and after the total session of treatment. All
the subjects were assessed for outcome on 1st day
(before the intervention), 4th day and the final data
was collected on 8th day.
Protocol for Group A (Taping): Tennis Specific
Unload, Block and Redirection Tape Technique
were applied according to the principle of
McConnell taping. This tennis-specific wrist taping
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technique protects and supports the injured

structures; however it restricts only the desired
motions (supination, ulnar deviation, and
extension).23 The technique meets the desired goal of
allowing a player to play with more support which
improves function, while restricting extreme range
of motion. It is designed to consider the anatomy
and patho-physiology of the injury and the
biomechanics of the two-handed backhand.23
Fig. 1.3: Tape with redirectional technique for
supination
1 subjects was dropout before the 4th day
assessment.

Fig. 1.4: Tape with supination end range block

Fig. 1.1: Fixomull Stretch with Gutter

Protocol for Group B (Conventional Therapy):

Conventional treatment of TFCC was given, which
include rest to the part, Ultrasound Therapy and
Home Exercise Program.23,2 The parameter for
Ultrasound was Frequency: 3 MHz, Intensity:
1.4W/cm2, Time: 6 minutes, Mode: Continuous.6
2 subjects were dropout, 1 before the 4th day
and other after the 4th day assessment.

DATA ANALYSIS

Fig. 1.2: Tape with directional force Data was analyzed by using SPSS software
(version 16). Paired t-test was applied to compare
the data within the groups whereas Independent t-

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 Scientific Research Journal of India ● Volume: 2, Issue: 1, Year: 2013

test was applied to compare the data between the

groups. The p value was set at (≤0.05) with 95%
confidence interval.

RESULTS

Table 1.1: Comparison of Pre and Post Grip Strength

score for Group A and B

MEAN SD
t p
PRE POST PRE POST
Fig. 1.6: Comparison of Pre and Post Wrist Extension
GROU
64.102 78.308
18.6662
24.674
ROM for Group A and Group B
PA 9 -6.697 .000

GROU 20.7864
52.5 69.306 24.55889
PB 4 -7.824 .000
Table 1.3: Comparison of Pre and Post Pain Score for
Group A and Group B

MEAN SD
t p
PRE POST PRE POST
GROUP
5.3077 0.6154 0.63043 0.50637
A 26.836 .000
GROUP
5.8333 1.3333 1.19342 0.65134
B 12.539 .000

Fig. 1.5: Comparison of Pre and Post Grip Strength

score for Group A and B

Fig. 1.7: Comparison of Pre and Post Pain Score for

Table 1.2: Comparison of Pre and Post Wrist Group A and Group B
Extension ROM for Group A and Group B

MEAN SD
t p Table 1.4: Comparison of Grip Strength between
PRE POST PRE POST
Group A and Group B
GROUP
67.692 71.692 4.38529 2.35884 -3.399 .005
A
MEAN SD
GROUP GROUP GROUP GROUP GROUP t p
68.75 71.667 3.76889 3.25669 -2.244 .046
B A B A B

PRE 64.102 52.5 18.66629 20.78644

1.464 .157

POST 78.308 69.306 24.674 24.55889

.913 .371

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Fig. 1.8: Comparison of Grip Strength between Group

A and Group B
Fig. 1.10: Comparison of NPRS between Group A and
Table 1.5: Comparison for Wrist Extension ROM Group B
between Group A and Group B

MEAN SD
t p Results of the study showed that there is significant
GROUP GROUP GROUP GROUP
A B A B
reduction in pain and improvement in grip strength
PRE 67.692 68.75 4.38529 3.76889
-.648 .523
POS
71.692 71.667 2.35884 3.25669
and range of motion in both the groups after the
T .023 .982
intervention. However, Group A (Taping) showed
more reduction in pain score when compared to
Group B and this was found to be statistically
significant p=.005 post intervention. Other variables
also showed improvement but it was statistically
non-significant.

DISCUSSION

Hand and wrist trauma accounts for 3-9% of all

athletic injuries.12 An injury to the TFCC is very
Fig. 1.9: Comparison for Wrist Extension ROM important as it is the most common cause of ulnar
between Group A and Group B
side wrist pain and limited wrist function in work or
in sports.29 According to Kathleen Stroia et al., when
Table 1.6: Comparison of NPRS between Group A the wrist is loaded into supination, ulnar deviation
and Group B
and extension, the TFCC, ECU tendon and sheath
MEAN SD are loaded with significant stress. This is the typical
t p
GROUP GROUP GROUP GROUP
A B A B position of the non-dominant wrist during the two-
PRE 5.3077 5.8333 0.63043 1.19342 -1.393 .177
handed backhand stroke, it also occurs during a
POST 0.6154 1.3333 0.50637 0.65134 -3.091 .005 forehand stroke.23

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The present study was done to find out the
efficacy of Taping in terms of grip strength, range of
motion and pain score in subjects with Triangular
Fibrocartilage Complex Injury.
The most probable reason for the reduction in
pain after the application of tape could be due to
reduction of strain on the injured structure in both
the acute phase and also during the ongoing repair
and rehabilitation phase. Supporting an injured joint
with tape is widely believed to be helpful in
reducing pain, preventing exacerbation of the injury
4
and promoting tissue healing. This technique met
the desired goal of allowing the players to play with
full support and improved function as said by the
23
Kathleen Stroia in his study.
Another possible effect of tape could be due to
a direct mechanical effect on the TFCC, presumably
by somehow improving the internal mechanics or by
protecting the damage tissues from excess forces and
as a result, decrease in pain and improving grip
strength.26
Along with it, this method of taping technique
also disperses the stress generated by the muscle
during contraction which results in decreasing the
pain level by reducing the painful inhibition. The
possible mechanism behind the reduction in pain is
due to its neurophysiologic effects on the nervous
system, particularly the nociceptive system. In this
neurophysiological model the tape may exert an
effect on grip strength by primarily altering pain
perception, either locally at the wrist by inhibiting
nociceptors, facilitating large afferent fiber input
into the spinal cord and/or possibly by stimulating
endogenous processes of pain inhibition thereby
increasing the grip strength and reducing the pain
level as according to the Alireza Shamsoddini et al
in his study.22
Limitations of the study are small sample size
and different grades of the TFCC injury was not
taken into consideration. So the further
recommendation for future studies need to be done
with broader dimension, on the workers who are
mainly involved with hand and wrist work, and its
effectiveness can also be checked with other taping
technique.
CONCLUSION
The present study demonstrates that both the
technique is effective in improving the grip strength,
range of motion and reducing the pain in subjects
with TFCC injury. However, Taping technique used
in this study proves to be effective in reducing the
pain in subjects with TFCC injury. So, it can be
concluded that Taping is the better choice of
treatment in subjects with TFCC injury along with
other therapeutic modalities.

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CORRESPONDENCE

* Asst. Prof. Department of Physiotherapy, Dolphin (PG) Institute, Dehradun (UK)

** Associate Prof. Department of Physiotherapy, SBS PGI Biomedical and Research, Dehradun (UK)
*** Student Researcher, Dolphin (PG) Institute, Dehradun (UK). Email: babloo83_sharma@yahoo.com