DESCRIPTION AND SYMPTOMS
WHAT IS A TRIANGULAR FIBROCARTILAGE COMPLEX INJURY?
Triangular fibrocartilage complex (TFCC) injuries occur in in one of two ways;
- Impact to the wrist with or without fracture. Falls with the wrist extended can lead to injuries to the TFCC. These injuries are acute and occur in patients with previously healthy wrists. About 35% of wrist fractures have injuries of this type.
- Chronic overuse injuries. These types of breaks are called chronic or impingement tears. In this case, the cause is a structural biomechanical problem: the ulna bone naturally hits or rubs against the nearby ligament, which can injure the TFCC over time when performing repetitive movements. This kind of injury is more common in people whose ulna is longer than their radius (known as ulnar positive variance).
Other related wrist injuries:
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SYMPTOMS AND DIAGNOSIS OF A TFCC INJURY
Symptoms of a TFCC injury include:
Pain in the wrist (on the side of the little finger). It can be associated with the appearance of a click. These discomforts increase with the performance of activities and decrease when you are at rest.- Feeling of weakness and even loss of grip strength in the hand.
- Pain with the position we call the “dart thrower” (the deflection movement of the wrist as when we throw a dart).
Pain in the wrist (on the side of the little finger). It can be associated with the appearance of a click. These discomforts increase with the performance of activities and decrease when you are at rest.Read more
The diagnosis of TFCC injury is based on medical history, physical examination, and complementary tests. A wrist x-ray is usually requested to assess the length of the ulna (ulnar variance), as well as the condition of the joint (to see if there is osteoarthritis). To complement the study, an MRI with or without contrast is usually requested.
IF THE INJURY IS NOT TREATED IN TIME
Work
The pain that this wrist injury produces can lead to an inability to perform work normally, either physically or mentally.
Sport
If the injury is not treated, athletes who practice sports such as golf, tennis, volleyball, basketball or rugby will not be able to practice them without pain or discomfort.
Loss of Function
If no treatment takes place, the wrist will lose flexibility and pain will increase.
TREATMENT
WHAT IS THE TREATMENT FOR A TFCC INJURY?
The initial treatment of a TFCC injury -be it degenerative or traumatic in nature, is conservative. Physiotherapy, the use of a rigid wrist strap along with intra-articular injections are the weapons we use initially. A directed and coordinated exercise program between the occupational therapist, trauma surgeon, and patient, with the aim of gaining full mobility and strength, is also vital for recovery.
Conservative treatment should last between 8 and 12 weeks. If pain and dysfunction persist after this time, only then id surgical treatment performed.
HOW IS AETHROSCOPIC WRIST SURGERY FOR FTCC INJURIES PERFORMED?
Local anesthesia is used. That is, during the procedure, only the arm to be operated on is put to sleep while the patient remains awake.
- Acute Traumatic TFCC Injury: The arthroscopic repair is carried out by making small incisions on the back of the wrist through which the camera and the rest of the instruments for the repair will be inserted.
- Degenerative TFCC injury: Arthroscopic repair is carried out by debridement (removal of damaged tissue) or suture (stitching of damaged tissue), depending on the type of injury. In cases in which an ulna positive variance is present (when the ulna is longer than the radius), open surgery is performed to shorten the ulna (osteotomy).
FREQUENTLY ASKED QUESTIONS
How long does an arthroscopic surgery for a TFCC injury take?
The duration time varies depending on factors such as the type of injury being treated, but averages between 45 and 90 minutes.
What is recovery like after arthroscopic wrist surgery?
- All patients will have to wear an immobilizer for a variable length time, depending on the characteristics of the procedure that has been performed.
- In the cases in which the procedure involves little complexity, gentle exercises of the wrist will begin the week after surgery.
What are possible complications after arthroscopic surgery for TFCC injuries?
The main complications derived from this type of procedure are:
- Mild to moderate intermittent pain
- Ulnar dorsal cutaneous nerve injury. Injury to this nerve means mild to complete numbing of the dorsal and ulnar area of the wrist (back of the hand in the area of the little finger).
REFERENCES
Fujio K. Arthroscopic Management of Triangular Fibrocartilage Complex Foveal Injury. Hand Clin. 2017 Nov;33(4):619-624. doi: 10.1016/j.hcl.2017.07.009. Review. PMID:28991574
Slutsky DJ. Arthroscopic Management of Ulnocarpal Impaction Syndrome and Ulnar Styloid Impaction Syndrome. Hand Clin. 2017 Nov;33(4):639-650. doi: 10.1016/j.hcl.2017.07.002. Review. PMID: 28991576
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