The wrist joint consists of eight small carpal bones in the hand that connect to the radius and ulna bones in the forearm. This joint allows for extensive movement and manipulation of the hand. The TFCC, triangular fibrocartilage complex, helps stabilize the distal radioulnar joint. It is made up of several ligaments and cartilage. There is a small articular disc in the center of the complex that cushions the wrist. Injury to the TFCC involves tears of the articular disc and surrounding ligaments. This injury can occur from an accident, falling onto an outstretched hand, repetitive wrist hyperextension and degenerative changes. Patients with positive ulnar variance, meaning the ulna is longer than the radius, are also more predisposed to TFCC injuries. This can be a result of a normal anatomic variant or from prior trauma. This relative difference causes the longer ulna to “abut” into the carpal bones, most commonly the lunate. This “impaction” can eventually cause TFCC tears along with other issues.
TFCC Tear – Modern Orthopaedics of New Jersey, Wayne, Parsippany, Paramus, NJ. Dr. Peter DeNoble MD, Dr. David Ratliff MD, and Dr. Lorraine Stern MD. Orthopedic Surgeons and Surgery, Hand Surgeon, Shoulder Surgeon, Finger, Wrist, Elbow, Pediatric, Hip, Knee, Foot and Ankle, Trauma. Passaic, Bergen, Morris County. 07054 07652 07470[/caption]
Pain from a TFCC tear is usually localized to the small finger side of the wrist, although in some cases the pain can be more diffuse. It is usually aggravated by any type of forearm rotation. Sometimes, patients may feel instability or catching inside the joint. Tears are diagnosed by a combination of history, clinical testing and MRI. Contrast is sometimes used during the MRI to help visualize the tear better, but this is not always necessary.
At your initial evaluation, you doctor will examine your wrist and do specific tests to assess the location of your pain and any instability you may have. X-rays will be done in the office to determine any potential abnormalities. If a TFCC tear is suspected your doctor will likely order an MRI to evaluate the extent and location of the tear. An MRI allows your doctor to see cross sectional images of the wrist and the surrounding tissues. Our doctors will ask that you bring a copy of your MRI to your next appointment so they can personally review the images. They will be able to look through the images with you and show you the source of your pain and the extensiveness of your injury.
There are different grades of TFCC tears, but treatment usually begins conservatively with immobilization and possibly a cortisone injection. Sometimes with rest and the help of cortisone to decrease inflammation in the area the pain may resolve. If the patient’s symptoms have not improved with conservative management or the patient is experiencing instability, they may be indicated for an arthroscopic TFCC debridement or repair.
A wrist arthroscopy involves using small cameras to see inside the wrist joint, assess the problems firsthand and treat them accordingly. Sometimes the TFCC needs to simply be debrided, which means cleaning up frayed pieces of damaged tissue. Other times the TFCC is torn and needs to be repaired with sutures. In the case where a repair is performed, you will be immobilized for a total of six weeks after surgery to allow for the repaired tear to heal. For the first few weeks you will be in a sugar tong splint that incorporates the wrist and the elbow. This prevents you from moving the wrist and rotating the forearm, which could affect your repair. At 2-3 weeks post op you will be transitioned into a Muenster cast which will allow for more movement of the elbow, but will still immobilize the wrist. After 6 weeks, you will be transitioned to a removable brace and begin formal physical therapy. Physical therapy will play a huge role in your recovery. You will being with range of motion exercises and progress to strengthening when your doctor thinks you are ready. Patients can generally return to most of their activities within 3-4 months of surgery. Although, it may take longer to return to sports that require heavy lifting or full weightbearing on the wrist.
TFCC tears can cause serious pain and dysfunction for patients of all ages. Our goal at Modern Orthopaedics is for you to return to the things you love! This may take time and patience, but we want you to experience a full recovery. We understand that every patient is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office with any wrist issues and receive superior care from our doctors and staff.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.