Our wrists are amazing joints that allow for a variety of complex movements with our hands. Performing a seemingly simple task such as rotating your hand requires stability through the wrist. The triangular fibrocartilage complex (TFCC) provides this stability. The TFCC is located in the wrist between the end of the arm’s ulna bone and the carpal bones. If a person falls forward with his or her palm down and the wrist extended the TFCC can tear. If serious enough, this injury may require TFCC surgery.
What Is the Function of the TFCC?
Because it involves various bones and ligaments, the wrist has a complex construction. It has to be both flexible and strong at the same time. The wrist is comprised of the distal radius and ulna bones of the arm, along with eight small carpal bones of the hand. Ligaments also connect these bones. The triangular fibrocartilage complex (TFCC) ligament can be found on the side of the wrist below the pinky finger. This ligament stabilizes the ends of the two forearm bones when you’re gripping items or rotating your forearm. It also provides cushion and suspends the carpal bones in place. The TFCC also makes it possible for the wrist to move in six different directions.
How Is the TFCC Usually Damaged?
TFCC is often injured in racket sports, baseball/softball, and gymnastics. A fall with an outstretched hand and the palm facing downward is the most typical injury. Gymnasts can injure their TFCC simply by landing on their hands in the wrong position. Construction workers using a drill can tear their TFCC when the drill binds and spins.
In older people, chronic tears are the result of a degenerative process that wears down the ligament over time. Some people may also have a longer than normal ulna bone that can pinch the TFCC ligament between the carpal bones, eventually wearing a hole in the ligament.
Symptoms of a Torn TFCC
Wrist pain along the ulnar side of the wrist (under the pinky finger) is the main symptom of an injury to the TFCC. In some patients, the pain can be pinpointed, but in others, the pain seems to diffuse. If the patient rotates the forearm or tilts the hand down toward the ulna bone, pain can result.
Simple actions such as using a manual can opener, turning a key in a lock, or lifting a gallon of milk with one hand will cause pain. Many patients feel a popping or clicking sensation in their wrist. The wrist may feel unstable as if it would give out if loaded.
Treatment for TFCC Tears
If the wrist is still stable, most TFCC tears can be resolved with conservative treatment. This involves immobilizing the wrist in a splint for about one month. This will allow scar tissue to help heal the injury. Anti-inflammatory drugs and physical therapy will likely be a part of this conservative approach. A corticosteroid injection may be used, as well.
When Is TFCC Surgery Necessary?
Surgery may be necessary if, after the splint is removed, pain and other symptoms of damage persist. Immediate surgery will be necessary if there is instability in the wrist, or if the injury also includes wrist fractures.
How Is TFCC Surgery Done?
The type of surgery required to repair the TFCC depends on the location of the tear in the ligament. Different areas of the ligament have different qualities of blood flow, so this can dictate different approaches. Many times, the ligament can be treated by cleaning the torn edges, also known as debriding.
TFCC surgery can usually be done arthroscopically. We confirm the damage and its location with an MRI as these ligaments will not show up on an X-ray. For the surgical repair, an arthroscope is inserted through a small hole on the back of the wrist. The arthroscope has a small camera and light source on the end, enabling our surgeons to see the ligaments and surrounding bones without needing “open” surgery through a large incision. Open surgery is usually not needed for TFCC repair, but certain conditions, such as full tears, may require it.
TFCC Surgery Results
The goal of TFCC surgery with the team at Advanced Orthopedics & Hand Surgery Institute is to restore full motion, strength, and function. The surgery needs to restore stability and the ability of the wrist to handle loads, such as when lifting an object with one hand. Resolution of ongoing pain is always a goal.
TFCC Surgery Recovery
If the ligament is debrided (cleaned), the patient will find that strength and motion return pretty quickly. We usually place the wrist in a splint for from two to six weeks. Depending on the type of surgery and location of the tear, we may start you with some small motion exercises just five to seven days after your surgery. From there, you’ll begin stretching and strengthening the wrist. If the ligament had to be repaired rather than simply debrided, the ligament needs to be protected and the wrist immobilized for about six weeks. From there, movement and stretching will be incrementally increased over the next six weeks.
TFCC Surgery Complications
With arthroscopic TFCC surgery, complications are rare. They may involve persistent pain and stiffness. Nerve injury may also result. If your injury also included a fracture, a bone reunion may also be a problem. Generally, however, this is a successful surgery, and the patient is able to resume the activities he or she enjoyed prior to their injury.