A TFCC injury refers to damage sustained by the triangular fibrocartilage complex in the wrist. This structure consists of several ligaments and cartilage arranged in a triangular shape.
The wrist is an intricate collection of joints. The forearm contains the radius and the ulna, the distal (furthest from the body) ends of which connect with the proximal (nearest the body) row of carpal bones of the wrist. A second row of carpal bones, the distal row, connects with the metacarpals (long bones) of the hand.
The part of the hand nearest to the little finger is called the ulnar side, as the ulna bone runs down the outer side of the forearm. The distal end of the ulna articulates (moves) against two of the proximal carpal bones, the lunate and the triquetrum. The TFCC lies between the ulna and the lunate and triquetrum bones, connecting them. Its roles are to:
Provide stability to the wrist bones as they rotate
Act as a shock absorber
Facilitate movement of the wrist by forming a continuous gliding surface for the radius and ulna.
A TFCC injury is the tearing or rupture of parts of the TFCC, which might include one or more of the ligaments and one or both cartilage structures. The cartilage structures are the triangular fibrocartilage, and the meniscus homolog that connects the triangular fibrocartilage to the triquetrum bone.
Causes:
The TFCC is most commonly injured during a fall onto an outstretched hand when the palm is facing down. Any action that forces the ulnar side of the wrist to move beyond its normal range can damage the TFCC structure.
Gymnasts and athletes are susceptible to this sort of injury. Some occupational requirements can lead to the degeneration of the TFCC tissues, which increases the risk of injury, as does the normal aging process. Other occupations, for example using power drills, can cause injury if the drill binds and forcibly rotates the wrist. Occasionally a person’s natural anatomy means that their radius is shorter than their ulna. This can cause a greater than normal curve in the ulna, which puts the TFCC under stress, increasing the risk of injury.
Symptoms:
Pain, often diffuse (not specific to one location) felt on the ulnar side of the wrist.
Pain made worse with rotation of the forearm or moving the wrist towards the ulnar side.
Swelling, tenderness, and weakness of the wrist
Clicking or crackling (crepitus)
Possible feeling that the wrist is unstable and may give out without warning.
Diagnosis:
Your doctor will ask you about your medical history, including any previous injuries to your wrist. Your general health, lifestyle, and activities will be discussed, and then your wrist will be physically examined.
It is important to evaluate the extent of the injury. TFCC injuries are graded according to how severely the tissues have been torn, and also whether the injury is an acute trauma (Class 1) or a chronic degenerative condition (Class 2). There are several tests that the doctor can perform to aid diagnosis. He or she will hold and manipulate the wrist in various ways to determine the exact location of the damaged tissue, and the stability of the wrist.
X-rays will probably be taken in order to see if there is a bone fracture of the distal radius. TFCC injuries are not visible on standard X-rays, so you may have dye injected into the wrist at three different locations, and an arthrography X-ray taken. Any leakage of the dye into the wrist joints will be a positive diagnosis of a TFCC injury. If swelling prevents a thorough examination you may have an MRI (magnetic resonance imaging) scan taken.
The most accurate method of diagnosing the extent and severity of a TFCC injury is through arthroscopy. This procedure uses narrow instruments, one with a lens and a light, inserted through small incisions around the wrist. This technique enables the surgeon to both see and repair any damage at the same time.
Treatment:
The type of treatment for a TFCC injury depends on the stability of the wrist. A stable wrist will require immobilization in a cast or splint for four to six weeks, followed by wearing a removable wrist splint for a further four to six weeks. You can take NSAIDs (non-steroidal anti-inflammatory drugs) to help reduce inflammation and pain. Your doctor may inject the wrist with a corticosteroid that can provide rapid relief from painful symptoms. Physical therapy to improve the range of motion and strength of the wrist would begin when the ligaments had healed. A program of graduated exercises would be designed for you and should be followed diligently in order to avoid reduced wrist function.
An unstable wrist has more severely torn tissues and should be surgically repaired. If for some reason surgery was not desirable, your wrist and forearm could be placed in a cast or splint for four to six weeks followed by a short arm cast for three to four weeks. Again, physical therapy would be an important factor in your recovery.
A ruptured ligament needs to be surgically repaired as quickly as possible. The outer edge of the TFCC is well supplied with blood so healing in that area is straightforward. However, the central part has no blood supply (avascular) so the surgeon would smooth or shave any rough areas that might catch on other structures and cause pain. Torn ligaments would be reattached using sutures (surgical stitches) or, occasionally, fixing devices such as screws or wires.
If surgery has been delayed for too long it might not be possible to repair a ligament. The surgeon can fashion a new ligament from a tendon and graft it into position to help stabilize the wrist.
Your doctor and surgeon will help you decide which is the best form of treatment for your particular injury to restore optimal function to your wrist.
Prognosis:
Mild or moderate TFCC injuries generally recover well and people can resume normal activities. Occasionally the wrist may remain a little unstable, which can lead to articular degeneration and the development of arthritis. Surgery to rectify this might be required. Surgery might also be needed if there is still pain or stiffness left after a previous surgery.
Typically, if treatment is prompt, medical advice is followed, and physical therapy exercises performed, you should regain full function, range of motion, and strength in your wrist.
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