TFCC Surgery

What is TFCC?

TFCC is also known as the Triangular Fibro Cartilage Complex, and it affects the area between one’s radius and ulna. These two bones make the forearm. The TFCC is made of various ligaments and tendons besides cartilage. Besides helping the wrist move and stabilize the forearm bones, one grasps something with their hand or rotates the forearm. A type of injury to the region is known as TFCC tear.

Types of TFCC Tears

There are two types of tears:

Type 1 Tears: It is usually caused by falling on an outstretched hand and excessive arm rotation. These are also called traumatic tears.

Type 2 Tears: It occurs over time with the wearing out of the cartilage with time. This type of tear is degenerative and chronic.

Causes of TFCC tear

• Type 1 TFCC tears are mainly caused due to injuries, for instance, falling or landing on the outstretched hand, which can easily damage cartilage, tendons, or ligaments in one’s TFCC.
• Type 2 TFCC tears are mainly caused due to slow cartilage breakdown in the TFCC, and it is due to the age of some underlying conditions, including rheumatoid arthritis or gout.

Symptoms

The main symptoms of a TFCC are pain on the outer aspect of the wrist. The pain may be constant or only appears when you move your wrist or apply pressure on it.

The other symptoms of a TFCC tear include:

• A clicking or popping sound when you move your wrist
• Swelling
• Instability
• Weakness
• Tenderness
• Pain at the base of the wrist, near the small finger.
• Bending of the wrist from side to side worsens the pain.
• Loss of grip strength.

Diagnosis

The doctor would also recommend the following tests to diagnose TFCC tear:

• X-Rays provide clear images of the wrist joint to rule out any fractures.
• Magnetic Resonance Imaging (MRI) will give an idea of the soft tissue damage around the wrist joint.

Treatments

Non-Surgical Methods

The different non-surgical treatment options are:

Rest: Giving proper rest to the wrist is the first step towards recovery. The patient is recommended to stay away from sports or strenuous activities that can aggravate the symptoms.

Icing the Elbow: It is recommended to be done for 20 to 30 minutes at intervals of 3-4 hours for two to three days. This will help reduce the pain and swelling.

Splint or Cast: It is recommended by doctors to relieve the symptoms by providing immobilizing the wrist and forearm for 4 to 6 weeks, allowing the scar tissue to develop and healing the TFCC.

Wrist Support Straps: They can help in mild compression and minimize the movement of the wrist.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs drugs like Ibuprofen etc., can help reduce pain and swelling.

Steroid Injections: Steroid Injections like cortisone can also help as anti-inflammatory medicines and help relieve the symptoms.

Physical Therapy: It is usually recommended with exercises for muscle strengthening and to reduce stiffness and increase flexibility.

Electrotherapy: Here usually ultrasound is used.

Surgical Treatment

The doctors will recommend surgical interventions when the non-surgical treatment does not prove effective after 8-12 weeks. The existence of additional unstable or displaced fractures or unstable DRUJ can also make the doctors recommend surgery.

The doctors usually opt for the Arthroscopy technique for the following:

• Arthroscopic Debridement of TFC discus tissue

The central part of the TFC cannot heal because it has no blood supply. A tear in the TFC area creates an unstable tissue flap that can catch on other joint surfaces. Removing or debridement of this damaged tissue is required.

• Arthroscopic Repair of TFCC Ligaments

The repair of the TFCC ligaments by suturing using the Arthroscopy technique is common. The ligaments and the surrounding structures face no serious damage. The torn ligaments will retract and lose length after some time and are not possible to re-suture again and reconstruction might be required.