What are the symptoms in a TFCC injury?

With a TFCC injury, there is pain on the little finger side of the wrist. Pushing up from a chair elicits symptoms on the little finger side of the wrist. Twisting movements with force and/or pinching with force produce pain. Loss of strength is also sometimes felt. If there is instability between the ulna and radius after trauma, then increased play is possible between these two bones and the so-called "piano key phenomenon" occurs. The patient themselves may also perceive instability.

Diagnosis

Based on the pattern of symptoms and physical examination, the symptoms are identified. Because there are many structures on the pinky side of the wrist, and because the TFCC and complex structure, it is not often easy to arrive at a diagnosis.

Additional X-rays are taken to assess the bones and joints in the wrist. Here, particular attention is also paid to the length of the ulna.

An MRI can be made, however, it is not always reliable for problems of the TFCC. For example, small tears can sometimes not be detected, or tears may be seen that occur with normal aging. These tears are then often not the cause of the symptoms. Therefore, it is often decided to perform keyhole surgery on the wrist where the TFCC and the rest of the wrist can be properly assessed.

Treatment

The type of treatment depends on the severity and especially on the cause of the symptoms. Here a good distinction must always be made between traumatic TFCC injury, or wear and tear of the TFCC. The goal of the treatment is pain reduction and a stable TFCC complex.

Non-operative (conservative) treatment

If there is a traumatic TFCC injury without instability, the first stage may be treatment with a cast or splint for 4-6 weeks. This is followed by treatment with the hand therapist to make the wrist stable and strong.

When there is a rupture in the TFCC due to wear and tear, that part of the wrist is often helped by relief. Avoiding or performing painful action differently leads to reduction of symptoms. Wearing a TFCC band or brace (temporarily) and hand therapy to make the wrist flexible and strong can relieve symptoms and improve functionality of the wrist.

The use of painkillers such as paracetamol and anti-inflammatories (only if the patient's overall condition allows) can also reduce pain symptoms. Flex Clinics is part of MSB Flex Coöperatie U.A.

If this does not help sufficiently, an injection of corticosteroids may be considered.

Surgical treatment

There are several surgical options for TFCC injury, depending on the type of injury and the length of the ulna.

The surgeries are all done in day surgery. The whole arm is numbed by a nerve block or general anesthesia is used. The wound is and sutured with stitches that can be removed after 10-14 days. The follow-up treatment depends on the type of surgery performed.

Keyhole surgery

With keyhole surgery, the inside of the wrist joint is viewed through a pair of peepholes and the TFCC can be assessed. The stability and cartilage coverage of the carpal bones can also be checked.

Some problems can also be treated through keyhole surgery. For example, in cases of wear and tear or central traumatic tears of the TFCC, the loose edge can be cleaned (shaven).

If a traumatic tear allows the TFCC to be sutured, in some cases it can also be done through keyhole surgery.

When wear also involves an overly long ulna, a slice of this can be "shaved" off. Irritation of the mucosa can also be cleaned.

Suture

As mentioned above, the TFCC can be sutured through keyhole surgery, but this can also be done with an open surgical procedure. This involves making an incision at the end of the ulna and suturing the TFCC or reattaching it to the bone.

Shortening of the ulna

When complaints of the ulna involve a relatively long ulna in relation to the radius, the choice may be made to shorten the ulna. This is an open surgical procedure that involves removing a small slice of bone from the ulna and securing the ulna with a plate and screws.

During the consultation hour, you will receive detailed information about the type of procedure that is necessary for you, explanations about post-treatment and recovery, and you will be given an information brochure about the procedure.