TFCC (Triangular Fibro Cartilage Complex) tear is an injury leading to instability and pain on the ulnar (little finger) side of the wrist. Clinical examination to assess site of pain, movements of the wrist, ulnar head (forearm bone) stability gives enough pointers to diagnose, however the extent of the tear and the condition of the surrounding structures such as tendons wouldn’t be easy to decipher.

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Diagnosis

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X-ray. X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray.

MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the TFCC ligament injury. In addition, it helps to assess the condition of the rest of the wrist joint and tendons around the wrist.

 

 

Treatment

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Non-surgical Treatment

 

TFCC ligament injuries can be treated with a wrist splint for upto 3 weeks in the first instance. In majority of patients this would be sufficient. If healing well this would be followed by stretching exercises to get the mobility back. In patients with poor healing or no improvement, it becomes necessary to get an MRI Scan done to assess the extent of the injury.

 

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Partial TFCC Ligament tears

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In partial tears which have refused to heal with simple splinting, a PRP (Platelet Rich Plasma) Injection and a plaster cast for 4 weeks is recommended. Here PRP stimulates the healing process and the cast immobilizes so that the ligament can stand a better chance to heal.

 

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Complete TFCC Ligament tears

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Complete TFCC ligament tears need a Arthroscopic TFCC Repair Surgery to heal the tear. This procedure is done either arthroscopically (through camera and small cuts) or as a mini – open surgery. The damaged tissue is debrided (removed) and the edges of the tear are freshened so that it can heal well. Post that, the ligament is reattached to the soft tissues on the sides with stitches. Large tears are repaired with the stitches and the sutures are fixed back to the ulnar bone using small bio-composite suture anchors.

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Rehabilitation

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Post-surgery, you can expect to be in a plaster slab upto above the level of elbow for 2 weeks followed by below the level of elbow for another 2 to 4 weeks depending upon the nature of repair undertaken. Once your cast has been removed you need physiotherapy to help regain range of movement first, followed by strength and full function of your wrist.

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