What is a TFCC lesion?
This is a sprain of the wrist with damage to a ligament known as the ‘TFCC’ or triangular fibrocartilage complex. This ligament serves primarily to stabilize the joint between the radius and ulna, the two bones of the forearm. Injuries to this ligament are most often due to accidents, but can also occur through wear and tear over the years.
Wrist pain is the most frequent symptom, and often occurs during screwing and unscrewing movements. The painful site is located at the ulna (or ulna head), i.e. on the side of the wrist in line with the “little finger”.
What tests are required?
Even if X-rays don’t show the ligaments, they can be useful in ruling out possible bone damage.
This is the most appropriate examination, as it allows the ligaments to be analyzed. It lasts around thirty minutes and sometimes requires the injection of a contrast agent directly into the wrist joint (arthro-MRI).
- Wrist arthroscopy
This is an outpatient surgical procedure involving the insertion of a camera into the wrist joint through small incisions. It may be necessary if MRI is unable to determine whether a lesion exists, but can also be proposed as an alternative to MRI.
What are the treatments for TFCC lesions?
Immobilization of the wrist with a splint and anti-inflammatory medication are the first stage of treatment.
You’ll need to combine this with a transitional change in your habits, such as sports and work. Occupational therapy sessions may be prescribed at a later stage. Sometimes, the wrist joint is infiltrated with anti-inflammatory drugs (cortisone) to alleviate the pain.
If pain persists or MRI shows severe ligament damage, surgical treatment is indicated.
Surgery can be performed either arthroscopically (through a camera) or conventionally through an opening in the joint (direct vision). The choice depends on technical factors and the surgeon’s preferences.
The aim of treatment may vary according to the type of ligament injury. This may involve reattaching the ligament if it has become detached from the bone, or cleaning the joint if it contains inflammation. In some cases, intervention on the bone is required, usually to shorten the ulna, which involves fitting a plate and screws.
When reattachment of the ligament is necessary, a splint or cast is required at the end of the operation. This cast supports the wrist and often the elbow. It should be left in place for between two and six weeks. Once it has been removed, physiotherapy rehabilitation often lasts several months. Time off work depends on the occupation, ranging from a few weeks (administrative work) to three months (heavy manual labor). Sports activities should be suspended for around three months.
When the ulna has been shortened, a cast is also applied for two to four weeks. If necessary, the plaque can be removed a year after it has been placed, but this is not always the case.
What are the possible complications?
Common to all surgeries
Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.
Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.
Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.
Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.
Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.
Complications specific to TFCC lesions
Osteoarthritis of the wrist (wear and tear of the joint’s cartilage) can occur in the medium to long term after a TFCC injury. This can lead to pain, lack of strength and limited wrist mobility.
In rare cases, the TFCC repair may come loose, necessitating a new operation.
Instability of the joint between the radius and ulna at the wrist may persist or even recur.
Sometimes, chronic wrist pain persists for which no clear explanation can be found.