Wrist Arthroscopy for TFCC Tear (Ulnar-Sided Wrist Pain)
What Is TFCC?
- Triangular Fibro Cartilage Complex
- Found in the wrist joint
- It is the ligamentous and cartilaginous structures that suspend the distal radius and ulnar carpus from the distal ulna
Causes of TFCC Tears
- Falls onto pronated hyperextended wrist
- Power-drill injuries in which the drill binds and rotates the wrist instead of the bit
- Distraction force applied to the volar forearm or wrist
- Distal radius fractures
Symptoms of TFCC Tear
- Ulnar sided (i.e. little finger side) wrist pain
- Associated with clicking
- Painful grinding or clicking with wrist range of motion (ROM)
- Ulnar deviation of the wrist with the forearm in neutral produces ulnar wrist pain and occasional clicking (Perform a TFCC compression test.)
- Instability of the distal radioulnar joint (DRUJ) with shucking the distal radius and ulna between the examiner’s fingers
Piano key sign, which is a prominent and ballottable distal ulna with full pronation of the forearm
- Ulnar carpal sag
- Lunotriquetral (LT) interval tenderness
- Positive LT ballottement or shuck test
- ECU tendon subluxation
- Wrist arthroscopy
- Done under General Anaesthesia or Regional Anaesthesia
- 2 to 3 Small Incisions at the Wrist level
- Minimally invasive
- Right handed lady who fell off a bicycle onto her right outstretched hand 2 months ago.
- Has ulnar sided wrist pain.
- Treated with wrist splint for 6 weeks but not better.
- MRI scan of her wrist showed a TFCC tear.
- Wrist arthroscopy under regional block.
- Right Hand and Wrist was suspended with 8 lbs of traction.
- The joint is entered using a 1.9mm arthroscope at the 3/4 portal.
- An outflow is achieved by inserting a 21G needle at the 6U.
- A working portal is created at 4/5 portal.
- The TFCC repair is done through a 6R portal which is enlarged.
The tear is repaired with an outside in technique with PDS 3/0 suture. The Smith & Nephew’s TFCC Mender device is used to pass the sutures through the torn TFCC. The sutures are tied outside the capsule while the ECU tendon is being protected by an assistant.
The wrist is immobilised in a backslab from above elbow to below the wrist with elbow at 90 degrees flexion and forearm in neutral rotation.
The plaster backslab is changed to a thermoplastic splint which is used to 3 weeks.
This is changed to a wrist brace for another 3 weeks.
Gentle range of motion exercises are started thereafter.