TFCC tears are a relatively common wrist injury. The TFCC (Triangular Fibrocartilage Complex), is a load-bearing structure that stabilizes and supports the joints of the forearm: the radius and the ulna. The TFCC also helps to connect and stabilize the bones of the forearm with the small bones of the hand on the “pinky side” of the wrist.
What are the primary indications for TFCC tears that would benefit from surgery?
TFCC tears that can benefit from surgery include tears associated with wrist instability, peripheral tears and central tears that fail nonoperative management. TFCC tears generally present in the form of ulnar-sided wrist pain, which typically worsens with activity and can be associated with instability and weakness.
How are TFCC tears repaired? (Arthroscopic versus Open?)
A TFCC tear can be repaired in two ways: Arthroscopically or with an open approach. The surgery performed depends on the type and severity of the TFCC tear.
Arthroscopic: Performing an arthroscopic TFCC repair (i.e., a minimally invasive orthopedic procedure performed using small incisions) involves the use of a small camera and instruments that are passed through the wrist via a small pokehole incision, allowing the surgeon to visualize the TFCC tear. Once the tear is identified and cleaned, a suture shuttling mechanism is used to capture the torn portions of the TFCC and repair them within the wrist, avoiding the disruption of surrounding soft tissues.
As a result of the minimal amount of soft tissue dissection (when compared to an open procedure), the extent of post-operative stiffness and pain significantly decreases, which results in a more rapid and improved functional recovery.
Open: Open procedures are elected for TFCC tears that cannot be completely or safely repaired arthroscopically. This is also usually associated with the chronicity of the injury. For example, an incompetent TFCC with associated wrist instability, would likely require a reconstructive procedure involving use of a tendon graft. Such reconstructive procedures are more demanding and typically cannot be performed arthroscopically through small incisions, thus necessitating an open procedure.
TFCC Tear Surgery: What should patients know preop?
Surgery is performed either under regional anesthesia with sedation or under general anesthesia. Patients would be instructed in advance on necessary preparation for the assigned type of anesthesia.
Surgery for TFCC Tears: What should patients know about post-operative process and recovery times?
Arthroscopic TFCC Repairs:
- Patients generally experience some amount of post-operative pain at the surgical site and in the wrist, depending on the specificities of the arthroscopic procedure.
- Your surgeon will determine if post-operative pain would be most appropriately managed with over-the-counter pain relievers or stronger prescription medications.
- TFCC surgery always requires placement of a cast for post-operative protection and healing. Repair of a TFCC peripheral tear may require a cast that includes the elbow for at least 6 weeks. Debridement of a TFCC central tear generally only requires a cast that immobilizes the wrist, for at least 2 weeks.
- At the two-week follow-up, the wound is assessed, sutures are removed if they were placed and a decision regarding postop immobilization is made based on the type of tear and surgical procedure performed.
- Resistance and strengthening activities, as well as heavy lifting, twisting, pushing or pulling are discouraged in the six-week postop period to allow for appropriate postoperative healing.
Open TFCC Repairs:
- Patients generally experience some amount of post-operative pain along the surgical incision and in the wrist.
- Your surgeon will determine the appropriate post-operative pain management regimen needed on a case-by-case basis.
- Open TFCC Repair Surgery requires approximately six weeks of cast immobilization, with inclusion of the elbow in a manner that will allow for bending the elbow but will not allow for rotation at the elbow.
- The cast cannot be removed for the first two weeks postoperatively.
- For the four weeks thereafter, the cast can be removed for hygiene purposes.
- At the six-week mark postop, patients would typically begin hand and wrist therapy to achieve range of motion for an additional six weeks.
- At the three-month mark postop, patients generally begin resistance, and strengthening exercises and activity restrictions are typically lifted depending on the patient’s unique injury and surgery.
Following a successful TFCC repair, can patients expect to resume their normal physical activities?
For TFCC tears that can be fully and successfully repaired and properly rehabbed, most patients are able to resume all normal physical activities that require the use of the upper extremities.