Triangular Fibrocartilage Complex Tear

Triangular Fibrocartilage Complex Tear
April 1, 2016

tfccWith the most skilled and stable hands in the field of upper extremity to perform surgery Dr. Vikas emphasizes, “triangular fibrocatilage complex is a structure of cartilage that protects the carpal bones that lie near the small finger side of the wrist. A wear or tear to this TFCC due to any traumatic injury or a degenerative disease can be debilitating. Though it is fairly common and can affect any person, people above 50 are more susceptible to this condition.”

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Even after20 years of experience andintrinsic knowledge on each enervating problem related to upper extremity from Germany and USA, Dr. Gupta believes that each condition that he treats teaches him some new concept or helps him to develop new combination methodologies to treat complexities. Talking about TFCC Tears, he stresses, “A doctor should immediately be consulted when your wrist pain is a result of falling on an outstretched hand, you belong to an athletic or gymnastic field or you are suffering from either a fracture or rheumatoid arthritis. With certain diagnostic tests to confirm that it is indeed a TFCC Tear, the doctor shall chalk out a technique accordingly.”

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Currently,Director ofThe Hand & Upper Extremity Surgery’ at The Medanta Institute of Bone & Joint Disease, Gurgaon, Dr. Gupta enforces, “It has to be understood that it is the TFCC that stabilizes the ulna and the radius bone in the joint and a tear to it may result in motion loss of the wrist. It can be treated by both conservative and surgical techniques depending on the severity and intensity of the cartilage tear.”

After having surgically repaired over 6000 limbs of upper extremity Dr. Gupta winds up his input on TFCC Tear by saying, “ TFCC Tear is becoming increasingly recognized problem that affects the functioning of the wrist thereby hindering routine daily activities. It is utmost essential to consult a specialized surgeon or doctor in the field to bring back the wrist to its initial position. Physical therapy is recommended from the beginning stage to after restoration stage in the TFCC Tears.”

FAQ – Triangular Fibrocartilage Complex Tear

Structure of cartilage that is found on the wrist part which lies towards the small finger and protects / supports the small carpal bones in the wrist is known as Triangular Fibrocartilage Complex (TFCC). They help keeping the forearm bones firm while it is rotated or when the hand grasps anything. A tear to TFCC is termed as TFCC tear. TFCC Tears can be caused either by traumatic injury or degenerative and chronic disorder.
The signs indicative of TFCC tear are- Patients with TFCC tear will often lose their strength while gripping and their wrist will feel very weak to them. Immense pain, swelling and a clicking sound while moving the wrist side to side is another symptom of TFCC Tear. In severe cases the wrist may either be bent towards the little finger side or the ulnar bone may become more prominent.
A person falling on an outstretched hand and the wrist getting bent backwards, a person already suffering with a fractured wrist, repetitive wrist movements and pressure by gymnasts or athletes involved in racquet, bat or club sports, ulna bone existent in the wrist longer than the radius bone thereby exerting more pressure on the TFCC and lastly age being over 50, are all contributory factors to TFCC Tears.
Since it is difficult to differentiate between TFCC Tear and other painful wrist conditions, TFCC is diagnosed by the doctor after careful physical examination of the condition in which the wrist is. With certain manipulating tests like the press test, piano test, load test or McMurray’s test he will try to assess the pain and immobility of the wrist. The doctor will also sought to confirm his diagnosis by running an X-Ray or MRI on the wrist. He might also seek the help of an Arthroscope or Arthrogram to further his diagnosing.
Depending on the severity of the condition the treatment techniques by which TFCC Tear is treated are either nonsurgical or surgical.

NON-SURGICAL TECHNIQUES:
Splinting / casting: Under this, the TFCC is immobilized in a splint to keep it protected and prevents movements that cause stress to the TFCC. They might either be placed in a sugar tong splint or an open braced cast.
Anti-Inflammatory Medications / Cortisone Injections: If the pain is mild the doctor prescribes non steroidal oral medicines to relieve the patient of the pain. If the enervating condition of the wrist is not able to be controlled after medication then cortisone injection is inserted in the wrist joint direct to relieve the painful condition.
Physiotherapy: During the period when your wrist is immobilized you will have to undergo a rehabilitation program to gently move your thumb and fingers to manage pain and thereafter to restore back lost motion in the wrist and its strength.
SURGICAL TECHNIQUES: If conservative treatment techniques fail then the patient has to be taken for surgical treatment methods which include
Wrist Arthroscopy: A minimally invasive procedure with small incisions which are made on the patient’s wrist and pencil like instruments containing a camera and some special tools to perform the surgery inserted, the damaged cartilage is repaired or removed and this technique is termed as Wrist Arthroscopy.
Open Surgery: Most invasive technique of treatment, under this surgical procedure the part of the wrist that are damaged or severely broken are put back together by fixing them with plates or K-wires.
Ulnar shortening Osteotomy: This is a technique that is used by the surgeon when the ulnar bone of the wrist is more in length and thus exerts pressure on the TFCC or when arthroscopy technique has failed to restore normal functionality to the wrist.
Your surgeon will remove the extra length of the ulnar bone within your wrist under this technique and bring ulnar bone to its required or optimum length for the wrist joint to function normally.

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