TFCC Injuries and Ulnar Dislocation: When to Consider Surgery

Q: TFCC Injuries and Ulnar Dislocation: When to Consider Surgery

Hello： There is a discrepancy in the position of the distal radioulnar joint. <br>A bilateral wrist X-ray should provide more information. <br>If a TFCC injury is suspected, forceful rotation of the wrist can cause pain in the distal radioulnar joint, which cannot be seen on X-ra

The issue of the ulna being misaligned and the injury to the triangular fibrocartilage complex (TFCC) raises the question of whether surgical intervention is necessary?

Hello Doctor, about four and a half months ago, I fell while playing basketball and landed on my hand.
Initially, I experienced pain on the inner side of my palm.
I have been consistently undergoing rehabilitation (four times a week) until last month when I noticed no improvement.
Currently, when I press on the back of my wrist and the ulnar side, it hurts.
I consulted another rehabilitation center, and three doctors suggested that I might have an injury to the TFCC (triangular fibrocartilage complex).
Based on my pain, it seems to be affecting the ulnar side and the inner wrist; even lifting 1 kg or applying pressure causes discomfort.

In the past three weeks, I visited two orthopedic specialists who took X-rays.
The doctors indicated that the ulnar bone appears to be misaligned, possibly pushed forward towards the wrist, which could be causing my symptoms.
They recommended conservative treatment, but I am currently experiencing significant discomfort and weakness.

To explain my current treatment: I am undergoing rehabilitation four times a week and applying heat three times a day, but I feel the effects are limited.
Doctor Wang, do you think surgery might be necessary at this point? It has been almost five months.
By the way, I have been visiting small clinics; should I make an appointment to see you for further evaluation? Thank you.

Mr. Li, 20~29 year old female. Ask Date: 2018/03/26

Dr. Wang Shouji reply Orthopedics

Hello: There is a discrepancy in the position of the distal radioulnar joint.
A bilateral wrist X-ray should provide more information.
If a TFCC injury is suspected, forceful rotation of the wrist can cause pain in the distal radioulnar joint, which cannot be seen on X-ray; an MRI examination is necessary.
If both imaging studies do not show improvement, further evaluation is required.
If a TFCC injury is confirmed, surgery will be necessary.

Reply Date: 2018/03/26

More Info

Understanding TFCC (Triangular Fibrocartilage Complex) injuries and ulnar dislocation is crucial for determining the appropriate treatment, including the potential need for surgery. The TFCC is a structure in the wrist that provides stability and cushioning between the ulnar bone (the smaller bone of the forearm) and the carpal bones of the wrist. Injuries to the TFCC can occur due to trauma, such as falling on an outstretched hand, which seems to be the case in your situation.

Based on your description, it appears that you have been experiencing persistent pain and discomfort in your wrist for over four months following your injury. The fact that you have undergone rehabilitation without significant improvement raises concerns about the severity of your injury. The pain localized to the ulnar side of your wrist, especially when lifting even light weights or applying pressure, suggests that there may be a significant issue with the TFCC or the ulnar positioning.

When assessing whether surgery is necessary for TFCC injuries, several factors come into play:
1. Severity of the Injury: If imaging studies (like X-rays or MRIs) indicate a complete tear of the TFCC or significant ulnar dislocation, surgical intervention may be warranted. Partial tears may respond to conservative treatment, but complete tears often require surgical repair.

2. Duration of Symptoms: You mentioned that it has been nearly five months since your injury, and despite consistent rehabilitation, your symptoms have not improved. Chronic pain and functional limitations can indicate that conservative measures are insufficient.

3. Functional Limitations: If your ability to perform daily activities is significantly impaired due to pain and weakness, this is a strong indication that surgical options should be considered. The goal of surgery is to restore function and alleviate pain.

4. Response to Conservative Treatment: You have been undergoing rehabilitation four times a week, along with heat therapy. If these measures have not provided relief, it may be time to reassess your treatment plan. Sometimes, a more aggressive approach or surgical evaluation is necessary.

5. Consultation with a Specialist: Given that you have seen multiple doctors and received varying opinions, it may be beneficial to consult with an orthopedic surgeon who specializes in wrist injuries. They can provide a comprehensive evaluation, possibly including advanced imaging like an MRI, to assess the extent of the injury and determine the best course of action.

In summary, if your symptoms persist despite conservative treatment, and if imaging suggests a significant injury, surgery may be necessary to repair the TFCC and address any ulnar dislocation. It is essential to have a thorough evaluation by a specialist who can guide you through the decision-making process and discuss the potential benefits and risks of surgical intervention. Your quality of life and ability to return to activities you enjoy, such as playing sports, should be the primary considerations in determining the need for surgery.

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