Triangular Fibrocartilage Complex Injury After a Car Accident

Triangular fibrocartilage complex (TFCC) injury?

Hello, doctor.
I was involved in a car accident on June 18 and subsequently visited an orthopedic department at a regional hospital and an orthopedic clinic, where I continued to take medication and follow up.
My wrist has been very uncomfortable, and the doctor assessed that there is ligament damage with a protrusion near the radius.
Later, the physician at the regional hospital informed me that since it has been about 7 weeks without improvement, there may be damage to the triangular fibrocartilage and recommended that I be referred to a specialist.
During this time, I only had X-rays taken.
I visited three hospitals and eventually went to a medical center, where they also suggested starting with X-rays and concluded that there is damage to the triangular fibrocartilage, requiring surgery.
Do I need to undergo an MRI to confirm this? The doctor I saw is an associate professor, but the orthopedic surgeons who reviewed the X-rays have provided differing assessments.

Mr. Li, 20~29 year old female. Ask Date: 2018/08/14

Dr. You Dianqi reply Orthopedics

Dear Mr.
Lee,
Hello.
Based on your description, I would like to ask you about a specific part: When you mentioned the prominence on the radial side, are you certain it is on the radial side, or could it be on the ulnar side? Generally, symptoms of a triangular fibrocartilage complex (TFCC) tear tend to be more pronounced on the ulnar side.
An X-ray alone cannot definitively diagnose a TFCC tear; it should be combined with a physical examination and appropriate imaging (such as X-rays after intra-articular contrast injection or MRI).
The gold standard for diagnosis is wrist arthroscopy, although the former is less invasive while the latter is considered an invasive procedure (but can also be therapeutic).
If you are looking for a non-invasive way to obtain clearer imaging for diagnosis, MRI might indeed be worth considering.
Thank you, and I wish you a speedy recovery.

Reply Date: 2018/08/14

More Info

Understanding a Triangular Fibrocartilage Complex (TFCC) injury after a car accident is crucial for proper diagnosis and treatment. The TFCC is a structure located in the wrist, specifically on the ulnar side, and it plays a vital role in wrist stability and function. Injuries to the TFCC can occur due to trauma, such as in car accidents, and can lead to significant pain and dysfunction in the wrist.

In your case, it appears that after the car accident on June 18, you have been experiencing persistent discomfort in your wrist, particularly around the area where the ulnar bone is located. The fact that multiple doctors have assessed your condition and suggested a TFCC injury indicates that there is a strong suspicion of damage to this structure. The presence of a "bump" on the radius could suggest a possible fracture or a bone contusion, which may also contribute to your symptoms.

Typically, the initial evaluation of wrist injuries often includes X-rays to rule out fractures. However, X-rays may not provide sufficient information regarding soft tissue injuries, such as those involving the TFCC. In many cases, Magnetic Resonance Imaging (MRI) is recommended to obtain a clearer picture of the soft tissues, including ligaments, cartilage, and the TFCC itself. An MRI can help confirm the diagnosis and assess the extent of the injury, which is essential for determining the appropriate treatment plan.

If your current physician has recommended surgery, it is likely due to the severity of the injury and the failure of conservative treatments to alleviate your symptoms. Surgical intervention for a TFCC injury may involve repairing the damaged cartilage or stabilizing the wrist joint, depending on the specific nature of the injury. It is essential to have a thorough discussion with your orthopedic surgeon about the potential benefits and risks of surgery, as well as the expected outcomes.

In terms of your concern about needing an MRI, it is generally advisable to follow your doctor's recommendations. If there is uncertainty regarding the diagnosis or if the treatment plan seems inconsistent among different physicians, obtaining an MRI can provide valuable information that may help clarify your condition. Additionally, it may be beneficial to seek a second opinion from a specialist who has extensive experience with wrist injuries and TFCC repairs.

In summary, a TFCC injury can significantly impact wrist function and quality of life, especially after a traumatic event like a car accident. While X-rays are useful for identifying fractures, an MRI is often necessary to assess soft tissue injuries accurately. If surgery is being considered, it is crucial to understand the rationale behind this decision and to ensure that all diagnostic avenues, including imaging studies, have been explored to confirm the diagnosis. Engaging in open communication with your healthcare providers will help you make informed decisions regarding your treatment and recovery.

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