Triangular Fibrocartilage Injuries: Treatment Options Explained

Triangular fibrocartilage

My older brother has been a long-term excavator driver.
About a year and a half ago, he reported pain in his wrist.
He underwent several examinations at hospitals in the Yilan area, including X-rays and MRI scans.
Different doctors diagnosed him with a triangular fibrocartilage complex (TFCC) injury.
However, there were two differing opinions: one group of doctors suggested trying rehabilitation, while another recommended surgical treatment.
The latter proposed not only minimally invasive surgery on the TFCC but also suggested that the ulnar bone be cut and reattached.
Our family unanimously feels that the issue is clearly with the TFCC in the wrist, while the ulnar area is completely asymptomatic.
Moreover, the risks and trauma associated with cutting and reattaching a healthy ulnar bone seem excessive.
We would like to ask if you have any better recommendations or if we should visit Keelung for you to examine him.

Qiu Xiansheng, 40~49 year old female. Ask Date: 2023/04/25

Dr. You Dianqi reply Orthopedics

Hello, in the case of a triangular fibrocartilage complex (TFCC) injury, it is recommended to temporarily suspend wrist activities during the acute phase.
After the acute phase, rehabilitation therapy can begin.
If the results are unsatisfactory, surgical options such as traditional open surgery or wrist arthroscopy may be considered.
Postoperatively, rehabilitation is also necessary.
It is advisable to discuss the subsequent treatment direction with family and your physician.
Thank you.

Reply Date: 2023/04/25

More Info

Triangular fibrocartilage complex (TFCC) injuries are common among individuals who engage in activities that involve repetitive wrist motions or trauma, such as operating heavy machinery. The TFCC is a structure located on the ulnar side of the wrist, providing stability and cushioning between the distal ulna and the carpal bones. Injuries to this area can lead to pain, swelling, and decreased wrist function, which can significantly impact daily activities and occupational performance.

In your brother's case, it appears that he has been diagnosed with a TFCC injury based on imaging studies (X-rays and MRI) conducted at hospitals in Yilan. The differing opinions from various physicians regarding treatment options can be confusing, but they reflect the complexity of managing TFCC injuries.

Treatment Options for TFCC Injuries
1. Conservative Management:
- Physical Therapy: Rehabilitation is often the first line of treatment for TFCC injuries. A physical therapist can design a program that focuses on strengthening the wrist, improving range of motion, and reducing pain. Modalities such as ultrasound, electrical stimulation, and manual therapy may also be employed.

- Bracing: A wrist splint or brace can help immobilize the wrist, allowing the TFCC to heal while minimizing pain during daily activities.

- Activity Modification: Avoiding activities that exacerbate wrist pain is crucial. This may involve altering how he operates machinery or taking breaks to reduce strain on the wrist.

2. Medications:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation associated with TFCC injuries. Over-the-counter options include ibuprofen or naproxen, but a physician may prescribe stronger medications if necessary.

3. Injections:
- Corticosteroid injections can provide temporary relief from pain and inflammation, particularly if conservative measures are insufficient. However, this is typically considered when other treatments have failed.

4. Surgical Intervention:
- If conservative treatments do not yield satisfactory results after a reasonable period (usually 3-6 months), surgical options may be considered. The type of surgery depends on the specific nature of the injury:
- Arthroscopic Repair: This minimally invasive procedure involves repairing the torn TFCC. It is often preferred due to its lower risk and quicker recovery time compared to open surgery.

- Ulnar Shortening Osteotomy: In cases where there is ulnar variance (the ulna is longer than the radius), this procedure involves shortening the ulna to relieve pressure on the TFCC.

- Ulnar Head Resection: In severe cases, removing part of the ulnar head may be necessary, though this is less common.

Considerations for Surgery
The suggestion to perform a surgical procedure that involves cutting and reattaching the ulna raises valid concerns. Surgical interventions should be carefully considered, especially when the area that is being operated on is asymptomatic. It is essential to weigh the potential benefits against the risks, including complications from surgery, prolonged recovery, and the possibility of not achieving the desired outcome.

Recommendations
Given the complexity of your brother's situation, it would be prudent to seek a second opinion from a hand specialist or an orthopedic surgeon who specializes in wrist injuries. They can provide a thorough evaluation and discuss the most appropriate treatment options based on the specifics of the injury, the patient's activity level, and overall health.

In conclusion, while conservative management is often effective for TFCC injuries, surgical options exist for cases that do not improve with conservative measures. It is crucial to have a detailed discussion with a qualified specialist to determine the best course of action tailored to your brother's specific condition and lifestyle.

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