Managing Persistent Pain and Swelling After TFCC Surgery: A Guide

The wrist TFCC rehabilitation still shows persistent swelling and pain?

Hello, doctor.
I would like to inquire about issues following my TFCC arthroscopy.
It has been almost six months since the surgery, and I have undergone some rehabilitation activities in between.
However, I am unsure why I continue to experience persistent pain and recurrent swelling.
I have had to reapply immobilization multiple times.
I also underwent a follow-up MRI, which revealed inflammation and edema.
My attending physician mentioned that there doesn't seem to be any significant issues, but my postoperative pain has noticeably increased.
Strangely, the swelling and inflammation have not subsided after rehabilitation activities.
I wonder if this could be related to my physical condition or a possible rejection reaction.
Currently, I can only perform slight flexion and extension of my wrist, and I am completely unable to pronate or supinate without pain.
The more I use my wrist, the more it swells.
I am considering whether adhesions post-surgery could be a contributing factor.
I truly don't know what to do; I feel quite depressed, and the pain and my mood are indirectly affecting my sleep.
It seems that many people online suggest resuming rehabilitation as soon as possible, but I don't understand why my wrist continues to swell, disrupting my plans.
My basic blood tests for CRP and ESR are normal, and I really don't know how to resolve the inflammation and edema.
Perhaps there is something I have overlooked.
I would greatly appreciate your advice.
Thank you so much! I really don't know what the right course of action is.

Mr. Pain, 30~39 year old female. Ask Date: 2024/04/29

Dr. Wang Zhaomin reply Rehabilitation

This consultation platform cannot provide a diagnosis.
If there is pain or other symptoms after TFCC arthroscopy, medication may be taken, and you may strengthen stretching exercises as needed.
Rehabilitation therapy should be conducted, including general treatments such as heat therapy and electrical stimulation.
If there is significant swelling and limited joint mobility, it is advisable to receive manual therapy.
It is recommended to discuss your condition with your treating physician and arrange for appropriate treatment.

Reply Date: 2024/04/29

More Info

Managing persistent pain and swelling after a Triangular Fibrocartilage Complex (TFCC) surgery can be quite challenging, especially when symptoms like inflammation and swelling persist for an extended period. It’s understandable that you feel frustrated and concerned about your recovery process. Let’s break down the potential causes of your symptoms and discuss some management strategies.

Understanding Your Symptoms
1. Persistent Pain and Swelling: After TFCC surgery, it’s not uncommon to experience pain and swelling, especially if there has been a significant injury or if the surgery was extensive. However, if these symptoms are worsening rather than improving, it could indicate several underlying issues:
- Inflammation: Post-surgical inflammation is a natural response, but excessive inflammation can lead to prolonged pain and swelling.

- Scar Tissue Formation: Adhesions or scar tissue can develop after surgery, potentially leading to restricted movement and increased pain. This is particularly relevant if you are experiencing limited range of motion.

- Re-injury or Overuse: Engaging in rehabilitation activities too soon or with too much intensity can exacerbate symptoms. It’s crucial to follow a rehabilitation plan that is tailored to your current condition.

2. MRI Findings: The presence of inflammation and edema on your MRI suggests that your body is still responding to the surgical trauma. While your surgeon may have indicated that there’s no significant structural issue, the inflammatory response can still cause considerable discomfort.

3. Body’s Response: Individual differences in healing can affect recovery. Factors such as age, overall health, and even genetic predispositions can influence how your body responds to surgery and rehabilitation.

Management Strategies
1. Rest and Activity Modification: It’s essential to listen to your body. If certain movements or activities exacerbate your pain and swelling, consider modifying or temporarily avoiding them. Gradually reintroducing activities can help you gauge your limits.

2. Physical Therapy: Working with a physical therapist who specializes in post-surgical rehabilitation can be beneficial. They can provide a tailored exercise program that focuses on gentle range-of-motion exercises and strengthening without overloading your wrist.

3. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help reduce inflammation and pain. However, consult your physician before taking any medication, especially if you have other health conditions or are on other medications.

4. Ice Therapy: Applying ice to the affected area can help reduce swelling and numb the pain. Make sure to ice your wrist for 15-20 minutes several times a day, especially after activities that increase swelling.

5. Compression and Elevation: Using a compression bandage can help manage swelling. Elevating your wrist above heart level when resting can also assist in reducing swelling.

6. Follow-Up with Your Surgeon: If your symptoms persist or worsen, it’s crucial to follow up with your surgeon. They may consider additional imaging or interventions to address any complications, such as scar tissue or other issues that may not have been apparent initially.

7. Mental Health Support: Chronic pain can take a toll on your mental health. Consider speaking with a mental health professional if you find that your pain is affecting your mood or sleep. Techniques such as mindfulness, cognitive behavioral therapy, or relaxation exercises can be beneficial.

Conclusion
Recovering from TFCC surgery can be a complex process, and it’s essential to approach it with patience and care. By understanding the potential causes of your symptoms and implementing appropriate management strategies, you can work towards improving your condition. Remember, open communication with your healthcare team is vital in navigating your recovery journey. If you feel that your current treatment plan is not effective, don’t hesitate to seek a second opinion or ask for further evaluation. Your health and well-being are paramount, and there are always options available to help you manage your pain and improve your function.

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