What is a TFCC tear and how is it treated?

Transcript

Let's take a look at TFC surgery. The TFC, or triangular fibrocartilage, is a cartilage in the wrist that's subject to trauma from many activities that cause a, that cause a violent twisting motion of the wrist. Weightlifting is common, lifting free weights where they torque the wrist. Next is a, uh, torque gun, torquing the wrist against resistance. And finally, uh, from the images, a tennis player, this is one of the top tennis players in the world, actually hurt his wrist from doing this, from hitting a topspin that can injure the TFC. This can also occur from lifting luggage off of a rapidly, uh, moving conveyor belt, or just simply falling on an outstretched wrist can cause this problem.

Let's look at the anatomy here. The TFC is made up of, is also part of a complex called the TFCC, or triangular fibrocartilage complex, which is made up of supporting ligaments of the wrist joint that come off the end of the ulna bone, and this thin disc or cartilage, or the TFC, which is this disc-like structure here. It's triangular in shape, as we're going to see. But we, this, you can see here a tear within the cartilage, as you can see, both palmar, front and back views of the distal ulna on both sides of this image, mostly showing the split and the cartilage.

Now looking at this further, uh, we look at a triangular diagram, it's a simple diagram right here. If you look at this color line though, this denotes the most common tear that's present in the majority of cases, which is a slit tear going across the, uh, base of the triangle here. The distal radius, radius bone, would be in this area, the ulna would be in this area. So it's a cross-section of that triangle.

So what we do surgically to correct this, because there's no good circulation to this area of the cartilage, we go in and simply trim out that cartilage tear and make a big hole so the edges can't meet, so when you rotate the forearm those edges aren't sawing back and forth on one another causing pain.

Now let's take a look at the most common way to diagnose a TFC tear or ligament injuries in, uh, in the wrist. That's an MR, or MRI arthrogram, where contrast, which is this white fluid right here as you can see beautifully on the MRI, is injected into the radiocarpal joint here. That should all stay in this joint, but with a tear, as you can see with this arrow right here, there's an opening in this black cartilage that, here's a TFC, you see this gap, fluid flows into this joint which shouldn't happen. That denotes a TFC tear.

Now the treatment for this is, uh, highly successful with minimally invasive arthroscopic surgery. This shows an image taken, uh, if we put a scope in through a 2 millimeter incision on the back of the wrist, we're viewing this on a TV monitor in the operating room, just what you're seeing here. This is the cartilage on the top of the radius bone, and then there's a slit, just as I showed you on the diagram, this cartilage tear right here. This is a metal probe we're putting in through that second incision, 2 millimeter incision on the other side of the wrist, and we're opening the cartilage tear up to show you.

Now what happens is that we put, in place of this probe, we put a Roto-Rooter, a vacuum cleaner in, as you'll see from this video right here. It's just sucking out fluid as well as debriding the cartilage into an oval shape, as I showed you on that diagram. You can see the ulna moving right here as the forearm rotates around the radius, around the, over the radius, over the ulna, and you can see movement.

Now let's take a look at a final image of this debridement. You can see again the probe coming in here. This shows the TFC that's been debrided or trimmed away. This shows a nice picture of the head of the ulna and the radius over here.

Now the second most common type of, um, of image, that, of the tear that we're going to look at is called a peripheral TFC tear. Now this is on the edge of the triangle. This is the most important part. Before, the last tear I showed you had poor circulation, so we trimmed it out. This actually has healing potential because the circulation is good to the edge of the triangle. It's also very important that this heal adequately because this gives stability to that distal radioulnar joint.

So you can see here on the diagram these little rings, or uh, mimic sutures that we're actually going to place in the wrist joint. But let's look at a live shot of a patient here. This shows the TFC or the cartilage coming out here peripherally, and you can see the probe on the far left hand side there that shows that this whole thing is being lifted up, denoting an unstable peripheral TFC tear. What we do is actually go then and make a little bit bigger incision over the back of the wrist, and we'll put a suture in, as you can see in the next image here. This blue line almost looks like licorice, but it's actually a suture that's placed into the wrist joint that anchors that back in place.

Now after this procedure, uh, the initial procedure, uh, if it's just a simple, uh, debridement procedure, which is present 90% of the time, we simply put the patient in a short brace for about a week and then start therapy. All in all that's about a six week recovery to back to highly competitive sports.

Now for that peripheral tear however, it's about a, uh, six weeks in a long cast, because we want that to heal and we don't want to move the wrist too soon. So about six weeks in that long cast above the elbow, and then about two to three months of rehab to return to normal activities. There's about a 95% success rate with this type of surgery, highly effective. For more on this condition and many other conditions, please visit the Hand and Wrist Institute website.