The triangular fibrocartilage complex (TFCC) is an important feature of the wrist. It suspends the ends of the radius and ulna bones of the forearm over the wrist. As the name suggests, it is triangular in shape and made up of several ligaments and cartilage. The TFCC makes it possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side).
Mild injuries of the TFCC may be referred to as a wrist sprain. As the name suggests, the soft tissues of the wrist are complex. They work together to stabilize the very mobile wrist joint. Disruption of this area through injury or degeneration can cause more than just a wrist sprain. Mild injuries often do respond well to hand therapy. But more severe injuries or radial-sided TFCC tears have a more difficult time healing because of a natural (anatomic) lack of blood supply.
In cases like yours where conservative (nonoperative) care does not yield the desired results, surgery may be necessary. But as you have discovered, it can take quite a while to reach this conclusion. The follow-up plan after surgery may vary depending on the type of procedure used by your surgeon. Newer and improved methods have made it possible for some patients to return to full, unrestricted activity as early as six weeks post-op.
At first, your wrist will be immobilized in a bulky dressing or cast. The type of immobilizing device used and the position your wrist is placed in depends on the type of surgery you had. Motion exercises for the fingers are usually started soon after the operation. Cast or brace removal is followed by Physical Therapy for six to eight weeks.
Physical Therapy may be needed to help you regain full joint motion, strength, and normal movement patterns. Some patients have difficulty regaining pinch and grip strength. The therapist will help you get back specific motions lost such as ulnar deviation (moving hand at the wrist away from the thumb and toward the little finger) and supination (palm up motion) or pronation (palm down motion). The therapist will help make sure you do not use compensatory shoulder motions to make up the difference.
The goal is to restore full motion, strength, and function. The rehab program will be geared toward your needs at home, work, and play. Many patients are able to return to work with no restrictions. A small number may require some work restrictions or changes in work tasks. If there are no complications, you can expect anywhere from a six-week recovery up to six month period of time to return to normal.
Reference: Chris Y. K. Tang, MBBS, et al. Another Light in the Dark: Review of a New Method for the Arthroscopic Repair of Triangular Fibrocartilage Complex. In The Journal of Hand Surgery. June 2012. Vol. 37A. No. 6. Pp. 1263-1268.
