Torn TFCC - no change in pain - Recommendations please

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Q: I am frustrated and very anxious. I have a torn TFCC in my right wrist (I am right handed). I've spent the last three months in a splint with no change in my pain. If it was going to heal on its own, would it have happened by now? The surgeon is recommending an arthroscopic exam before trying something different. What do you think?

A: As the name suggests, triangular fibrocartilage complex (TFCC) is triangular in shape and made up of several ligaments and cartilage. It stabilizes the distal radioulnar joint (where the two bones of the forearm meet at the wrist) while improving the range of motion and gliding action within the wrist. The TFCC makes it possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side).

As the name suggests, the soft tissues of the wrist are complex. They work together to stabilize the very mobile wrist joint. Mild injuries of the TFCC may be referred to as a wrist sprain. Disruption of this area through injury or degeneration can cause more than just a wrist sprain. A TFCC injury can be a very disabling wrist condition. For a more detailed description and understanding of this wrist problem, see A Patient Guide to Triangular Fibrocartilage Complex (TFCC) Injuries.

The natural history of TFCC injuries is unknown. Natural history refers to what happens over time. Can these injuries heal on their own? If so, is it possible to predict who will heal and who won't? Is there a timeline for how long to wait for healing to occur? These are questions we don't have answers for just yet.

Clearly, there are some patients who do recover with conservative (nonoperative) care. The location and severity of damage, age of the patient, activity level, and cause of the original injury (e.g., trauma versus degeneration) may be important factors determining results.

Surgery is often a consideration when conservative care with cortisone injections, splinting, and hand therapy don't change the patient's symptoms. But there isn't enough evidence to show that surgery gives any better results than the nonoperative approach.

Even with a complete diagnosis, treatment decisions aren't easy. Each case of TFCC injury must be examined one-by-one. The presence of other associated injuries (e.g., torn ligaments, bone fractures) can influence both the treatment and results.

If your wrist is stable and the surgeon thinks there is potential for healing, it is reasonable to try waiting a bit longer to see if recovery without surgery is possible. If there's no improvement, further evaluation with diagnostic arthroscopy as suggested by your surgeon is the next step. Any further treatment decisions would have to wait pending the results of these first two steps.

Reference: Kevin Roenbeck, MD, and Joseph E. Imbriglia, MD. Peripheral Triangular Fibrocartilage Complex Tears. In The Journal of Hand Surgery. October 2011. Vol. 36A. No. 10. Pp. 1687-1690.

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