What is a TFCC tear? 

The lower end of the radius and ulna, along with eight small carpal bones comprise the wrist.  Ligaments connect these bones and a few of these ligaments are prone to injury.  The triangular fibrocartilage complex (TFCC), which is made up of ligaments and a central trampoline-like fibrocartilage, is located on the side of the wrist below the small finger (ulnar side) and is approximately the size of a dime.  The ligaments and fibrocartilage of the TFCC stabilize the ends of the two forearm bones (radius and ulna) during gripping/lifting activities and forearm rotation.  It also helps cushion and suspend the carpal bones of the wrist.  Many patients diagnosed with a “wrist sprain” have injury to this ligament, which can cause ulnar-sided wrist pain.  

How is the TFCC ligament injured?

There are two types of injuries, acute or chronic.  An acute TFCC tear may occur after a fall on an outstretched hand or excessive rotation of the forearm.  Chronic tears are caused by a degenerative process that wears the ligament down over time.  In some patients, the ulna bone, due to excessive length, can pinch the TFCC ligament between the carpal bones, subsequently wearing a hole in the ligament.  Inflammatory disorders such as gout and rheumatoid arthritis can also lead to a chronic, degenerative tear.

What are the symptoms of a Triangular Fibrocartilage Complex tear?

Wrist pain (on the ulnar aspect) is the most common symptom of both acute and chronic tears.  The pain often increases during grip activities and forearm rotation.  Many patients complain of a popping or clicking sensation in the wrist with use.   Acute injury findings can range from mild wrist swelling and bruising to instability or dislocation of the distal radioulnar joint.

What treatment is necessary?

Most TFCC tears resolve with activity modification, splinting, and non-steroidal anti-inflammatory medications.  If symptoms persist, a corticosteroid injection in the ulnar wrist can be helpful.  Operative treatment may be required for persistent symptoms despite appropriate splinting and injection.  TFCC tears resulting in instability of the wrist or in association with wrist fractures may require immediate repair.

What is the surgical treatment for TFCC tears?

The type of surgery varies depending on the location of the tear in the ligament and the chronicity of the injury. Surgery can be performed either arthroscopically or using an open technique.  Chronic tears many times are related to excess length of the ulnar bone pinching the an ulnar shortening osteotomy. 

What kind of complications can occur with surgery?

Complications are rare, especially with arthroscopic treatment techniques.  Stiffness, sensory nerve injury, persistent wrist pain and infection have all been reported in the literature with surgical treatment of TFCC tears.  If an ulnar shortening osteotomy is required, non-union of the bone and pain in the location of the plate can occur.

How much rehabilitation is required after the surgery?

If the ligament is debrided, strength and motion typically return after surgery. The wrist is typically placed in a splint for two to six weeks after surgery and then the patient is allowed to start strengthening and stretching the wrist.  If ligament repair is performed, the ligament needs to be protected and the wrist immobilized for approximately six weeks to allow healing.  Incremental stretching and strengthening are then performed for the next six weeks.

Carpal tunnel syndrome treatment is available at Raleigh Hand Center. Carpal tunnel syndrome is the most common compression neuropathy (pinched nerve) in the hand and arm. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as numbness, tingling, weakness, and pain can result if the nerve is compressed or “pinched.” Common treatments include wearing a wrist brace at night, avoiding prolonged wrist flexion postures, stretching exercises with therapy,  and cortisone injections. Surgery is recommended if the symptoms do not improve with conservative treatment or if nerve compression is severe. Raleigh Hand Center physicians are specialists in treating hand and arm conditions including carpal tunnel syndrome. Watch video below by the American Society for Surgery of the Hand.

Additional video, with images of carpal tunnel release surgery, see below

On 11/16/2015 Dr. John Erickson of Raleigh Hand Center discussed treatment options for patients with carpal tunnel syndrome including complex and revision cases. Triangle area hand surgeons, therapists, and orthopedic residents were in attendance at the UNC Orthopedic Hand Conference at WakeMed Raleigh.

The cost of medical care has increased significantly in the United States in recent years. Due to changes in health insurance plans, many patients are now responsible for paying a larger portion of the cost associated with the treatment they receive. Raleigh Hand Center physicians are aware of the financial burden of medical expenses for patients and strive to reduce costs in several ways.

The Raleigh Hand Center has been committed to providing high-quality and cost-effective treatment for many years. Since the founding of the Center, Raleigh Hand has remained an independent practice in the community. Independent physician practices have been shown to be less expensive than hospital-owned practices in recent studies.

Cost-effective treatment begins with providing appropriate, evidence-based medical care to patients. Conservative treatment options are emphasized at Raleigh Hand; surgery is recommended only when necessary. MRIs, CT scans, and other expensive tests are only ordered when required for treatment. Additionally, Raleigh Hand Center offers same day and next day appointments for patients with urgent problems, which reduces the need for costly emergency room visits. The physicians are also on-call 24/7 to help triage emergency cases from doctors’ offices, urgent cares, and emergency rooms to expedite patient treatment.

Raleigh Hand Center physicians perform the majority of their outpatient surgeries at Capital City Surgery Center, which charges a much lower facility fee than local-area hospitals. Additionally, the price of equipment and implants used during surgery has been negotiated with manufacturers to keep costs down.  Many hand procedures can be performed using local anesthesia only, avoiding the anesthesiologist’s fee. Raleigh Hand Center physicians maintain a low infection rate and low complication rate, reducing the need for secondary surgeries or additional treatment.  Less-invasive surgery is available in many cases, allowing patients a more rapid return to their work and livelihood.

Raleigh Hand Center has been recognized by several insurance companies as preferred providers who provide high quality care at low cost. RHC is in-network with the BCBS Blue value plan.

At Raleigh Hand Center, we don’t just treat hands. We are dedicated to helping patients with problems of the hand, wrist, elbow, and shoulder. From wrist tendonitis to severe wrist fractures, we have expertise in the diagnosis, treatment, and rehabilitation of patients with pain and problems of the wrist. The wrist is a complex link between the forearm and hand, comprised of eight bones, in addition to cartilage, ligaments, tendons, nerves and blood vessels. Wrist pain or a wrist injury may significantly alter a person’s lifestyle and livelihood. At the RHC, our goal is to improve a patient’s quality of life through effective non-surgical and surgical treatments in Raleigh NC. We work closely with on-site hand therapists to improve patient outcomes. Our doctors are also aware of the increasing costs of medical care in today’s healthcare market, and try to provide cost-effective care.