The TFCC lesion

definition

The TFCC ( triangular fibrocartilaginous complex ) refers to a cartilaginous structure located in the wrist. The TFCC mainly forms the link between the ulna and the first row of carpal bones. However, it is also partially between the ends of the ulna and the spine and covers a small portion of the joint between the spine and carpal bones.

Through its connection to bones that form the wrist, which has a great function in the mobility of the wrist. At the same time a variety of different mechanisms can contribute to the injury (medial lesion) of the TFCC.

Causes of a TFCC lesion

The causes of a TFCC lesion must be decided between degenerative and traumatic causes.

Older people often suffer from degenerative changes in the TFCC. It affects mainly people who have worked a lot with their hands. The frequent use leads to signs of wear and tear which, for example, lead to indurations in the TFCC or even minor injuries. In the long run, this can restrict mobility in the wrist.
Also, rheumatic diseases can attack the TFCC and lead to lesions.

In young people and especially in children, the TFCC is not yet highly trained. Wrist injuries can quickly lead to tears in the TFCC. Typical is a trauma in which one falls on the wrist while a rotational movement takes place.

The ulna plus variant

Normally ulna and spokes in the wrist end at about the same height. In the case of the ulna plus variant, however, the ellipse is slightly longer in comparison to the spokes. This leads to an increased burden especially on the side of the ulna of the wrist.
The TFCC is located mainly between the ulna and the wrist and is therefore particularly stressed in the ulna plus variant. This can lead to small injuries of the TFCC as well as the surrounding cartilage layers at the ulna and carpal bones.

In the long term, signs of wear and tear develop more quickly, causing pain primarily in old age and restricting the flexibility of the wrist. At the same time there is an increased risk of TFCC lesions when falling on the wrist.

The accompanying symptoms

The symptoms, which are mainly caused by a TFCC lesion, are pain and restricted movement in the wrist. The pain can already occur at rest, but are usually amplified during the movement of the wrist. Since the TFCC lies mainly between the ulna and the carpal bones, especially the lateral movement of the hand in the direction of the little finger in a lesion is limited and possible in pain. Due to the positional relationship of the TFCC to Elle and Spoke, turning the wrist is usually painful.

With strong degenerative changes, other movements may not be possible. Especially in acute traumatic TFCC lesions, bleeding into the wrist can occur with corresponding swelling, pain and bruising.

Depending on the cause of the TFCC lesion, there are also other symptoms. Thus, rheumatic changes in the entire wrist, on the fingers and other joints of the body through painful movement restrictions and swelling noticeable. In the case of traumatic causes, the bones may additionally be sprained or broken, so that malpositions can occur here.

The diagnosis

The diagnosis of a TFCC lesion initially consists of a medical history. The doctor asks the person concerned specific questions to find out the cause of the symptoms.

Subsequently, the examination of the wrist, in which range of motion, strength and pressure tenderness are tested. To exclude accompanying injuries in the wrist, an X-ray of the joint should be made. One can judge especially bony structures well. The TFCC itself is best recognized in an MRI scan of the wrist.

The MRI from the wrist

An MRI is the most appropriate imaging to assess softer structures such as cartilage, ligaments and muscles. Therefore, a good diagnosis of TFCC lesions usually requires an MRI from the wrist.
It can detect tears, holes and degenerative changes in the TFCC. The localization of the lesion is usually easy to recognize in an MRI, as one can reconstruct a three-dimensional image of the wrist from the images. In addition, the cartilage can be assessed on carpal and forearm bones.

The treatment options

The conservative treatment

The conservative treatment of the TFCC lesion usually consists first of an immobilization of the wrist by means of splint, later with an orthosis. As a result, the TFCC can regenerate, small defects can be repaired by the body. At the same time one should begin with a cautious physiotherapy, so that the immobilization does not cause any later restriction of movement.

The conservative treatment is especially suitable for small defects in which the TFCC is sufficiently perfused. Even degenerative lesions are usually best conservative to treat.

The physiotherapy

Physiotherapy can be started at the same time as a conservative care. First, the mobility of the wrist is in the foreground, as they can be lost quickly by a rest position without appropriate exercises. Also after an operation movement exercises should be performed in a physiotherapy. In addition, swelling and pain immediately after surgery can be reduced more quickly by physiotherapy.

Later, the physiotherapy is the targeted power in the wrist. When the TFCC lesion has healed, the wrist can return to normal weight. Movement restrictions that may have been retained until then can also be treated further.

The orthosis

An orthosis refers to a bandage that is used on various parts of the body, usually joints. In a TFCC lesion, an orthosis is often used on the wrist. This may initially have fixed portions similar to a splint, restricting movement in the wrist until the lesion heals in the TFCC.
Subsequently, a more elastic orthosis can support the wrist in his movements, until enough muscle power is built up again to perform all everyday movements and to withstand the stresses.

When do you need an operating room?

An OP is increasingly used in young people with a TFCC lesion. Thus, surgery in elderly people with a degenerative change of the TFCC is usually not effective.
However, young people with acute TFCC trauma often benefit from the surgery. In particular, if there are accompanying injuries in the wrist, an OP is indicated.

Another indication for surgery is disrupted perfusion of the TFCC due to the lesion. This worsens the chances of recovery enormously, which is why an adequate blood supply to the TFCC must be restored during surgery. The surgery can often be performed arthroscopically. This means that only small incisions are made, an open surgery is rarely necessary.

The duration of the operation

The duration of surgery for a TFCC lesion is usually very short and usually only about 30 to 60 minutes. This is followed by the complete immobilization of the wrist for about a week. Thereafter, through targeted physiotherapy exercises gradually more movement in the wrist can be allowed.

The healing phase is usually 8 to 12 weeks. Afterwards, the hand can be used again in everyday life. However, sports such as boxing and tennis should be avoided altogether for about 5 months.


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