The TFCC lesion
The TFCC (triangular fibrocartilaginous complex) describes a cartilaginous structure that is located in the wrist. The TFCC mainly forms the connection between the ulna and the first row of the carpal bones. However, it is also partially located between the ends of the ulna and the radius and covers a small portion of the joint between the radius and the carpal bone.
Because of its connection to the bones that make up the wrist, it has a great function in the mobility of the wrist. At the same time, the various functions can lead to a wide variety of mechanisms leading to an injury (medical lesion) of the TFCC.
Causes of a TFCC Lesion
When it comes to the causes of a TFCC lesion, a decision has to be made between degenerative and traumatic causes.
Older people often suffer from degenerative changes in TFCC. This particularly affects people who have worked a lot with their hands. The frequent use leads to signs of wear and tear, which for example lead to hardening in the TFCC or small injuries. In the long run, this can limit the mobility of the wrist.
Rheumatic diseases can also attack the TFCC and lead to lesions.
In young people and especially in children, the TFCC is not yet particularly well developed. If the wrist is injured, the TFCC can quickly tear. Typical is a trauma in which one falls on the wrist and at the same time a twisting movement takes place.
Read more about the topic here: Wrist osteoarthritis.
The ulna plus variant
Usually cubits end (med. Ulna) and the spoke in the wrist about the same height. With the ulna plus variant, on the other hand, the ulna is slightly longer than the radius. This leads to increased strain, especially on the ulna side of the wrist.
The TFCC lies mainly between the ulna and the wrist and is therefore particularly stressed in the ulna plus variant. This can lead to small injuries to the TFCC and the surrounding cartilage layers on the ulna and carpal bones.
In the long run, signs of wear and tear occur more quickly, which in old age mainly cause pain and restrict the mobility of the wrist. At the same time, there is an increased risk of TFCC lesions when falling on the wrist.
Find out more about the topic here: Wrist pain.Appointment with a hand specialist?
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The accompanying symptoms
The symptoms that are primarily caused by a TFCC lesion are pain and restricted movement in the wrist. The pain can occur even at rest, but it is usually increased when the wrist is moved. Since the TFCC is mainly located between the ulna and the carpal bones, lateral movement of the hand in the direction of the little finger in particular is limited and painful in the case of a lesion. Due to the positional relationship of the TFCC to the ulna and radius, turning the wrist is usually painful.
In the event of severe degenerative changes, other movements may no longer be possible. Especially with acute traumatic TFCC lesions, there may also be bleeding into the wrist with corresponding swelling, pain and bruises.
Depending on the cause of the TFCC lesion, there are also other symptoms. Rheumatic changes in the entire wrist, fingers and other joints of the body become noticeable through painful movement restrictions and swellings. In the case of traumatic causes, the bones can also be sprained or broken, so that misalignments can occur here.
The diagnosis of a TFCC lesion consists initially of an anamnesis. The doctor asks the person concerned specific questions to find out the cause of the symptoms.
This is followed by an examination of the wrist, in which the range of motion, strength and tenderness are tested. An X-ray of the joint should be taken to rule out accompanying injuries to the wrist. Above all, bony structures can be assessed well. The TFCC itself is best seen in an MRI scan of the wrist.
The MRI of the wrist
An MRI is the most suitable imaging tool to assess softer structures such as cartilage, ligaments and muscles. Therefore, a good diagnosis of TFCC lesions usually requires an MRI of the wrist.
Tears, holes and degenerative changes in the TFCC can be recognized. The localization of the lesion is usually easy to recognize in an MRI, as the images can be used to reconstruct a three-dimensional image of the wrist. The cartilage on the carpal and forearm bones can also be assessed.
Find out more about the topic here: MRI of the hand.
The treatment options
The conservative treatment of the TFCC lesion usually consists of immobilizing the wrist with a splint and later with an orthosis. This allows the TFCC to regenerate and the body can repair small defects. At the same time, careful physiotherapy should be started so that the immobilization does not trigger any later movement restrictions.
Conservative treatment is particularly suitable for small defects in which the TFCC is adequately supplied with blood. Degenerative lesions are also usually best treated conservatively.
Physiotherapy can be started at the same time as conservative care. The focus is initially on the mobility of the wrist, as this can quickly be lost through immobilization without appropriate exercises. Movement exercises should be carried out in physiotherapy even after an operation. In addition, swelling and pain can be reduced more quickly through physiotherapy immediately after an operation.
Later on, physiotherapy is used to specifically build up strength in the wrist. When the TFCC lesion has healed, the wrist can return to normal weight bearing. Restrictions of movement that may have remained up to then can also be treated further.
Find out more about the topic here: Physiotherapy for diseases of the wrist.
An orthosis refers to a bandage that is used on various parts of the body, mostly joints. A wrist brace is often used for a TFCC lesion. This can initially have fixed parts, similar to a splint, so that movement in the wrist is restricted until the lesion in the TFCC has healed.
Then a more elastic orthosis can support the wrist in its movements until sufficient muscle strength is built up again to carry out all everyday movements and to withstand the loads.
More about this topic can be found: Wrist bandage.
When do you need an operation?
Surgery is increasingly used in young people with a TFCC lesion. In older people with a degenerative change in the TFCC, the operation is usually not effective.
However, young people with acute trauma to TFCC often benefit from the operation. Surgery is particularly indicated if there are accompanying injuries to the wrist.
Another indication for surgery is impaired blood flow to 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 an operation. The operation can often be performed arthroscopically. This means that only small incisions are made, and open surgery is rarely necessary.
Read more about the topic here: Arthroscopy.
The duration of the operation
The duration of the operation for a TFCC lesion is usually very short and is usually only about 30 to 60 minutes. This is followed by complete immobilization of the wrist for about a week. Thereafter, targeted physiotherapeutic exercises can gradually allow more movement in the wrist.
The healing phase is usually 8 to 12 weeks. After that, the hand can be fully used again in everyday life. However, sports such as boxing and tennis should be avoided for a total of about 5 months.