The Triangular Fibrocartilage Complex (TFCC) is the most common cause for pain on the ulna side of the wrist.

What is it?
A common cause of wrist pain is damage or degeneration of the Triangular Fibrocartilagenous Complex (TFCC). The TFCC sits on the end of the ulna bone at the wrist and has two roles. It helps to hold the radius and ulna bones together. It also transmits about one third of force passing across the wrist from the hand to forearm. TFCC problems can occur independently or in combination with those affecting the distal radio-ulnar joint (DRUJ). Combinations may result from wrist fractures.

When the TFCC is torn or damaged, it is usual to get pain in the wrist. This occurs particularly during twisting movements. Patients also may experience clicking or popping sensations during movement. Often a MRI scan will be performed to help with the diagnosis.

What can be done?
Arthroscopy involves placing a small telescope into the wrist joint. The telescope is inserted into two to four areas on the back of the wrist. The procedure is primarily for diagnosis. Often it can be combined with the removal of loose fragments or trimming of cartilage tears. If an abnormality is found which requires more extensive surgery, I will not proceed to this “open” operation unless this has previously been discussed with you.

The operation is performed under general anaesthetic but you can usually be discharged on the day of surgery. Return to your normal activities after the operation can be variable, especially if additional procedures have been performed. This will all be discussed with you.

Occasionally the cause of the damage to the TFCC is due to the ulna bone being too long, thus leading to squashing of the TFCC against the wrist during movement. If this is the case, then shortening the ulna bone is a good option in order to take the pressure off the TFCC. This will be discussed in further detail if relevant.

Majority of tears to the TFCC occur in the area where there is no blood supply, and so the only option is to remove the torn area. Less commonly the tear occurs in the area of the TFCC where there is a blood supply. This can therefore be repaired. This can be done either through the arthroscope or done as an open procedure. You will almost certainly be placed in a above elbow Plaster of Paris for a period of time after surgery, and rehabilitation can take up to 6 months.

Scar
You will have 2-3 small scars on the back of the wrist. These will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with moisturizing cream.

Nerve damage
Nerves running in the region can be damaged during the surgery. This would cause the formation of a painful spot in the scar (neuroma) or a small area of loss of sensitivity on the dorsum of the hand. This complication is rare (4%) but may require a further operation to correct.

Infection
Superficial infection can occur after any operation and would be treated with antibiotics. Deeper infection, involving the joint is very rare.

Tendon damage
Tendons running to the fingers can be damaged or cut. This is very rare (1%) but would require further surgery to correct.

Stiffness
About 5% of people are sensitive to hand surgery and their hand may become swollen, painful and stiff after any operation (complex regional pain syndrome). This problem cannot be predicted but will be watched for afterwards and treated with physiotherapy.

As noted above rehabilitation can take 6 months to reach a plateau after surgery to this area.