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Sports Medicine

Re-tear of the TFCC ligament

08/07/2007

Question:

Greetings! I am a 44 year old man, in pretty descent shape. A year ago in April I had a an accident and tore the TFCC ligament. After 6 weeks in a cast followed by a 3 compartment Gatalinian dye MRI, it was determined that I had indeed tore the TFCC. I had surgery to repair the tear which included two pins to stabilize the wrist. Needless to say 5 casts later, two pins removed and several months of rehab, I was semi back in business. What would be considered a pretty good success. Almost exactly a year later, on memorial day, I retore the previous injury. I went to see my surgeon, and was quickly followed up with an MRI. I did tear the TFCC again and it is way worse then the original tear. My surgeon immediately wanted to place my arm in a cast for 6 weeks. So I complied. Two weeks into my cast, while working out in the yard, I fell with the cast on. I figured out that something was very wrong when my thumb and fingers were swelling so I went in to see him again. It was determined that I had broke the scaphoid bone in my same wrist as the TFCC tear. This time though the TFCC tear seems way worse and was very painfull to the touch when he examined it. MY QUESTION: He says that the tear is pretty bad. He also says that he feels as though he wouldn`t be able to repair the TFCC again. I get very very mixed emotions from him as though he maybe feels as though he isn`t capable of repairing the wrist. He also says that he has never seen a re-injury repair turn out good. I am very confused as to what I should do about this. I know that while in this cast it is very very painful. Should I see another surgeon and present the facts? Do you have any suggestionsor recommendations for my situation with the limited information I have discussed with you? Thank you so much for your time. I pray that I get a reply!

Answer:

Just to clarify: there is no single "TFCC ligament". TFCC refers to  "Triangular Fibrocartilage complex", which is indeed a complex combination of at least 5 ligaments, two different cartilages, and a tendon sheath. Therefore, surgery for an injury to this complex is quite complex, as well. In addition to repairing whichever portions of the TFCC were injured, sometimes it's necessary to also shorten the ulna if it's too long in relation to the radius; this may or may not be true in your case.

Since you have also injured your scaphoid bone, hopefully this potentially difficult-to-heal bone has fully healed and is not contributing to the pain symptoms you are still experiencing.

Another potential contributor to your pain symptoms could be what's referred to as a "complex regional pain syndrome," abbreviated "CRPS." This condition is manifested by severe pain and tenderness/hypersensitivity to touch, and may or may not be accompanied by sensations of burning, tingling and/or numbness. If this condition is present, another surgery could exacerbate your pain.

Ask your orthopedist what your treatment options are, along with estimates regarding the likelihood of benefit from one option compared to another. You can certainly also obtain another opinion from a different orthopedist who specializes in hand and wrist problems. If further surgery is decided against, nonoperative treatment may include further treatment by a Certified Hand Therapist as well as possible consultation with a Pain Medicine physician.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University