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Arthroscopy for TFCC tears

There are two bones in the forearm the bone on the thumb side is called the radius and the little finger side is the ulnar. At the wrist joint at the end of the ulnar (the little finger side) there is a cartilage within the joint. This is very similar to cartilage that lies within the knee. Knee cartilages can tear and those tears are generally operated on using arthroscopic techniques to trim them. A similar procedure is done in the wrist as the triangular cartilage in the wrist (TFCC) can tear. This can happen in younger people following wrist injuries and can happen as a degenerative process in middle age and elderly people. Arthroscopic debridement which means that the tear edges are shaven so that they are flat and do not flap around in the wrist and cause pain.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

The wrist joint is entered through three tiny stab incisions to the back of the wrist. Two incisions go into the joint between the radius and the carpal bones and one incision goes into the joint between the two carpal rows.

A 2mm telescope is passed into the wrist joint through one of the three wounds. The wrist joint is visualised and the triangular cartilage is seen through the telescope and through one of the other wounds a probe can be passed into the joint which can be placed into the tear to elucidate it and determine the extent of the tear. The probe is then removed and an arthroscopic shaver (circular sheathed cutting instrument) enters the wound through which the probe was in and placed over the tear of the triangular cartilage and the flaps in the cartilage are shaved flat. This procedure takes 30 - 40 minutes. The telescope and shaver are then removed. Local anaesthetic is infiltrated into the joint and also into the wounds to help the pain post-operatively and the wounds are generally closed with steri strips (paper stitches).

POST OPERATIVELY

Dressings are placed over the back of the wrist and firm bulky bandage is wrapped round the wrist. The patient goes home in a high arm sling which they can remove at 48 hours along with the bulky bandage. The sticky dressing should be kept intact until the patient is reviewed at two weeks.

COMPLICATIONS

  1. Infection - this is incredibly rare and in fact Mr Field has not seen it but it is feasible if one is inserting something from outside of the joint into the joint then one can introduce infection into the joint at that stage.
  2. Tendon damage- incredibly rare.
  3. Nerve damage - incredibly rare.
  4. Complex regional pain syndrome