Aspetar surgeons are now using arthroscopic surgery to diagnose and treat patients with persistent and painful ligament injuries, which is designed to reduce the time patients have to wait for the investigation and treatment of these problems. Injuries to the Triangular Fibrocartilage Complex (TFCC) – a ligament that stabilizes the wrist – are common among athletes in multiple sports, such as handball, golf, volleyball and football, especially among goalkeepers.
TFCC wrist injuries affect the ulnar (little finger) side of the wrist. Mild injuries to the TFCC may be referred to as a wrist sprain. However, more severe ligament injuries to the wrist are common, especially in concurrent fractures of the wrist, and can cause long-standing problems.
Isolated TFCC injuries can occur after rapid torque trauma in, for example, handball, tennis and goalkeepers. Golfers are prone to ulnar wrist problems. Tennis players and table tennis players are more likely to have degenerative TFCC injuries, known as ulnar impaction and chronic central TFCC injuries due to overuse.
A specific injury to one part of the TFCC is sometimes found among ice hockey players – the so-called “hockey wrist,” caused by repetitive load bearing, rotational stress, and wrist impact from contact with the ice or surrounding boards.
Football goalkeepers have a seven-fold increased risk of hand and wrist injuries compared to outfield players. But compared to all injuries among professional football players, only about 1% of all such injuries affect the hand and the wrist (4/5 affects the lower limb).
Dr Jonny K Andersson, an orthopaedic surgeon at Aspetar who led TFCC surgery, said: “Conventional treatment options include physiotherapy, approximately one-third of patients with TFCC injuries can be improved by hand therapists and physiotherapists, by special customized brace and, above all, by neuromuscular rehabilitation and proprioceptive training. If this conservative treatment does not help significantly in 2-3 months, an arthroscopic re-insertion of TFCC is recommended. For athletes and in other cases with severe instability or sub-dislocation of the ulnar head, an early surgical procedure is recommended.”
Dr Andersson, who has a long experience of performing different surgical techniques in the area of wrist ligament repair, stressed that postoperative rehabilitation takes time; 3 weeks of elbow cast, 4 weeks of custom-made brace. Gradually increasing training of range of motion and proprioception is required Full strength is allowed after 4 months.
“Wrist arthroscopy is the gold standard in diagnostics of wrist ligament injuries (MRI is not reliable enough to disclose a significant injury). The grade of instability can be dynamically evaluated during arthroscopic surgery and the healing capacity can be assessed. Arthroscopic re-insertion of the TFCC is done under perfect view of the repair and its strength. The results in terms of functional outcome and incidence of re-instability are comparable, but less stiffness, less scar and less risk of neuroma of sensory nerve-branches are seen after the arthroscopic technique, compared with open technique,.” Dr Andersson said.
Nowadays, Aspetar surgeons perform approximately 30 cases of arthroscopic re-insertion of TFCC each year. It is crucial and mandatory to provide specific knowledge of these wrist ligament injuries and their treatment among all athletes.
Aspetar’s Orthopaedic Surgery Department focuses on the surgical management of musculoskeletal injuries. With highly qualified surgeons achieving the highest levels of excellence in the field of clinical care and orthopedic education, as well as academically, the team aims at achieving the highest quality and functional outcomes for patients and a quick return to athletes. Aspetar’s surgeons are experts in both arthroscopic and open surgical techniques. With the development of the Hand and Wrist unit, Aspetar can now also provide all kinds of surgical treatment from fingertips to elbows.
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