The ulnar sided wrist pain is one of the common wrist problems nowadays, the presence of many important structures at the ulnocarpal joint make it difficult to detect the actual cause of the ulnar-sided wrist pain.
Accurate history taking followed by proper clinical examination and investigation play important role in the diagnosis of ulnar-sided wrist pain.
TFCC is considered the most important structure at the ulnar side of the wrist and it plays a key role in the stability of the DRUJ, due to the complexity of the TFCC and being formed of 6 structures, it is considered the most common cause of ulnar sided wrist pain.
Testing the DRUG stability is very crucial to detect the method of treatment of the TFCC traumatic tears. So DRUJ Stability test should be done in both pronation and supination and compared with the normal side.
X-ray AP view and lateral view are the primary diagnostic investigations. MRI plays a very important role also in evaluating the ulnocarpal structures. Good quality MRI and experienced radiologist are very important to detect the type of the TFCC lesions.
Arthroscopy is considered the gold standard to evaluate the TFCC and other wrist pathologies. So wrist arthroscopy helps us to complete the evaluation of the wrist joint and together with the clinical examination and investigation give us full details in order to plan for the proper surgical management.
We assessed the arthroscopic management of triangular fibrocartilage complex tears. Twenty consecutive patients with triangular fibrocartilage complex tears were operated on between June 2014 and April 2016. One patients (5%) had type 1A TFCC injury for which debridement was done, ninteen patient (95%) had type1B TFCC injury for which repair was done,
Post-operative range of motion, grip strength, VAS, MMWS and DASH score improved significantly.
Postoperative splint for 6 weeks lead to decrease in the range of motion especially pronation-supination, which is improved later with physiotherapy. Another problem was caused by the irritating PDS suture which is also improved in 4- 6 months. Patient should be informed about this preoperatively in order to be more cooperative in the postoperative management.
No major complications were documented in the current series apart from superficial branch of ulnar nerve irritation in three cases that resolved spontaneously in two of them.
|
