Introduction
Initial treatment of most tears is non-surgical. The aim for surgery is to visualise and debride or repair the tear.
Indications
- Failure to improve after non-surgical therapy.
- Large displaced tears unlikely to heal.
- A traumatic tear causing instability at the wrist bones.
Procedure
Surgery is day only. Surgery is performed under general anaesthesia.
This is performed with wrist arthroscopy (key hole) surgery using two or three 2mm incisions in the skin, with possible addition of a larger open incision in some cases.
Wrist arthroscopy begins with an insertion of a small 1.9mm camera and inspection of the wrist cartilage and ligaments and the TFCC.
An instrument is then inserted through a second small 2mm incision to repair the tear. Some tears can be addressed by simply debriding torn/frayed edges. Other tears will require repair with sutures or anchors.
The skin is closed with dissolvable sutures after the surgery and arm may be placed in a plaster cast.
Recovery
- Patients go home the same day on painkiller.
- Arm elevation is encouraged to help with swelling and pain.
- Finger movement exercises are encouraged to minimise stiffness and swelling.
- Rehabilitation is divided into three phases:
- Phase 1 (0-6 weeks): Fulltime in a plaster. No driving. Gentle finger exercises.
- Phase 2 (6-12 weeks): Cast removed. Exercises to improve wrist and hand movement.
- Phase 3 (>12 weeks): Strengthening exercises.
- Sedentary office work can start 2-6 weeks after surgery.
- Driving can be commenced 6 weeks after surgery.
- Manual labourers may require 3-4 months before commencing normal work.
Results
Satisfactory results are seen in around 70-90%. Patients will continue to show improvement up to 1-2 years post surgery.
Risks and Complications
These include:
- Stiffness.
- Re Tear of the TFCC.
- Infection.
- Nerve injury.