Doha, 13 July 2020 - Aspetar surgeons now use arthroscopic surgery to diagnose and treat patients with persisting and painful wrists with ligament injuries, which aims to cut the time patients have to wait for investigation and treatment in terms of these problems. Injuries to the Triangular Fibrocartilage Complex (TFCC) – a ligament that stabilizes the wrist, are common in athletes in multiple sports, such as: handball, golf, volleyball and football - mainly goalkeepers.
The TFCC injuries of the wrist affect the ulnar (little finger) side of the wrist. Mild injuries of the TFCC may be referred to as a wrist sprain. But more severe ligament injuries of the wrist are common, especially in concomitant wrist fractures and these injuries can cause long-standing problems.
Isolated TFCC injury can occur after quick torque trauma in for example handball, tennis and among goalkeepers. Golfers are prone to have ulnar-sided wrist problems. Tennis players and table tennis players more often display degenerative TFCC injuries, so called 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 impact to the wrist from contact with the ice or surrounding boards.
Football goalkeepers have a sevenfold increased risk of hand and wrist injuries compared with outfield players. But compared to all injuries among professional football players, only approximately 1% of all these injuries affect the hand and wrist (4/5 affects the lower limb).
Dr Jonny K Andersson, a consultant Orthopaedic surgeon at Aspetar who led TFCC surgeries, said: “Conventional treatment options include physiotherapy, approximately one-third of the patients with TFCC injury can be improved by Hand therapists and Physio therapists, by specific custom-made brace and, above all, neuro-muscular rehabilitation and proprioceptive training. If this conservative treatment does not help significantly in 2-3 months, surgery with arthroscopic re-insertion of TFCC, is recommended. For the athletes and in other cases with gross instability or sub-dislocation of the ulnar head, I recommend an early surgical intervention.”
Dr Andersson; who has a long experience of performing different surgical techniques in terms of wrist ligament repair, stressed that the postoperative rehabilitation takes time; 3 weeks of above elbow cast, 4 weeks of custom-made brace. Gradually increasing training of range of motion and proprioception is needed 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 is comparable, but less stiffness, less scar and less risk of neuroma of sensory nerve-branches are seen after the arthroscopic technique, compared with open techniques.” Dr Andersson said.
Nowadays, Aspetar surgeons perform approximately 30 cases of arthroscopic re-insertion of the TFCC, every year. Providing a specific knowledge of these wrist ligament injuries and its treatment among all athletes is crucial and mandatory.
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 fields of clinical care and orthopaedic education as well as academically, the team aim for highest quality and functional outcome for the patients and a quick return to play for the athletes. The surgeons of Aspetar 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 the fingertip to the elbow.