I play tennis competitively at the collegiate level but I'm off the court with a wrist injury. Looks like I tore the triangular cartilage on the outside of my wrist. What are my chances for recovery without having surgery? The surgeon didn't seem very optimistic.
Wrist pain from a triangular fibrocartilage (TFC) tear can be very disabling for the athlete. The TFC is a thin, oval plate of fibrous cartilage. It is sometimes referred to as the articular disc or radioulnar disc because of its location between the distal radius and ulna (bones of the forearm). Distal refers to the bottom ends of these two bones where they meet the wrist.
This triangular-shaped soft tissue structure binds the distal radius and ulna together while also providing a buffer between the ends of these bones and the wrist bones. The articular disc also creates an even spread of forces between the connecting surfaces of bones.
Besides increasing the stability of the joint, the TFC also helps move synovial fluid to areas of the articular cartilage that have the most friction. Several wrist ligaments interconnect with the TFC to form a stable but pliable wrist. All of these features are important in sports that require strong, repetitive wrist motions such as golf, soccer, tennis, and volleyball.
Many athletes at this level are able to rehab without surgery. A carefully planned approach is needed that will get the athlete back into competition as soon as possible. Some experts advise a combination of antiinflammatories and immobilization in a cast or splint. Physical therapy is often helpful. Steroid injections may be tried if these other methods don't work.
But if conservative (nonoperative) care fails to change symptoms or improve function, then surgery may be needed. There aren't very many studies following high-level athletes who have surgical repair of a torn TFC. Results from a small study from Stanford University was recently published. High-level athletes with TFC tears had good success with surgery after failed nonoperative care.
Results were very positive with most of the athletes returning to their sport within three months. Pain was reduced. Full wrist motion and improved function were achieved. They were able to fully participate at a high-level. Ulnar-sided repairs had slightly better results. This may be because there is more blood supply on that side of the wrist.
Your surgeon likely has some information about the type of injury and extent of damage in your case that may affect your prognosis. Don't hesitate to ask more questions to help you understand your own situation and what can be done about it. You may want to seek a second or even third opinion in plotting out your fastest way to return to the court with the fewest problems.
Timothy R. McAdams, MD, et al. Arthroscopic Treatment of Triangular Fibrocartilage Wrist Injuries in the Athlete. In The American Journal of Sports Medicine. February 2009. Vol. 37. No. 2. Pp. 291-297.
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