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  • Central TFCC Tear/Ulnar Impaction Syndrome

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    Old 09-16-2015, 09:36 AM   #1
    CameraGirl1112
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    Central TFCC Tear/Ulnar Impaction Syndrome

    Hello, I guess I've just got some questions. In June 2014 (about a year & 3 months ago now) I tore the central portion of my TFCC ligament and micro-fractured two carpals. At the beginning though, the MRI only showed that the TFCC was perforated, so they sent me through hand therapy to see if it would improve on its own- it didn't. I eventually had two cortisone shots, went through steroid treatment in hand therapy, and tried the e-stim and ultrasound machines. All of these still did not help the pain that I was having, so my surgeon decided to do a TFCC debridement. When I saw the doctor again, he told me that I had tore my central portion of my TFCC and that it was a very large tear. I went through another round of hand therapy after the surgery, and I was still in pain constantly. At this point, we were discussing either trying to shave off part of the head of my ulna bone to shorten it, or to attempt to repair my TFCC (although he initially told me it couldn't be repaired). Well, workers' comp sent me to a different hand surgeon, where I was told that the surgery wasn't done properly, and that I needed to have the same surgery again. During this new surgery, the doctor took out a BUNCH of scar tissue and debrided some cartilage damage that was probably from ulnar impaction syndrome. I see him for a check up tomorrow (this last surgery was 3 months ago, & it's STILL not better) to see if I now need an Ulnar Shortening Osteotomy (which he said I most likely will if it's not better at this point). Of course, I'm pretty freaked out by this whole thing. I've done research on it, but I still have some recovery questions like:
    -How long are you casted?
    -Did the metal eventually bother you?
    -I know this is dumb, but can you have MRIs with this?
    -How soon were you able to return to "normal" activity?
    -Any complications?
    -And the big one, how is my TFCC going to be okay after all of this when there is still a huge hole in it? They told me it's not repairable, so that means it'll never heal? Will this continue to cause me problems despite all of these surgeries?

     
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    Old 09-16-2015, 09:39 PM   #2
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Quote:
    Originally Posted by CameraGirl1112 View Post
    -How long are you casted?
    -Did the metal eventually bother you?
    -I know this is dumb, but can you have MRIs with this?
    -How soon were you able to return to "normal" activity?
    -Any complications?
    -And the big one, how is my TFCC going to be okay after all of this when there is still a huge hole in it? They told me it's not repairable, so that means it'll never heal? Will this continue to cause me problems despite all of these surgeries?
    Hi,
    Welcome to HealthBoards.

    I had TFCC problems for over a year that wouldn't heal, despite the PT and repeated splints. The MRI didn't show a tear, but I had 2 hand specialists both tell me it was a high probability there was one there. In my case, they suspected a split tear so I can't speak on your hole.

    I had an ulnar osteotomy for my Ulnar Impaction Syndrome a few years ago. I had 4mm of bone removed. I was in a splint/cast for 10 days until swelling went down. Then I was in a short fiberglass cast for a few weeks and then an Exos removable "cast" for a couple weeks. The last one was because I had thumb pain in the cast and complained something wasn't right. He told me I failed casting and put me in the other kind. It is heated and molded to the arm. When it cools, it is as hard as the cast. It worked much better for me. (I digress, but have since found out I have hypermobility issues and my thumbs now regularly hyperextend backwards so I think that was the cause of my problem.) Anyway, I had a couple months of PT twice a week with a hand therapist. The bone had healed well, but I struggled getting my supination movement back. I also found that the pain in my TFCC area was exactly the same. After those couple months, my insurance said I wasn't making progress well enough and dropped my therapy coverage. My original surgeon said I was fixed and offered a cortisone shot, but that was all. I was frustrated and in tears.

    After some research, I chose a different hand specialist who had some specialized training. He immediately found several issues going on with my hand/wrist. First was that the plate was 'loose'. He said that it alone could cause the pain I was still feeling. I'd also developed a cyst towards the top of my incision towards my elbow. (That wasn't painful though.) He pointed out various areas of my hand and wrist that were very lax. He suspected I had a UT split tear. This is something that doesn't show on MRI's and was newly discovered in 2008. He was trained by the surgeon who discovered it. Anyway, I had my plate and cyst removed. He also did the debridement surgery in my hand/tfcc area. He said there was tons of debris and inflammation in the area and he cleaned it up for me. He didn't find the tear that was suspected though. I only had a wrap after that surgery. I wore it for a short time (less than 2 weeks). I started PT after about a week. Within a couple months, I'd regained full ROM and my pain was gone. By this time, it was 2 years after my original injury. To date, I still have full ROM and strength and I've had no further problems.

    One thing I appreciated about both surgeons was how nicely they did the incision. Mine is 4 inches, but it is extremely straight and tight so the scar isn't bad at all. The second surgeon actually removed the plates out of 1 inch incisions at the ends of the original scar to keep it looking nice. The 4 incisions from debridement are only barely noticeable now too. (I'm sure you know this, but thought I'd mention for other viewers.)

    You ask about "normal" activity. It really depends on what you are doing. I was driving, writing, and typing when I got my fiberglass cast on. The writing and typing were a bit more awkward, but I was able to do that. I regained the lifting of heavier objects as soon as the cast came off. My only limitations there were my limited ROM issues. My first hand therapist said it can be a rough PT for some people and it does take time. Once I had my plate removed and regained the ROM, I did pretty much everything. The only thing that still makes me nervous is bowling. I throw a pretty heavy ball and I'm always worried about messing up what took so long to heal. I wear a brace when I bowl, but I no longer bowl in leagues like I used to. My greatest accomplishment though in knowing when I was back to normal was when I could cup water in my hand. I celebrated when I regained that last bit of movement back.

    I'm not sure if this was encouraging or discouraging. If you asked if it was worth having the surgery, I'd tell you that for me it was. If you ask if I would do it again, I'd say yes. I just probably would have gone the second specialist first just because I really really liked him. I have full ROM and no pain, even though it took a long time to heal.

    If you choose surgery, let us know. I'll give you some of the tips of what I learned while going through the process.
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    Old 09-18-2015, 05:39 AM   #3
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Hello, MountainReader. Thank you for your reply!

    I went to the surgeon's office yesterday, and I will be having the Osteotomy on September 28th. So soon! They are taking 3mm off of the bone, and I will be in a long arm cast for 2 weeks, and a short arm cast for 4 weeks. After that I will be in physical therapy for 6 weeks, and then he says that I should be released to full duty (I'm on worker's comp). I have been wearing the splint that was molded to my wrist using hot water and has Velcro straps for about a year now, being weaned out of it on and off. I'm on strict one handed duty and to wear the splint until my surgery. He said again yesterday that the tear in my TFCC was very abnormal and "huge"; reassuring, right? Lol. It sounds like my incision will be a bit larger; he said that it will be about 6-7 inches because my bones and arms are so small- he had a very hard time doing the last surgery. He also said that I have an 80% chance of needing the hardware removed because my bones are so small. I feel like if the hardware was removed, I'd be unintentionally cautious with it just in case.

    Anyway, thanks for the reply!

     
    Old 09-20-2015, 11:51 AM   #4
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    its interesting that you've been told you will be in a long arm cast - seems like every Dr has different thoughts on this. Im not sure or me - have pre-op tomorrow (21st) then surgery for the ulnar shortening osteotomy on Fri 25th so we will be going through things pretty much at the same time. Most people I speak to online who have had the surgery seem to have had better outcomes with above elbow cast first then short arm. Im rather worried about the pain etc afterwards and would rather have my arm immobilised as much as possible to stop me from any movement that could either cause pain or damage the plate site.
    Fingers crossed all goes well

     
    Old 09-20-2015, 06:06 PM   #5
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    I did just fine with my short arm cast after my ulnar osteotomy. If I'd needed repair work done on my TFCC, I would have had the above the elbow one though.

    Basically, there isn't a lot of difference having an ulnar shortening osteotomy than having a broken bone plated. Healing is the same.

    As for the pain...elevate constantly and ice frequently. I crushed ice in my Ninja and turned it to 'snow'. That wrapped nicely around the cast in the ice bag they gave me in the hospital. I've since had other surgery and learned about the wonders of the polar ice machines. You might ask if they will provide one to you

    I was able to wean off the pain killers fairly quickly. I did have a couple bad days after transitioning from the first surgical cast to the fiberglass one. Didn't expect that to hurt and had to go back in for a new pain killer script since my first was small.

    Surgery to remove the plate is easy. I had ulnar side debridement done at the same time as I had my plate removed and left with just a wrap on my hand that I was able to remove in less than a week. I started therapy quickly after the surgery too.
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    Old 09-21-2015, 06:49 AM   #6
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Quote:
    Originally Posted by NowMrJJ View Post
    its interesting that you've been told you will be in a long arm cast - seems like every Dr has different thoughts on this. Im not sure or me - have pre-op tomorrow (21st) then surgery for the ulnar shortening osteotomy on Fri 25th so we will be going through things pretty much at the same time. Most people I speak to online who have had the surgery seem to have had better outcomes with above elbow cast first then short arm. Im rather worried about the pain etc afterwards and would rather have my arm immobilised as much as possible to stop me from any movement that could either cause pain or damage the plate site.
    Fingers crossed all goes well

    Yeah, it does seem that we will be going through things at the same time. It'll be interesting to see the differences between our doctors' ways of doing things. I'm worried about the pain, too. I've had quite a few surgeries, but I've never broken a bone before. However, my surgeon is giving me the nerve block, so I'm glad about that. Plus it's about to get colder where I live (Michigan), and I never do well with pain & cold!

     
    Old 09-21-2015, 06:51 AM   #7
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Quote:
    Originally Posted by MountainReader View Post
    I did just fine with my short arm cast after my ulnar osteotomy. If I'd needed repair work done on my TFCC, I would have had the above the elbow one though.

    Basically, there isn't a lot of difference having an ulnar shortening osteotomy than having a broken bone plated. Healing is the same.

    As for the pain...elevate constantly and ice frequently. I crushed ice in my Ninja and turned it to 'snow'. That wrapped nicely around the cast in the ice bag they gave me in the hospital. I've since had other surgery and learned about the wonders of the polar ice machines. You might ask if they will provide one to you

    I was able to wean off the pain killers fairly quickly. I did have a couple bad days after transitioning from the first surgical cast to the fiberglass one. Didn't expect that to hurt and had to go back in for a new pain killer script since my first was small.

    Surgery to remove the plate is easy. I had ulnar side debridement done at the same time as I had my plate removed and left with just a wrap on my hand that I was able to remove in less than a week. I started therapy quickly after the surgery too.
    How long was it after your surgery that you had the plate removed?

     
    Old 09-21-2015, 05:36 PM   #8
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    I had my ulnar osteotomy in March and had the plate removed in November. I understand anything after 6 months should be OK. The bone was healed at about 6 weeks though.

    Healing from plate removal was extremely easy with no cast or splint. Just a wrap for a while.

    Aside from the obvious need for plate removal, I think I would have done it after awhile anyway. There really isn't much 'padding' over that ulnar bone. Winters could easily make the plate cold. I have some nice snowy winters here. Also, I ended up with a cyst at the top of the plate that I needed removed and that was taken care of when the plate was removed.

    I see a holistic dentist. He has spent a lot of time educating over the years about the fact that metals in the body can disrupt the energy flow of the body. I figure having it out couldn't hurt.

    If the plate isn't bothering you though, there really isn't a need to have it removed though.
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    Old 09-22-2015, 05:21 AM   #9
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Oh, okay. Thanks!
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    Old 09-23-2015, 07:43 AM   #10
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Okay, I'm really freaking out here guys! The surgeon's office just called me and informed me that they are not putting me under general anesthesia, but under the twilight sleep and giving me the nerve block. UM. I'm really freaked out.
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    Old 09-23-2015, 09:36 PM   #11
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Hi CameraGirl,

    Unfortunately, in recent years I've had 6 joint related surgeries. In my opinion, they are offering you the very best option. It is what I would ask for if given a choice.

    Being asleep this way, you won't feel or remember anything. It is much easier to wake afterwards and I don't have the nausea issues like with general anesthesia. Also, I developed wicked TMJD after one of my intubations. I plan to avoid it as much as possible if I need future surgeries. You should like the nerve block. It really does help with some of that initial bad pain and keeps you from having to take such high dosages of the pain killers. I appreciate that because I dislike taking pain killers unless I have to and because pain killers can really cause constipation issues as a side effect and dealing with that while healing from surgery just isn't fun.

    If they give you an option, I'd ask about a polar ice machine. That is the other thing I've found extremely helpful after surgeries. Ice really does help, even over the cast or splint you will be in. You just need to leave it on a bit longer at times so the cold penetrates.

    I encourage you to try not to freak out so much. I've had this for 4 of my surgeries and it is a good option. I understand about the stress of waiting though. It can be almost the hardest part.

    If you need to cheer yourself up after the surgery, consider treating yourself to a nice colorful Cast Cover. I had one with denim and brown swirls, one with lots of dots, and one that was tie dye style. They go over casts or splints and can add some fun to something not so fun. They also keep you from snagging the cast on things and help keep the cast clean.

    Keep good thoughts and be well.
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    Old 09-24-2015, 05:29 AM   #12
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Do you remember anything from your surgeries? My biggest fear is waking up during surgery, I think that's why I freaked out so much.

    Thanks for the tips.
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    Old 09-24-2015, 07:24 PM   #13
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Nope. Typically, they either administer medication to your IV that almost immediately puts me asleep before wheeling me back to surgery or they wheel me to surgery and have me help transfer myself to the surgical table then they administer the medication. After that, I never remember anything until I wake in recovery. Usually that is because a nurse is prompting me to wake and giving me some water.

    They monitor you in recovery for a while to see how you are doing. Usually, they will administer some additional medication if you need it for pain or nausea. The doctor may or may not come in to talk to you in recovery. They do talk to whoever takes you in. They always go over your results at your first post-surgical appointment. Before being released, they will go over your post-op instructions to make sure you understand them. Then they help you get dressed and put you in the wheelchair so you can leave.

    I've found that despite the pain of the surgery, the nerve blocks and medication they gave me in the IV keep the pain down long enough to get home and settled. Make sure you take your pain medication before the pain sets in bad. If you stay on top of your pain, you will rest better and it helps with coping better. Ice frequently. Use lots of pillows to prop your arm up. They will have you keep your wrist elevated for several days after surgery. You will have a lot of swelling. That will go down over the course of a couple weeks. I had my transition to a fiberglass cast after 10 days, but had a new cast a week or so after that because I had so much more swelling that went down after that. Not sure that is normal, but they didn't have a problem when I went in for that.

    I've had that same type of sedation for multiple endoscopies and other minor surgery also and the experience with them is pretty much the same minus the surgical pain.

    Have you chosen what you are wearing yet? Big t-shirts are good. I had a short sleeve zip up hoodie that worked perfectly for my wrist and shoulder surgeries. It was easy and loose. I also used elastic waist sweats, shorts or yoga pants to make it easy to get the bottoms on. Slip on shoes are great too.

    I really do wish you luck.
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    Old 09-25-2015, 05:29 AM   #14
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Okay, that makes me feel better about the twilight sleep. Thanks!

    I plan on wearing sweats and a large t-shirt that I have. I'll probably bring a hoodie just in case, and slip on shoes.

    I've had plenty of surgeries, but I've only had the twilight sleep once for a colonoscopy, and I actually remember some of that; that's what freaked me out about it! But I didn't have as many problems coming out of the twilight sleep as GA, so that's a plus.
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    Old 09-25-2015, 12:59 PM   #15
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    Re: Central TFCC Tear/Ulnar Impaction Syndrome

    Hello,

    I had my tfcc and radius shortened, I had long arm casts before and after surgery to keep me outta pain, my dr said whatever I needed to be painfree. I had general and was in surgery for 3-4 hours then recovery for 2 then admitted because of pain and nausea for 3 days after, I freaked out about the nerve block and cath. I had a long arm cast for 3 months then a short arm for two and PT for three months. I had surgery in december 2014 and feel about 80%, now I have pain while sleeping probaly cuz I bend my wrist so I wear a brace or removable cast. I am very happy with my results. Althought I was casted for a long time I feel it was worth it, when I got the cast off in March, I reinjured the tfcc and had another cast till may, then pt. Becareful as your arm will be weak for a few months and reinjuring it will be easy.
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