1- Why a treatment arthroscopic treatment of a lesion central of the ligament triangular ligament is– necessary ?
– Visit ligament triangular (also called complex fibrocartilaginous triangular or TFCC) is a structure ligament located at à the part internal from wrist, bringing together visit two bones from the front-arm (radius and ulna). He play a role essential in the stabilization from wrist in visit movements from rotation from the front-arm (pronation and supination). He a also a function damper between visit bones from wrist (carp) and from the front-arm at from support on the hand.
– The ligament triangular can be injured in some movements extension forced from wrist (fall) or from twist extreme (back from drill). Sa portion power plant can then go to tear, resulting in from pain à the part internal from wrist.
- The first course of treatment for central triangular ligament injury is immobilization in a splint for a few weeks, which may be combined with anti-inflammatory medication, corticosteroid infiltration or rehabilitation sessions. In some cases, these treatments prove inadequate, with persistent :
- disabling pain in the inner wrist,
- limited wrist mobility,
- snapping movements of the wrist,
- lack of strength.
- In these cases, surgery is proposed to treat the central lesion of the triangular ligament.
- During your consultation, the surgeon will suspect a lesion of the triangular ligament in the presence of suggestive signs and symptoms. He may prescribe additional tests to help with the diagnosis, in particular :
- X-rays to determine the bone morphology of your wrist,
- An MRI scan to visualize the triangular ligament and show any damage,
- An arthroscanner (CT scan with an injection of contrast medium inside the wrist) which will highlight the central lesion of the triangular ligament.
- None of these tests is 100% reliable, and they are only one of the elements that will enable your surgeon to diagnose your pathology and propose a treatment.
2 – Procedure
- The procedure is usually performed under local anaesthetic, but in certain circumstances a general anaesthetic may be preferred. The anesthesiologist will explain the procedure to you in a consultation prior to the operation.
- The procedure involves surgically repairing the central tear in the triangular ligament and removing the damaged tissue from inside the joint. The arthroscopic method (using a camera introduced into the joint) reduces the size of the incisions required for this operation.
- For your safety, a number of checks will be carried out prior to the operation, concerning your identity, the planned operation, the side to be operated on, and the availability and functioning of the necessary equipment. Only once all these checks have been carried out can the operation begin.
- During the operation, certain observations or circumstances may lead the surgeon to adapt or modify the procedure initially planned.
- Post-operative immobilization with a splint is not systematic, but may be proposed for a few days for pain relief. Dressings must be worn for 10 to 15 days. Progressive use of the wrist is permitted from the day after surgery, while remaining below the pain threshold. However, the full benefit of the operation can only be appreciated a few months afterwards.
- In most cases, the operation results in the disappearance of pain and the resumption of normal use of the wrist. However, some complications may occur:
- A lesion of the dorsal cutaneous branch of the ulnar nerve can lead to a loss of sensitivity on the inside of the back of the hand: most often, this is a benign lesion that improves on its own in a few months. More rarely, a section of this nerve may need to be surgically repaired.
- Tendon damage in the wrist may require surgical repair
- It is always possible that pain persists despite surgery. In this case, further surgery may be proposed.
3 – Your intervention in practice
- Preparing for intervention
- A pre-anaesthetic consultation is mandatory before any procedure. The anaesthetist will gather all the necessary medical information and may prescribe additional tests.
- Take a shower the evening before and the morning of your procedure.
- On the day of the operation, do not use skin moisturizer and remove jewelry (including wedding rings), piercings, nail polish and false nails.
- Fasting according to the anaesthetist’s instructions
- Follow the anaesthetist’s recommendations for taking your usual medication.
- The procedure is usually performed on an outpatient basis, but a short hospital stay is sometimes proposed.
- After outpatient surgery, you will need to be accompanied when you leave the hospital and return home, and you should not be left alone in the evening or at night.
- Always take the prescribed analgesic.
- Keep your arm in a sling at least until you wake up from anesthesia
- Move your fingers regularly as soon as the anaesthetic wears off.
- Take care not to get your bandage wet or dirty
- It is important to follow the instructions given to you by your anaesthetist and surgeon.
Feel free to ask your surgeon any questions you may have before your operation.
This information sheet is not exhaustive. Some complications are particularly exceptional and may arise in a specific context. It is important to understand that not all complications can be described exhaustively.
