Sports surgery – wrist sprains

Definition of wrist sprains:

In sports surgery, severe wrist sprains, lesions to the scapholunate or TFCC ligament, are indeed less frequent than wrist fractures. But these sports injuries can have significant medical consequences on the way the wrist ages, especially in the athlete. Among severe wrist sprains, lesions to the TFCC ligament are found especially in sports accidents where the wrist is bent forcefully.

Severe wrist sprains are usually found in sports where the wrist is bent forcefully. Tears of the TFCC ligament are also found as a result of falls onto a bent wrist in sports

 

The TFCC ligament is a fibrocartilaginous complex located on the radial part of the wrist joint, it is not vascularised on its radial side. For this reason, in sports injuries where the TFCC ligament is severely sprained, only ulnar lesions can be repaired durably, in particular by wrist arthroscopy for athletes.

Video of arthroscopic surgery for wrist sprain:

Video of arthroscopic sports surgery for a severely sprained wrist / Toulouse specialist

The main complaint reports pain in resistive prono-supination movements.
This frontal section CT arthrography of the wrist shows an ulnar tear of the TFCC ligament, with a leak of the contrast agent into the distal radioulnar joint.

Surgery of severe wrist sprain by ulnar tear of the TFCC ligament, preoperative CT arthrography, ToulouseSurgery of severe wrist sprain by ulnar tear of the TFCC ligament, preoperative CT arthrography, Toulouse

 

Surgical treatment for wrist sprains

Arthroscopic repair is performed on an outpatient basis under locoregional anaesthesia.
Only three 2-mm incisions are necessary.

Surgery on severe wrist sprain by ulnar tear of the TFCC ligament, loss of trampoline effect linked to tear, ToulouseSurgery of severe wrist sprain by ulnar tear of the TFCC ligament, debridement of lesion with a shaver, Toulouse

 

The assessment of the lesions is conducted through the radiocarpal arthroscopic portal; in this case we can see an old lesion with loss of trampoline effect and inflamed synovitis opposite. The lesion is then debrided with a shaver.

To reattach the ligament, an ulnar path is then used: two needles are introduced on either side of the cubital styloid through the TFCC ligament.

 

Surgery of severe wrist sprain by ulnar tear in the TFCC ligament, introduction of 2 needles, ToulouseSurgery of severe wrist sprain by ulnar tear of the TFCC ligament, the thread is passed through each needle, Toulouse

Two threads are passed through the needles and secondarily retrieved so as to form a U stitch that will be put under tension so as to reattach the ligamentous disc to the inner capsule surface. The threads are then tied on the ulnar side of the wrist, with the stitch secured by the styloid .

Surgery of severe wrist sprain by ulnar rupture of the TFCC, retrieval of sutures, ToulouseSurgery of severe wrist sprain by ulnar tear of the TFCC, reattachment put under tension, Toulouse

 

Repair solidity and trampoline effect restoration are verified.
The incisions are closed with Steri-strip.

Recovery after wrist sprain surgery

Wrist immobilization with a removeable splint will be necessary for 5 weeks.
This is the cosmetic result at 1 month.

Surgery of severe wrist sprain by ulnar tear of the TFCC ligament. Postoperative immobilization lasts 5 weeks, ToulouseSurgery of severe wrist sprain by ulnar rupture of the TFC, scar at 1 month, Toulouse

Rugby will resume after 2 to 3 months.

Surgery of severe wrist sprain by ulnar rupture of the TFCC, rugby resumes at 3 months, Toulouse