Designing a 20 mm incision to protect the dorsal branch of the ulnar nerve during arthroscopic repair of triangular fibrocartilage complex injuries: Cadaver study and preliminary clinical results

This review includes updated understanding of the roles of intrinsic and extrinsic carpal ligaments in scapholunate instability and details the author’s experience of indications, arthroscopic repair methods, and outcomes of treating the instability. A classification on triangular fibrocartilage complex injuries is reviewed, followed by author’s indications, methods, and outcomes of arthroscopic repair of triangular fibrocartilage complex injuries.

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Injury to the dorsal sensory branch of the ulnar nerve in the arthroscopic repair of ulnar-sided triangular fibrocartilage tears using an inside-out technique: A cadaver study

The Journal Of Hand Surgery ◽

10.1053/jhsu.2002.34370 ◽

2002 ◽

Vol 27 (5) ◽

pp. 840-844 ◽

Cited By ~ 37

Author(s):

Timothy R. McAdams ◽

Vincent R. Hentz

Keyword(s):

Ulnar Nerve ◽

Cadaver Study ◽

Arthroscopic Repair ◽

Triangular Fibrocartilage ◽

Inside Out

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Arthroscopic repair of triangular fibrocartilage complex injuries

Orthopedic Clinics of North America ◽

10.1016/s0030-5898(05)70249-2 ◽

2001 ◽

Vol 32 (2) ◽

pp. 279-294 ◽

Cited By ~ 20

Author(s):

Sheldon R. Cober ◽

Thomas E. Trumble

Keyword(s):

Triangular Fibrocartilage Complex ◽

Arthroscopic Repair ◽

Triangular Fibrocartilage ◽

Complex Injuries

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Results of Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tear With Exploration of Dorsal Sensory Branch of Ulnar Nerve

The Open Orthopaedics Journal ◽

10.2174/1874325001711010525 ◽

2017 ◽

Vol 11 (1) ◽

pp. 525-532 ◽

Cited By ~ 3

Author(s):

Alvin Chao-Yu Chen ◽

Chun-Jui Weng ◽

Chih-Hao Chiu ◽

Shih-Sheng Chang ◽

Chun-Ying Cheng ◽

...

Keyword(s):

Ulnar Nerve ◽

Treatment Success ◽

Sensory Nerve ◽

Triangular Fibrocartilage Complex ◽

Activity Level ◽

Arthroscopic Repair ◽

P Value ◽

Significant Difference ◽

Triangular Fibrocartilage ◽

One Year

Background: Ulnar-sided approach in arthroscopic triangular fibrocartilage complex (TFCC) repair may jeopardize treatment success by exposing the dorsal sensory branch of ulnar nerve (DSBUN) in risk of injury. We aim to conduct a follow-up assessment of arthroscopic outside-in TFCC repair and efficacy of sensory nerve exploration. Methods: We conducted a retrospective chart review of 58 patients (59 wrists) who received arthroscopic repair of the peripheral attachment of the TFCC. Ulnar-sided skin incision and exploration of DSBUN were performed before arthroscopy setting. Arthroscopic outside-in repair through pullout suture ligation was performed. Functional survey at 6 months and 1 year postoperatively was based on Mayo Modified Wrist Score (MMWS), and compared to the preoperative assessment. A p-value of less than 0.05 was considered significant as calculated using paired t-test. Results: Postoperative MMWS averaged 74.32±11.50 at 6 months, and 84.41±9.52 at one year; both showed significant difference as compared to preoperative status. Significant improvement was noted in all 4 individual items except motion retrieval between 6 months and 1 year. Totally, 45 (76%) cases achieved good or excellent results at one year; however, less patients resumed pre-injury activity level when treatment delay was more than 6 months than those treated earlier (41% vs. 57%). Complication included 6 transient paresthesia; 1 anchor migration and 1 distal radioulnar arthrosis. No more nerve complication was found after modification of perineural dissection. Conclusion: Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear. Modified perineural dissection can minimize sensory nerve complications.

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