Diagnostic wrist arthroscopy: findings in patients suspected of TFCC lesions

Lyse van Wijk, Sandesh Kasie, Claire Koeyvoets, Sebastiaan Souer, Steven Hovius, Brigitte van der Heijden & Hand-Wrist Study Group

Abstract

Introduction

Ulnar-sided wrist pain remains a diagnostic challenge due to its complex anatomy and broad differential diagnosis. This study evaluated the diagnostic role and therapeutic consequences of wrist arthroscopy in patients with ulnar-sided wrist pain and suspected triangular fibrocartilage complex (TFCC) lesions.

Materials and methods

A retrospective cohort study was conducted on patients undergoing diagnostic wrist arthroscopy for suspected TFCC lesions based on clinical and imaging assessments between 2012 and 2021. Data on the indication, arthroscopic findings, treatment, and complications were collected.

Results

500 patients were included with a median age of 38 years (IQR 28.0–49.0), of whom 65.0% were women. The median symptom duration was 8 months (IQR 5.0-16.5), with 61.4% reporting wrist trauma. TFCC lesions were confirmed in 73.6% of cases, most commonly Palmer type 1B and 2C. Additional findings, such as scapholunate or lunotriquetral injuries and cartilage damage, were identified in 31.6% of patients, while 16.0% showed no arthroscopic abnormalities. Based on arthroscopic findings, 46.4% underwent immediate arthroscopic intervention, including TFCC debridement (174, 34.8%), synovectomy (170, 34.0%), or ganglion removal (4, 0.8%). 51.0% proceeded to open surgery within a year, most often TFCC repair or ulnar shortening. Complications occurred in 7.4% of patients, mostly mild.

Conclusions

These results highlight wrist arthroscopy as a decisive tool in the diagnostic workup of patients with suspected TFCC lesions, providing valuable information to confirm, classify, or exclude pathology, and to identify concomitant wrist abnormalities. Both positive and negative arthroscopic findings are important for treatment decisions, providing essential guidance for surgical and non-surgical management of ulnar-sided wrist pain.