Day Surgery

Wrist Ligament and Cartilage Injuries

Wrist ligament and cartilage injury treatment in Townsville - scapholunate ligament and TFCC injuries. Dr Jonathon de Hoog, Aspire Orthopaedics.

Performed at: Townsville Day Surgery Mater Hospital Pimlico

Overview

The wrist is stabilised by a complex arrangement of ligaments and cartilage structures. Injuries to these structures are a common cause of persistent wrist pain that doesn’t settle after what appears to be a simple sprain.

The two most commonly injured structures are:

  • The scapholunate (SL) ligament - on the thumb side of the wrist, the primary stabiliser between the scaphoid and lunate bones
  • The triangular fibrocartilage complex (TFCC) - on the little finger side of the wrist, the main stabiliser between the forearm and the wrist

Scapholunate ligament injuries

What happens

The SL ligament connects the scaphoid and lunate bones. A tear disrupts the coordinated movement of these bones, causing instability. Over years, untreated SL instability leads to progressive wrist arthritis (SLAC wrist).

Symptoms

  • Pain on the thumb side of the wrist, often worse with weight-bearing or gripping
  • A clunk or click with wrist movement
  • Weakness of grip
  • Sometimes a history of a fall onto an outstretched hand followed by persistent pain that was written off as a sprain

Diagnosis

  • Clinical examination - specific tests for SL instability
  • X-rays - may show widening between the scaphoid and lunate (the “Terry Thomas sign”) in complete tears
  • MRI - sensitive for detecting significant ligament tears
  • Wrist arthroscopy - the gold standard; allows direct visualisation and staging of the tear

TFCC injuries

What happens

The TFCC is a cartilage and ligament structure on the ulnar (little finger) side of the wrist. It can be torn acutely (from a fall or forced rotation) or wear progressively with loading. Tears are classified as traumatic (Type 1) or degenerative (Type 2).

Symptoms

  • Pain on the little finger side of the wrist
  • Pain with rotation of the forearm (turning a key, opening a jar)
  • A clicking or clunking sensation
  • Sometimes associated with instability of the distal radioulnar joint (DRUJ)

Diagnosis

  • Clinical examination - loading tests of the TFCC and DRUJ
  • X-rays - may show relevant bony anatomy (ulnar variance)
  • MRI - useful for identifying significant tears
  • Wrist arthroscopy - definitive diagnosis and often simultaneous treatment

Non-surgical treatment

Many wrist ligament and cartilage injuries, particularly partial or degenerative tears, can be managed without surgery:

  • Splinting and activity modification - particularly for acute or low-grade injuries
  • Hand therapy - proprioceptive and strengthening exercises
  • Corticosteroid injection - for symptomatic TFCC tears, can provide significant relief

Surgical treatment

Surgery is considered for:

  • Complete ligament tears with instability
  • TFCC tears that have failed non-surgical management
  • Injuries in younger, active patients where instability risks long-term arthritis

TFCC repair or debridement is typically performed arthroscopically. Central degenerative tears are debrided (trimmed); peripheral traumatic tears may be repaired.

Scapholunate ligament repair or reconstruction involves either direct repair of the torn ligament (for acute, complete tears) or reconstruction using a tendon graft for chronic or complex injuries.

Surgery is performed at Townsville Day Surgery or Mater Hospital Pimlico, under regional block with light sedation, usually as a day procedure.

Recovery

Recovery depends significantly on the structure treated and the extent of the surgery:

  • TFCC debridement - wrist movement restored over 4-8 weeks; relatively quick recovery
  • TFCC repair - splinting for 4-6 weeks; full recovery 3-6 months
  • SL ligament repair or reconstruction - splinting for 6-8 weeks; return to manual work and sport at 6-12 months; full recovery can take 12 months or more

Hand therapy is central to recovery and is available through NQ Hand Care Clinic at the same North Ward location.

Risks

  • Stiffness - some permanent loss of wrist movement is common after major ligament reconstruction
  • Persistent pain - wrist ligament injuries can be difficult to fully resolve
  • Progression to arthritis - particularly with untreated or inadequately managed SL tears
  • Re-tear - especially in high-demand patients returning to heavy manual work
  • Infection - rare
  • Complex regional pain syndrome - recognised but rare

Recovery timeline

What to expect at each stage of your recovery.

  1. Initial assessment

    First appointment

    Clinical examination, X-rays, and MRI. Arthroscopy may be needed for definitive diagnosis and simultaneous treatment.

  2. Non-surgical or surgical treatment

    Varies

    Splinting, therapy, and injections for mild or chronic injuries. Arthroscopic repair or reconstruction for significant ligament tears.

  3. Protected recovery

    Weeks 1-6

    Splinting to protect repaired or reconstructed structures. Hand therapy begins with protected movement protocols.

  4. Return to activities

    3-12+ months

    Return to manual work and sport after confirmed healing. Full recovery of wrist movement and strength takes 6-12 months for major repairs.

Common questions

Frequently asked questions about this procedure.

What is the scapholunate ligament?

The scapholunate ligament is the primary stabiliser between the scaphoid and lunate bones in the wrist. A tear of this ligament disrupts wrist mechanics and can lead to progressive wrist instability and, if untreated, wrist arthritis over years. It is the most commonly injured intrinsic wrist ligament.

What is a TFCC tear?

The triangular fibrocartilage complex (TFCC) is a cartilage and ligament structure on the ulnar (little finger) side of the wrist. It stabilises the joint between the forearm bones and the wrist. TFCC tears cause pain on the little finger side of the wrist, often with rotation. They can occur acutely from a fall or develop gradually with repetitive loading.

Will I need surgery for a wrist ligament injury?

Not necessarily. Many partial or low-grade wrist ligament injuries respond to splinting, hand therapy, and occasionally injections. Surgery is considered for complete ligament tears causing instability, injuries that fail non-surgical management, or when wrist instability risks progression to arthritis. The need for surgery depends on the ligament injured, the degree of injury, your activity demands, and how long the injury has been present.

Can wrist ligament injuries cause arthritis?

Yes. Untreated or inadequately managed scapholunate ligament tears in particular can lead to a predictable pattern of wrist arthritis known as SLAC (scapholunate advanced collapse) over years. This is why persistent wrist pain after a fall or wrist injury should be investigated, even if initial X-rays are normal.

Do I need a GP referral?

Yes. A GP referral to Aspire Orthopaedics is the standard pathway for wrist ligament and cartilage injuries.

Speak with Dr de Hoog

A GP referral is required to see Dr de Hoog. Ask your GP to refer you to Aspire Orthopaedics, or contact the rooms directly for guidance.

Get a referral Email the clinic