TAME & Musculoskeletal Embolization
TFCC Injury and Guyon's Canal Syndrome: TAME with Ultrasound-Guided Nerve Hydrodissection — Case Report
Author: Bow Wang, M.D.
Ms. W, in her early twenties, has been experiencing persistent pain on the ulnar side of her wrist since injuring it while moving a patient a year ago. The pain limits her ability to bear weight and perform activities like bracing her wrist against a table. In addition, Ms. W has experienced intermittent tingling and numbness in her fourth and fifth fingers since the injury.
After local injection treatment, Ms. W showed no significant improvement. Following a clinical physical examination by orthopedic surgeon Dr. Hong Zhikai and a diagnosis of [triangular fibrocartilage complex injury, TFCC injury] using National Cheng Kung University Hospital and magnetic resonance imaging (MRI), she was referred to Bow Wang, M.D. at the Interventional Medicine Center for further treatment.
After discussion, Bow Wang, M.D. was first used on Ms. W. Under X-ray fluoroscopy guidance, local anesthesia, and arterial angiography, contrast agent was injected to identify excessive and disordered capillary-like vessels in the triangular fibrocartilage complex. Embolizing medication was then injected via a microcatheter to remove these abnormal capillary-like vessels.
Following the treatment, Ms. W's pain on the ulnar side of her wrist improved significantly, but numbness and pain in her fourth and fifth fingers persisted. After performing nerve conduction and electromyography examinations and evaluating the patient's medical history, Bow Wang, M.D. diagnosed her with Guyon's tunnel syndrome.
After discussion, Bow Wang, M.D. performed a US-guided entrapped nerve hydrodissection on Ms. W. Guided by ultrasound, under local anesthesia, a needle and injection solution were used to release the nerve.
Two days after the injection treatment, Ms. W's numbness and pain in her fourth and fifth fingers were greatly reduced, and her quality of life improved significantly.
The triangular fibrocartilage complex (TFCC) is a complex structure located between the ulnar side (little finger side) of the wrist joint and the carpal bones. It is composed of a group of ligaments and fibrocartilage, often described as a semi-lunar version of the wrist joint. The TFCC is responsible for maintaining the stability of the distal radioulnar joint and the ulnar side (near the little finger) of the carpal bones, as well as bearing and transmitting pressure from the hand.
Once the TFCC is injured, wrist stability decreases, and pain begins to appear, becoming the most common cause of ulnar side wrist pain. TFCC injuries are usually caused by repetitive or traumatic wrist sprains, weight-bearing swings, or prolonged repetitive movements. Treatment methods for TFCC injuries include rest, physical therapy, bandages and braces, and surgery.
Ulnar tunnel syndrome is commonly seen in the elbow (proximal ulnar tunnel, cubital tunnel syndrome) and the wrist (distal ulnar tunnel syndrome, Guyon's tunnel), and is associated with repetitive movements, improper posture, or trauma.
Distal ulnar tunnel syndrome (Guyon's tunnel) is compression of the ulnar nerve in the wrist, possibly due to wrist injury, overuse, or anatomical variations. Clinical symptoms include numbness and pain in the little and ring fingers, weakened grip strength, and may also affect fine motor skills. Ulnar tunnel syndrome is primarily diagnosed through clinical evaluation and nerve conduction and electromyography (EMG) examinations.
If repetitive movements or improper postures that compress the ulnar nerve can be avoided, the condition usually improves or even resolves. If numbness and pain persist and worsen, or if muscle atrophy and weakness have occurred, treatment such as the ultrasound guided entrapped nerve hydrodissection (US-guided entrapped nerve hydrodissection) or even surgery may need to be considered.
Patients wishing to undergo treatments such as the Transarterial Microembolization (TAME) or ultrasound guided entrapped nerve hydrodissection (US-guided entrapped nerve hydrodissection) are advised to undergo a thorough evaluation by a physician to confirm the true source of pain. It is also recommended that patients have a full discussion with their physician and family to understand the treatment process and related precautions before receiving treatment for better assurance.
This page is for medical education and academic communication. It does not replace individual diagnosis or treatment advice.
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