TFCC Tear

Symptoms of a TFCC Tear

• Pain in the wrist, on the little finger side.
• Tenderness over the back (dorsum) of the wrist.
• Pain is worst on bending the wrist sideways so the little finger moves towards the forearm (ulna deviation).
• Swelling.
• Clicking on wrist movements.
• Reduced grip strength.

What is the Triangular Fibrocartilage Complex?

The triangular fibrocartilage complex consists of:

• The triangular fibrocartilage disc.
• Ulna meniscus homolog.
• Ulnar collateral ligament.
• Several carpal ligaments.
• Extensor carpi ulnaris tendon sheath.

The function of this group of structures is to provide stability, cushioning and smooth movement at the wrist joint.

Causes of a TFCC Tear

A TFCC tear can be either traumatic - from a specific injury, or degenerative.

Traumatic injuries usually involve a compressive and twisting force and 50% of the time also result in a fracture of the Ulna or Radius. Falls onto an outstretched hand, with the palm down and wrist extended (bent backwards) are a common incident which may cause this injury.

Sports in which this injury is common include racket and bat sports like tennis and baseball and gymnastics due to weight bearing on the hands.

Degenerative tears occur due to repetitive loading over a long period and are usually in the older population. They may also occur as a result of a genetically longer Ulna which pinches on the cartilage complex.

Diagnosis

If a TFCC tear is suspected visit a Doctor, who will:

• Examine the wrist for signs and symptoms of the injury.
• Perform some manual tests which place stress on the complex, looking for the symptoms to be reproduced.
• Refer the patient for investigations. This will usually involve an MRI scan which is most effective at diagnosing this particular injury (90% accuracy).
• An X-ray may be used to rule out fractures.
• Once the extent of the injury is known, a decision can be made regarding the best treatment options.

Treatment of Triangular Fibrocartilage Complex Injuries

In most TFCC tears, conservative treatment is successful. This involves:

• Immobilisation in a splint for approximately 4 weeks.
• After this period a removeable splint may be used which permits some movement.
• Anti-inflammatory medication such as ibuprofen may be prescribed.
• Electrotherapy such as ultrasound may be used.
• Progressive mobility and strengthening exercises as pain allows.
• A corticosteriod injection may be given in some cases.

Large tears, or degenerative injuries may require surgery:

• The procedure is usually done as an arthroscopy (key-hole).
• It involves trimming the torn piece of cartilage.
• In cases where the Ulna is too long, the end of the bone may be shaved away.
• The wrist is then immobilised for 2-4 weeks.
• A rehabilitation programme should be followed after this period, to regain full strength, mobility and co-ordination.