TFCC Tear

TFCC tear wrist injury

A TFCC tear is an injury to the triangular fibrocartilage complex found in the wrist. It is caused either by sudden trauma or may develop gradually. Here we explain the symptoms, causes and treatment for a TFCC tear.

TFCC tear symptoms

  • Symptoms of a TFCC tear include wrist pain on the little pinky finger side.
  • There will be tenderness over the back of the wrist.
  • Pain worsens when bending the wrist sideways so the little finger moves towards the forearm (called ulnar deviation).
  • There is likely to be swelling in the wrist, reduced grip strength and sometimes a clicking sound or feeling when moving the wrist.

Diagnosis

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  • If a TFCC tear is suspected, visit a doctor, who will examine your wrist for signs and symptoms. They will perform some manual tests which place stress on the complex. By reproducing symptoms they can get an understanding of which structures are injured.
  • One thing you can do at home is to lift your bodyweight off a chair. If this reproduces symptoms then the test is positive1.
  • An MRI scan is most effective at diagnosing this particular injury with a 90% accuracy rate. An X-ray may also be used to rule out fractures. Once the extent of the injury is known, a decision can be made regarding the best treatment options.

What is a TFCC tear?

A TFCC tear is a tear of the triangular fibrocartilage complex, which consists of:

  • The triangular fibrocartilage disc.
  • Ulna meniscus.
  • 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.


What causes 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 backward) 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. It also occurs in Water skiing.

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


Treatment of TFCC injuries

  • In most TFCC tears, conservative treatment (without surgery) is successful. This involves immobilization in a splint for approximately 4 weeks.
  • After this period a removable 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 wrist mobility and strengthening exercises should be followed, as pain allows. A corticosteroid injection may be given in some cases.

TFCC tear surgery

  • 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 immobilized for 2-4 weeks.
  • A rehabilitation programme should be followed after this period, to regain full strength, mobility, and coordination.

Mr. Elliot Sorene MBBS FRCS (Tr & Orth) EDHS Consultant Orthopaedic, Hand & Upper Limb Surgeon explains TFCC Surgery.

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There are a number of ligaments in the wrist, however, the ligaments that are of most importance are the scapholunate ligament (on the back of the wrist) and what is known as the TFCC or triangular fibrocartilage complex.

This is a combination of ligaments and cartilage which holds together the radius and the ulna and is responsible in part for the stable rotation of the forearm.

A twisting injury can cause damage to the TFCC. Both injuries to the scapholunate ligament and TFCC are managed by first making a correct diagnosis which includes taking a full history of the patient in relation to the injury. These ligament injuries are not seen on X-rays so an MRI scan would be needed to see the soft tissue damage.

Mild injuries

If the injury is mild then it will be treated conservatively with rest, ice, splinting the wrist followed by physiotherapy. If however, the injury is more severe then an arthroscopic evaluation of the wrist would be required which is an operation to examine exactly what the damage to the wrist is.

Keyhole surgery is done and a very small camera is inserted into the back of the wrist to image the ligaments and examine the injury. These ligaments can then be tightened up and repaired with the minimum of invasive surgery.

Severe injuries

If there is a total disruption or tear of the ligaments then it may not be possible to repair them with keyhole surgery. Occasionally one needs to undertake an open technique and sometimes us a piece of tendon to repair the damage.

This is a complex subject but modern surgical techniques enable high-level sportspeople to return to full fitness in the minimum of time.


References & further reading

  1. Lester B, Halbrecht J, Levy IM et al. ‘Press test’ for office diagnosis of triangular fibrocartilage complex tears of the wrist. Ann Plast Surg 1995;35(1):41–5.
  2. Rettig AC. Athletic injuries of the wrist and hand. Part I: traumatic injuries of the wrist. Am J Sports Med 2003;31(6):1038–48.
This article has been written with reference to the bibliography.

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