tfcc

Explore what a TFCC tear is and how it is treated

Explore what a TFCC tear is and how it is treated

The Triangular Fibro Cartilage Complex, or TFCC, is an important structure in the wrist. The TFCC is made of tough fibrous tissue and cartilage. This tissue supports the joints between the end of the forearm bones (radius and ulna), adding to their stability. The TFCC also helps connect the forearm with the small bones in the ulnar side (“pinkie finger” side) of the wrist. There are several different tissues that form the TFCC, and they blend together to stabilize the ulnar side of the wrist. Sustaining an injury or tear to this area can cause pain along the outside of the wrist and limit its range of motion.

The TFCC stabilizes and cushions the wrist, particularly when a person rotates their hand or grasps something with it. Due to its structural complexity, the TFCC is vulnerable to damage, and injuries are common. The TFCC also acts as a cushion between the end of the ulna and small bones. In patients whose ulna is longer than the radius at the wrist, the TFCC is usually thinner and more likely to tear.

Causes

The TFCC connects the bones in the hand to the bones in the forearm to form the wrist. It plays an important role in:

  • moving the wrist
  • rotating the forearm
  • supporting the forearm when the palm is gripping an object

A TFCC tear is any injury or damage to the TFCC. A TFCC tear can happen in two different locations and is usually caused by different problems. The first type of TFCC tear is due to natural wear, and the other is usually from injury. Tears due to wear are the most common and are usually not seen in younger people. They become more common as one gets older.

Tears from injury can come from:

  • A fall on the hand or wrist
  • A twisting injury (like a drill bit catching, causing a twist of the arm)
  • A fracture at the end of the radius

Accurate classification of a TFCC tear is important for guiding treatment decisions.

Symptoms

TFCC tears commonly cause pain along the outside of the wrist. Other symptoms can include:

  • stiffness or weakness in the wrist
  • pain when touching or moving the wrist
  • a limited range of motion in the hand or wrist
  • wrist swelling
  • a clicking or popping sound when moving the wrist

Causes and risk factors

Playing certain sports, such as tennis, increases the chance of injuring the wrists.

The wrist is one of the most complex joints in the body. This makes it prone to sprains and injuries. TFCC tears can occur due to physical injuries, excessive use, or the aging process.

Factors that can increase a person’s risk of developing a TFCC tear include:

  • Age. TFCC tears are more common as a person gets older. This may be due to natural wear and tear, or because the body becomes less able to repair damage to the TFCC.
  • Chronic inflammation. Inflammatory conditions such as rheumatoid arthritis and gout can damage the wrist over time. A small retrospective study found that 38.9 percent of people with severe rheumatoid arthritis developed TFCC tears.
  • Playing sports. People who play sports such as baseball, football, or tennis have a higher risk of injuring their wrists. Research suggests that around 25 percent of sports injuries affect the hand or wrist.

Diagnosis

To diagnose a TFCC tear, a doctor will usually begin by asking the person about their symptoms and medical history. They may then perform a physical examination of the wrist area.

During the physical exam, the doctor may:

  • Carefully apply pressure to the outer edge of the wrist to isolate the source of the pain.
  • Rotate the wrist.
  • Gently move the ulna up and down.

To help the doctor confirm their diagnosis, they may order an X-ray and MRI. These tests create an image of the inside of the wrist.

These images help healthcare professionals check for fractured bones and assess the severity of the tear.

Treatment

Treatment options for TFCC tears depend on the type, cause, and extent of the damage.

In many cases, a TFCC tear will heal on its own. However, a person will need to avoid using the affected wrist to prevent further injury and to allow it to heal properly.

A healthcare professional may also recommend wearing a splint, brace, or cast to protect and immobilize the wrist. They may also prescribe pain medications, such as ibuprofen or steroid injections, to help reduce pain and swelling.

Physical therapy can also be beneficial for some people with TFCC tears. A physical therapist will guide the person through some gentle stretches, exercises, and activity adjustments for the injured wrist that aim to:

  • reduce pain and swelling
  • improve flexibility and range of motion
  • increase strength

For people with severe or persistent TFCC tears, a doctor may recommend surgery. One surgical option is a type of minimally invasive procedure called an arthroscopy. During an arthroscopy, a surgeon will make a number of small incisions on the outer edge of the wrist, which allows them to repair the damage to the TFCC. Sometimes, they may also shorten the ulna to alleviate symptoms.

The wrist must remain immobilized for up to 6 weeks following surgery.

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Recovery

Recovery time for a TFCC tear depends on the type, severity, and treatment of the injury. Case studies suggests that TFCC tears that do not require surgery can take up to 12 weeks to fully heal. Following surgery, it may take around 3 months heal completely.

Exercises

Picking up and gently squeezing a tennis ball can help restore mobility and strength to the wrist following injury.

Doing some gentle exercises can help restore mobility and strength to the wrist following the tear. Exercises can include:

  • bending the wrist forward and backward
  • rotating the wrist while keeping the forearm straight
  • rotating the forearm by bending the arm at the elbow and extending the forearm, wrist, and hand in a straight line, then rotating the entire forearm from a palm-up position to a palm-down position, and then back again
  • picking up and gently squeezing a tennis ball

Summary

TFCC tears are often painful and can affect a person’s ability to use their hand or wrist. They can result from sports injuries, overuse of the wrist, and inflammatory conditions such as rheumatoid arthritis. TFCC tears are also more common in older people.

TFCC tears often get better without treatment, but a person will need to avoid using their wrist while the injury heals. For severe or persistent tears, a doctor may recommend surgery or physical therapy.

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