Triangular Fibrocartilage Complex (TFCC) Tear

The triangular fibrocartilage complex (TFCC) is an essential structure on the ulnar part of the wrist, consisting of tendons, ligaments, and cartilage. These components function together to support wrist stability and facilitate smooth rotational motion, especially during activities requiring twisting or gripping.

TFCC tears typically occur due to a fall on an outstretched hand and are classified as a type of wrist sprain. These injuries can lead to significant pain during wrist movements and loss of the forearm’s ability to rotate properly.

Symptoms

TFCC tears can manifest through various symptoms, such as:

• Pain: Usually felt on the wrist’s ulnar side, particularly during twisting or turning motions.
• Swelling: Inflammation in the affected area may restrict comfortable wrist movement.
• Weakness: Reduced grip strength or a sense of instability, especially when bearing weight.
• Clicking or popping: A clicking or popping feeling, often occurring during wrist rotation.
• Loss of range of motion: Difficulty moving the wrist in particular directions because of discomfort or stiffness.

Causes and Risk Factors

TFCC tears can develop due to various factors, including:

• Trauma: The most common TFCC injury is falling on an outstretched hand, particularly when the wrist is extended. This impact can result in a sharp, sudden pain on the wrist’s ulnar side.
• Repeated motion: Engaging in activities that require repeated wrist movements—such as gymnastics, racquet sports, or manual labor—can gradually wear down the TFCC, eventually leading to degeneration.
• Degenerative changes: The TFCC may weaken due to wear and tear over time. This causes thinning of the cartilage and reduced ligament strength, making it more vulnerable to injury.
• Rheumatoid arthritis: Inflammatory disorders like rheumatoid arthritis can contribute to TFCC weakening, increasing the likelihood of tears or injuries.
• Ulnar variance: Individuals with a longer ulna than the radius (positive ulnar variance) may experience heightened pressure on the TFCC. This elevates the risk of injury or tear.

Diagnosis

Medical professionals at The Joint Pain Clinic will evaluate the wrist’s range of motion, tenderness, and swelling during TFCC tear diagnosis. They might also carry out particular movements like the ulnar grind test, which involves rotating the wrist while applying pressure to the TFCC region.

A TFCC damage may be indicated by pain or clicking during this examination. If necessary, patients may need to have diagnostic testing done.

Treatment Option

Our clinic usually addresses triangular fibrocartilage complex tears through conservative and surgical methods.

Common non-surgical options include:

• Rest
• Cast or splint immobilization
• Physiotherapy

In case these approaches are ineffective, then surgery will be required. The two surgical procedures used to correct TFCC tear include:

Arthroscopic TFCC repair

This minimally invasive technique involves making two to three tiny, 5 mm wrist incisions. When necessary, additional surgical tools are inserted along with a thin viewing device known as an arthroscope. The extent of the ligament and cartilage damage determines the repair.

Minor tears and injuries in the cartilage are fixed through debriding or removing damaged or dead tissues. Tears are occasionally stitched and reconnected. Screws, sutures, and wires are used to reattach ruptured ligaments in order to stabilize the area until it heals fully.

Open TFCC repair

This procedure is ideal for complex TFCC tears. A wider incision is created below the wrist to improve access and visualization of the injury site. The injury to the cartilage and ligaments provides the basis for repair. Wires can be used to support bone joints and reconnect ligaments. Shortening the ulna (the forearm bone that joins to the wrist) reduces the stress on the TFCC side of the wrist in chronic and degenerative damage.