Triangular fibrocartilage complex (TFCC) tears

What is a TFCC tear?

A TFCC tear is an injury to the triangular fibrocartilage complex, soft tissues in the wrist that cushion and support the carpal bones and help stabilize the forearm. Injuries range from mild to severe, but all can disable the wrist.

What causes a TFCC tear?

There are two types of TFCC tears: traumatic and degenerative. Traumatic tears typically result from falling on an outstretched hand, excessive arm rotation or a blow to the wrist. Athletes are at risk, especially those who use a racquet, bat or club or put pressure on the wrists.

Degenerative tears occur over time and with age as the cartilage wears down. Repetitive pronation and gripping can accelerate this condition. Tears can occur with minimal force or trauma.

A congenital condition called ulnar variance, in which the ulna is longer than the radius (the bones that make up the forearm), may predispose some people to a TFCC injury.

What are the symptoms?

Common symptoms of a TFCC tear include pain at the base of the wrist that worsens with movement, swelling, tenderness, loss of grip strength and a clicking sound in the wrist. In some cases, it may be difficult or impossible to rotate your forearm.

How is a TFCC tear diagnosed?

In addition to a patient history and physical exam, your doctor may order an X-ray or MRI to determine the severity of your injury and rule out other conditions, such as a fracture.

What is the treatment?

Mild to moderate TFCC tears respond well to non-surgical treatment, including rest, anti-inflammatory medication, corticosteroid injections and physical therapy. Patients often wear a splint or cast for several weeks to aid healing.

Severe tears, or those that fail to respond to conservative measures, may require surgery. Options include:

Arthroscopy. In this minimally invasive procedure, the surgeon makes several small incisions around the wrist joint and inserts a miniature camera (called an arthroscope) to examine the ligaments and assess the impairment. Tiny instruments are used to clean the torn edges and remove damaged tissue (called a debridement), or repair the injury. If ulnar variance is present, the surgeon may cut the ulnar bone down to an appropriate length. Arthroscopy allows a full view of the wrist without having to cut through nerves or muscles. Patients experience less pain and blood loss, fewer complications and a faster recovery.
Open surgery. If the TFCC tear is severe or involves multiple injuries, the surgeon may need to repair it with metal pins, screws or other fixation devices. This more extensive surgery requires an open incision. Open surgery may also be necessary to shorten the ulna.

Following either type of surgery, patients spend several weeks in a cast or splint. Rehabilitation with a Certified Hand Therapist is recommended to strengthen and stabilize the muscles around the wrist joint, and improve hand dexterity. Specific recovery time varies based on the severity of your injury and your overall health.