The Triangular Fibrocartilage Complex (TFCC) is a small but vital tissue in the wrist that provides support between the forearm bone (ulna) and the hand bones on the little finger side. It connects the two forearm bones (radius and ulna) and attaches to various ligaments and tendons within the wrist, making it essential for maintaining wrist stability.
Relevant TFCC wrist anatomy
The Triangular Fibrocartilage Complex (TFCC) consists mainly of a central disc that connects the two forearm bones (the radius and ulna) on the little finger side of the wrist. It also connects to different small bones, ligaments, and tendons within the wrist, thus playing an important role in wrist joint stability and mechanical movements, specifically supination (palm-up rotation) and pronation (palm-down rotation). The TFCC facilitates the transfer of forces between the hand and forearm bones.
What are the causes of Triangular Fibrocartilage Complex (TFCC) tear?
A direct fall on the hand is the most common cause of a Triangular Fibrocartilage (TFCC) tear. Certain sports such as boxing, weight training, and racquet sports like tennis can also put extra stress on the TFCC due to forceful wrist rotation, potentially resulting in a ligament tear. In many cases, the cause of the TFCC tear may not be clear.
How to tell if I have a Triangular Fibrocartilage (TFCC) tear?
The symptoms of TFCC tear include:
Pain and swelling on the little finger side of the wrist.
The pain typically gets worse when bending or rotating your wrist. Activities that put extra stress on the wrist, like weightlifting or press-ups, can also worsen the pain.
The pain can be associated with uncomfortable clicking on wrist movements. What conditions can simulate a triangular fibrocartilage complex (TFCC) tear?
What other conditions can cause ulnar-sided wrist pain?
Various conditions can resemble a triangular fibrocartilage complex (TFCC) tear. These include:
Thumb osteoarthritis, De Quervain's Tenosynovitis and Scapholunate ligament injury. These conditions would cause pain at the thumb side of the wrist and should not be mistaken for a TFCC tear.
Carpal Tunnel Syndrome. This refers to pressure on the median nerve within the carpal tunnel. It is often associated with numbness and sometimes weakness in the fingers.
Wrist osteoarthritis: The pain here tends to be generalised, involving the entire wrist joint and may be associated with wrist swelling and stiffness. while in TFCC tears, the pain is more localised to the little finger side of the wrist and can be associated with clicking, particularly on rotational wrist movements.
How to diagnose triangular fibrocartilage complex (TFCC) tear?
After clinical assessment by a hand specialist, a wrist MRI examination is required to confirm the diagnosis and rule out other causes of wrist pain. An MRI (Magnetic Resonance Imaging) is a special scan that uses a big magnet and radio waves to produce detailed images of the imaged body part. An MRI scan would require you to stay still for approx. The images are taken for 20-30 minutes inside the machine's tunnel. It can be slightly noisy inside the machine; therefore, headphones (usually with some music) will be used. The technician will see you before the scan to ensure you have no metallic objects before entering the scanner. This can be dangerous as the scanner has a strong magnet, and any small metallic object can become a projectile.
How to treat a TFCC tear?
The TFCC is a complicated structure that links different tendons and ligaments. TFCC tears can vary in degree and configuration, affecting some or all parts. As a result, some tears may be minor and stable, whereas others can be more severe, leading to wrist instability. Treatment for TFCC tears varies based on the extent of the injury.
Typically, management begins with conservative treatment for wrist injuries. This involves physiotherapy, using a wrist splint for support, and resting the joint for about six weeks to aid healing.
An ultrasound-guided steroid injection may sometimes be recommended to relieve pain and reduce discomfort while undergoing wrist-strengthening exercises. Ultimately, wrist Key-hole surgery may be necessary to repair large unstable tears.
