Triangular Fibrocartilage Complex Tears

What is a TFCC tear?

The triangular fibrocartilage complex (TFCC) helps stabilize your wrist. Your TFCC consists of ligaments and cartilage. It attaches your forearm bones (ulna and radius) to each other and to the small bones of your wrist. Your TFCC helps stabilize, support, and cushion your wrist.

You can rotate your wrist and grip objects tightly thanks to your TFCC. When you tear your TFCC, your wrist joint may feel weaker and less stable.

How common are TFCC tears?

This small but complex structure can tear easily as a result of a sudden impact or twisting injury. TFCC tears also happen more often in older adults, as the tissues that make up your TFCC break down and become thinner with age. This degeneration leaves your TFCC more vulnerable to tears. These are also common injuries in athletes.

What causes a TFCC tear?

• Injury: The force of falling on your hand or wrist can tear your TFCC. A fall or other injury that fractures your radius can also tear your TFCC. A sudden twist of your arm that over-rotates your wrist can also cause a TFCC tear. Sometimes use of powerdrills or similar rotational instruments can result in a TFCC injury.
•  Degeneration: Like all tendons and ligaments in your body, your TFCC wears down and gets thinner with age. Thinner tissues are more likely to tear. These chronic TFCC tears often occur gradually over time. Repetitive motions (such as swinging a bat or racket) can also break down tissues that make up the TFCC, leading to tears.

What are the symptoms of a TFCC tear?

In many cases, chronic or degenerative TFCC tears don’t cause pain or other symptoms. If you tear your TFCC as the result of an acute injury, you may have symptoms such as:

•  Sounds, like “clicks” or “pops”, when you rotate your wrist or forearm.
•  Difficulty rotating your wrist.
•  Pain on the side of your wrist nearest the small/pinky finger.
•  Reduced ability to grip objects tightly.
•  Wrist weakness.

What are the complications of a TFCC tear?

A minor TFCC tear may heal on its own. However, a more severe TFCC tear can lead to a weak or unstable wrist.

Diagnosis and Tests

How is a TFCC tear diagnosed?

Your healthcare provider will ask about your medical history and ask how and when your wrist pain started. They'll also perform a physical exam. They'll press on different areas of your wrist to assess your range of motion and strength.

Your provider may also recommend imaging tests — such as X-rays or MRI— to look for fractures or soft tissue tears.

Management and Treatment

How is a TFCC tear treated?

Minor TFCC tears often heal without treatment. If you don’t have pain or weakness in your wrist, your provider may recommend letting the tear heal on its own through conservative management.

Some TFCC tears cause symptoms and interfere with your ability to perform daily activities. In these cases, your provider may recommend treatment. Options include:

•  Medication: Anti-inflammatory medications (such as NSAIDs) can help reduce swelling and relieve pain.
•  Bracing: Keeping your forearm and wrist stable with a brace can allow your TFCC to heal.
•  Injections: Though less commonly performed, a corticosteroid injection can help reduce the swelling of torn tissue.
•  Physical or occupational therapy: Exercises can strengthen the muscles in your wrist and forearm to prevent further injury.
•  Surgery: If more conservative treatments don’t provide relief, your provider may recommend surgery. In most cases, minimally invasive can repair TFCC tears.

Prevention

How can I prevent a TFCC tear?

You can’t always prevent an accident that tears your TFCC. But you can take steps to lessen your risk of a TFCC tear:

•  Do warmup exercises before a sport or activity that involves twisting your arm or wrist (like playing tennis or baseball).
•  Strengthen your wrist and forearm muscles.
•  Watch your footing while walking to prevent falls.

Outlook/Prognosis

What is the prognosis (outlook) for people with a TFCC tear?

Most minor TFCC tears can heal on their own with rest and therapy, though can take a prolonged period of time (6 months). Surgery can repair more severe tears if indicated. Most people with TFCC tears regain most function within 12 weeks of surgery.

When should I call the doctor?

You should call your healthcare provider if you experience:

•  Difficulty rotating your wrist.
•  Pain on the pinky/small-finger side of your wrist.
•  Popping or clicking when you rotate your wrist.
•  Swelling.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

•  Will I need surgery to repair my torn TFCC?
•  How long will it take for my TFCC tear to heal?
•  What activities are safe while I’m healing?
•  How can I minimize my risk of future wrist injuries?