The triangular fibrocartilage complex (TFCC) is a network of ligaments, tendons, and cartilage that sits between the ulna and radius bones on the small finger side of the wrist.
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.
In this article, we discuss the symptoms, causes, diagnosis, and treatment of TFCC tears. We also cover estimated recovery time and some rehabilitation exercises.
What is TFCC tear?
The TFCC connects the bones in the hand and forearm, forming the wrist.
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. There are two types of TFCC tear:
- Type 1. These tears result from physical injury, such as when a person overextends or over-rotates their wrist, or when they fall on their hand with it extended.
- Type 2. Also called chronic tears, these occur gradually and can result from damage due to aging or an underlying condition, such as gout or rheumatoid arthritis.
Accurate classification of a TFCC tear is important for guiding treatment decisions.
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.
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 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.
Recovery time for a TFCC tear depends on the type, severity, and treatment of the injury.
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 a TFCC 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
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.