Understanding the Causes and Treatments of TFCC Tears

What is a TFCC?

The triangular fibrocartilage complex (TFCC), often called the wrist meniscus, is a shock absorber for wrist joints. It’s a complex structure made up of multiple ligaments.

  • Components:
    • Cushion at the top of the ulna
    • Dorsal and palmar radioulnar ligaments (RUL) to prevent ulna-radius separation
    • Ulnar collateral ligaments (UCLs):
      • Ulnotriquetral ligament
      • Ulnolunate ligament
      • Extensor carpi ulnaris (ECU)

What does the TFCC do?

The TFCC is the wrist’s main stabilizer.

  • Functions:
    • Supports grip, weight-bearing, and rotation (supination/pronation)
    • Keeps radius and ulna (distal radioulnar joint) from painfully spreading apart
  • Load Distribution:
    • Radius: 80% of axial load
    • Ulna: 20% of axial load

Note: Colored sections in the animation represent TFCC components.

What causes a TFCC tear?

TFCC tears result from various stressors or injuries.

  • Common Causes:
    • Rotational movements (e.g., hyper-rotation with a drill)
    • Excessive weight-bearing
    • Fall on an outstretched hand (palm down)
    • Traumatic injury (e.g., direct blow to the wrist)
  • Risk Factors:
    • Age:
      • ~50% of people over 65 have TFCC tears (Market Research)
      • 27% of wrist injury patients ≤30 years old have TFCC tears
    • Chronic Inflammation:
      • 38.9% of severe rheumatoid arthritis cases develop TFCC tears (small retrospective study)
  • Associated Effects:
    • Wrist pain, swelling, tenderness
    • Decreased grip strength
    • Difficulty with activities
    • Clicking/popping sensation
    • Joint instability

What are the symptoms of a TFCC tear?

  • Key Symptoms:
    • Pain on the ulnar (pinky) side of the wrist
    • Worse pain with gripping or rotation (e.g., opening a door, using a can opener)
    • Clicking, snapping, or crackling (crepitus—not in all cases)
    • Pain during weight-bearing activities
    • Feeling of instability

Notes: Typically no swelling or loss of motion. Swelling may indicate a fracture or additional injury.

How is a TFCC tear diagnosed?

Diagnosis combines multiple factors.

  • Diagnostic Process:
    • History and mechanism of injury
    • Imaging:
      • MRIs: Helpful but not always accurate
      • X-rays: Can’t define TFCC tears well; used to rule out other injuries

Recommendation: Consult a physician for a hand specialist referral (wait time: 1-3 weeks, depending on location).

How are TFCC tears treated?

Nonsurgical options are often the first step.

  • Common Treatments:
    • Splints (casting or removable)
    • Activity changes (e.g., rest)
    • Anti-inflammatory medicine
    • Injections
    • Physical therapy
    • Ice and heat

The WristWidget® TFCC Protocol

Wendy Medeiros, OTR, CHT, developed this approach after noticing rising TFCC injuries since 2000.

  • Background:
    • Lack of easy, accurate TFCC tests inspired an objective solution
  • Weight Bearing Test:
    • Uses an inexpensive non-digital scale
    • Measures wrist’s ability to press on the scale
    • Most accurate way to assess TFCC damage
  • Treatment Insight:
    • Surgery often has poor outcomes and long recovery
    • Hard braces make tasks painful
    • TFCC tears can heal without surgery if protocol is followed
  • Expertise:
    • Wendy’s 25+ years as an Occupational Therapist and Certified Hand Therapist

Additional Resources