Understanding the Causes and Treatments of TFCC Tears

What is a TFCC?

The triangular fibrocartilage complex (TFCC), more popularly known as the wrist meniscus; is a kind of shock absorber for some of the joints in your wrist. The TFCC is made up of numerous ligaments. It acts as a cushion at the top of the ulna and stops the ulna and radius from being separated along with the dorsal and palmar radioulnar ligaments (RUL). This complex also comprises the Ulnar collateral ligaments (UCLs) which are composed of the ulnotriquetral ligament, the ulnolunate ligament, and the extensor carpi ulnaris (ECU). It is evident that the TFCC is quite intricate.

What does the TFCC do?

The TFCC is the main stabilizer of the wrist. It supports the wrist with grip, weight-bearing, and rotation (supination and pronation). It keeps the radius and ulna (distal radioulnar joint) from painfully spreading apart. The radius supports 80%, and the ulna supports 20% of axial load. The colored sections in the animation represent the components of the TFCC.

What causes a TFCC tear?

The TFCC can tear with rotational movements (hyper rotation while using a drill), excessive weight bearing, a fall on an outstretched hand (palm down), etc. It can also be caused by a traumatic injury, such as a direct blow to the wrist.

TFCC tears can be accompanied by wrist pain, swelling, and tenderness in the wrist. This can also lead to a decrease in grip strength, difficulty with certain activities, and a clicking or popping sensation in the wrist. In some cases, a TFCC tear can also cause the joint to give way, making it difficult to move the wrist.

Age

According to Market Research, TFCC tears were present in nearly 50% of the over 65 aged population. On the other end of the spectrum, 27% of patients presented for wrist injuries age 30 or younger had TFCC tears.

Chronic inflammation

A small retrospective study found that 38.9% of people with severe rheumatoid arthritis developed TFCC tears.

 

What are the symptoms of a TFCC tear?

Some common signs and symptoms of a TFCC tear are:

Pain, localized to the ulnar (pinky) side of the wrist;

Pain that gets worse with simple gripping and rotation movements (opening a door or using a can opener).

It normally does not swell.

Clicking, snapping, or crackling (crepitus) These are not present in all patients with TFCC tears.

Pain weight-bearing activities;

Feeling of instability.

TFCC tears don’t cause loss of motion or swell. However, a fracture or other injury can accompany a TFCC tear if there is swelling.

TFCC tears don’t cause loss of motion or swell.  However, a fracture or other injury can accompany a TFCC tear if there is swelling. 

How is a TFCC tear diagnosed?

A TFCC definitive diagnosis takes the history, mechanism of injury, and imaging into consideration. MRIs are helpful but not always accurate.

Xrays can NOT define TFCC tears well. They are important to rule out any other injuries that cause ulnar sided wrist pain.

It is recommended to consult your physician to get a referral to a hand specialist (depending on your location this may take 1-3 weeks!). Seeing a doctor who specializes in the hand can save you a lot of time and effort.

How are TFCC tears treated?

After receiving a TFCC tear diagnosis, common nonsurgical treatment suggestions often include:

Splints (casting or other removable splints)

Activity changes (such as rest)

Anti-inflammatory medicine

Injections

Physical therapy

Ice and heat

The WristWidget® TFCC protocol

After opening her practice in 2000, Wendy noticed an increase in TFCC injuries and realized that there wasn’t an easy, accurate, and 100% reliable test presence of a TFCC tear. This variable and difficulty in diagnosing a TFCC tear inspired her to create an objective and reliable test that anyone can perform at home using an inexpensive non-digital scale.

This is a priceless tool to assess the wrist when suspecting tfcc tears. It is actually the most accurate way to determine TFCC damage and is called the Weight Bearing Test. It measures the wrist's ability to press upon the scale.

Surgery often yields disappointing results and extended recovery times; thick, hard, uncomfortable braces turn sports and everyday tasks into painful obstacles. The good news! TFCC tears will heal without surgery when the treatment protocol is followed.

Wendy Medeiros, OTR, CHT. Wendy’s 25+ years experience as an Occupational Therapist and Certified Hand Therapist has given her great insight into this injury.

 

 

Case Review

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 TFCC injuries heal without surgery 

Read a great white paper about the use of WristWidgets® as a non-surgical alternative to repairing TFCC tears:

CASE REPORT:  A Non-surgical Intervention for Triangular Fibrocartilage Complex Tears