What is the triangular fibrocartilage complex (TFCC) of the wrist?
The TFCC is made up of ligaments, tendons and cartilage. It connects the bones in the forearm (the radius and ulna) with the bones in the wrist and helps to stabilise, support and cushion the wrist.
What causes a TFCC injury or tear?
There are two main causes of TFCC injuries/tears:
- Acute injuries such as falling on the hand or wrist, a sudden twisting injury that over-rotates the wrist, as well as a fall or injury that fractures the end of your forearm bones (radius and/or ulna bones).
- Chronic degeneration with age results in the TFCC wearing down and becoming thinner, increasing the risk of developing tears over time.
How common is a TFCC injury?
The TFCC is one of the most commonly injured structures in the wrist, with research studies suggesting that its prevalence increases with age. One study found a 49% prevalence of TFCC injuries in the elderly population and a prevalence of 27% in individuals aged 30 or younger.
How do I know if I have a TFCC injury?
Signs and symptoms of a TFCC injury may include:
- Clicking or popping sounds or sensations in the wrist when you rotate your wrist or forearm
- Pain over the little finger side of your wrist
- Weakness in the wrist
- Reduced ability to grip objects tightly
- Limited motion in your wrist
How are TFCC injuries diagnosed?
Your specialist Doctor will obtain your health history and perform a physical examination. Your Doctor may also order radiological investigations (e.g. X-rays, MRI scans) to look for fractures or ligament tears.
How are TFCC injuries treated?
TFCC injuries can be treated both surgically and non-surgically, depending on the severity of the injury.
Mild TFCC injuries/tears which do not affect the stability of the wrist joint may be treated non-surgically by a cast or splint. The cast or splint helps to keep the wrist and forearm stable while the TFCC heals and needs to be worn for 2 to 6 weeks, depending on the severity of the injury/tear. Once your specialist Doctor ascertains that the wrist joint is stable and the TFCC is healing adequately, your Doctor will refer you to our Hand Therapist to start wrist and forearm exercises. Your specialist Doctor may also prescribe anti-inflammatory medication and/or corticosteroid injections to help reduce pain and inflammation over the injured site.
For cases where the TFCC tear is more severe with an unstable wrist joint, or if non-surgical treatment fails to provide relief, your specialist Doctor may recommend that you undergo surgery to repair the TFCC tear. After surgery, your specialist Doctor may refer you to our Hand Therapist for a customised splint to immobilise your wrist and forearm for at least 4 to 6 weeks in order to protect the TFCC repair while it heals. When your Doctor ascertains that the wrist joint is stable and the TFCC is healing adequately, your Doctor will advise you to start Hand Therapy.
Joint stiffness, weakness and loss of function of the wrist and forearm are common problems in the early stages of recovery from a TFCC injury. As such, daily activities such as self-care (e.g. dressing, showering, brushing of teeth), work activities and leisure pursuits (e.g. cycling, tennis, gym activities, yoga) are often affected. Hand therapy plays a pivotal role in the recovery of upper limb movement, strength and function after a TFCC injury. Most TFCC injuries take around 4 to 5 months to heal before you are able to return to your normal daily activities, and full recovery from these injuries can take up to a year.
If you require protective immobilisation for your TFCC injury/tear, your specialist Doctor may refer you to our Hand Therapist for a customised splint. Once you are able to start therapy for your wrist and forearm, our Hand Therapist can then help you in your recovery through treatment options such as:
- Advice and education pertaining to your condition
- Wax therapy
- Ultrasound therapy
- Exercises to improve wrist/forearm joint and muscle movements
- Management of swelling
- Scar management
- Strengthening exercises
- Soft tissue mobilisation and release
- Pain relief/management
- Functional retraining of the wrist and forearm
- Personalised home exercise program