What is triangular fibrocartilage complex (TFCC) Injuries

Triangular fibrocartilage complex (TFCC) injuries of the wrist affect the ulna or little finger side of the wrist. Mild injuries of the triangular fibrocartilage complex may be referred to as a wrist sprain. The soft tissues work together to stabilise the very mobile wrist joint. Disruption of this area through injury or degeneration can cause more than just a wrist sprain. A TFCC injury can be a very disabling wrist condition.

Anatomy

The TFCC suspends the ends of the radius and ulna bones over the wrist. It is triangular in shape and made up of several ligaments and cartilage. The TFCC makes it possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side).

There is a small cartilage pad called the articular disc in the centre of the complex that cushions this part of the wrist joint.

Why do I have this condition?

The triangular fibrocartilage complex (TFCC) stabilises the wrist at the distal radioulnar joint. It also acts as a focal point for force transmitted across the wrist to the ulnar side. Traumatic injury or a fall onto an outstretched hand is the most common mechanism of injury. The hand is usually in a palm down position. Tearing or rupture of the TFCC occurs when there is enough force through the ulnar side of the hyperextended wrist to overcome the tensile strength of this structure. 

Athletes such as tennis players or gymnasts are at greatest risk for TFCC injuries. TFCC injuries in children and adolescents occur more often after an ulnar styloid fracture that doesn’t heal. Power drill injuries can also cause triangular fibrocartilage complex rupture when the drill binds and the wrist rotates instead of the drill bit.TFCC injuries can also occur with degenerative changes. Degeneration of the TFCC structure increases in frequency and severity as we get older. Thinning of these soft tissue structures can result in a TFCC tear with minor force or minimal trauma.

What may this condition feel like?

• Wrist pain along the ulnar (little finger) side is the main symptom. Some patients report diffuse pain.  This means the pain is throughout the entire wrist area. It can’t be pinpointed to one area.
• The pain is made worse by any activity or position that requires forearm rotation and movement in the ulnar direction. This includes simple activities like turning a doorknob or key in the door, using a can opener, or lifting a heavy pan or gallon of milk with one hand.
• Other symptoms include swelling; clicking, snapping, or crackling called crepitus; and weakness. Some patients report a feeling of instability – like the wrist is going to 
• give out on them. You may feel as if something is catching inside the joint. There is usually tenderness along the ulnar side of the wrist.
• If a fracture of the wrist is present along with soft tissue instability, then forearm rotation may be limited. The direction of limitation (palm up or palm down) depends on which direction the ulna dislocates.

Diagnosis

Our Osteopath’s rely on the history (how, when, and what happened), symptoms, and physical examination to make the diagnosis. Tests of joint stability can be conducted. Special tests such as stress testing of the wrist radioulnar and ulnocarpal joints help define specific areas of injury.

An accurate diagnosis and grading of the injury (degree of severity) is important. Usually, the grade is based on how much disruption of the ligament has occurred (minimal, partial, or complete tear). There are two basic grades of triangular fibrocartilage complex injuries

Type 1 – tears are caused by trauma or injury. For example, falling and landing on an outstretched hand.

Type 2 – tears are caused by breakdown of the cartilage in your TFCC over a prolonged period of time, commonly due ageing and inflammatory arthritic conditions.  

Treatment

What treatment options are available?

• Osteopathic manipulative treatment techniques of the joints and soft tissue structures help to restore their range of motion, reduce inflammation and pain.
• Strengthening exercises for the arm and hand help steady the hand and protect the wrist joint from shock and stress. Strengthening improves joint stability and prevents deformity and/or dislocation.
• Dry needling to encourage healing and reduce pain
• Taping to support and stabilise the injured site whilst its healing
• Surgery is generally needed for those tears that don’t heal or respond to the conservative treatment. Some tears can be “fixed”, simply by “debriding” or cleaning the torn edges and damaged tissue off. Other tears can be directly repaired using sutures. Following surgery, recovery is usually about 6 weeks in a cast to keep your wrist from moving. Once your cast is removed, manual therapy and rehab is required to help regain previous wrist strength and function.