A TFCC tear is an injury that is near and dear to my heart. This is mostly because I have been dealing with my tear for more than a decade. I injured my right TFCC doing arm balances in yoga class. I never considered surgery and but rehabbed instead. Today I really don’t notice my wrist and it does not affect my daily life. I continue to do exercises and use other strategies to maintain my wrist health. A TFCC tear is a difficult injury, but it can be treated. Read on, to learn more about this injury. Let’s start with anatomy.
The wrist
The wrist is made up of 3 joints. These include the distal radioulnar joint, radiocarpal joint, and the mid carpal joint. The distal radioulnar joint is made up of the ends of the forearm bones, the radius and ulna, at the wrist. This joint is essential for supination and pronation. Pronation is rotating the forearm, so the palm faces downward, and supination is forearm rotation where the palm faces upward.
The radiocarpal joint is made up of the radius and the first row of carpals. Carpals are the small wrist bones in between the forearm bones and the hand bones. The first row of carpals includes the scaphoid, lunate, and triquetrum. The pisiform is also in this row of carpals, but it is not part of the joint. It sits on top of the triquetrum. This joint is the dominant joint for wrist extension. It assists in wrist flexion, radial deviation, and ulnar deviation.
Wrist extension is when the back of the hand moves toward the back of the forearm. Wrist flexion is when the palm of the hand moves toward the forearm. Radial deviation is when the hand moves to the thumb side. Ulnar deviation is when the hand moves towards the little finger side.
The mid carpal joint is the joint made up of the first and second row of carpals. The second row of carpals include the trapezium, trapezoid, capitate, and the hamate. This joint assists in wrist extension and ulnar deviation. It is the dominant joint for the motions of wrist flexion and radial deviation.
What is the triangular fibrocartilage complex?
The triagular fibrocartilage complex (TFCC) is a triangular-shaped ligamentous structure. It is located on the little finger side of the wrist. The TFCC stabilizes the wrist bones and attaches the ulna and radius together at the wrist.
What is a TFCC tear?
A TFCC tear is an injury to one or more of the ligaments that make up the TFCC. Since it is a tear of a ligament, then it would be considered a sprain. This injury can happen with a sudden trauma such as using your hand to break a fall. It can also occur from repetitive compression such as using your hands to support your body weight in gymnastics.
TFCC tears often occur in racquet sports, as well, because of the stress placed on the little finger side of the wrist when swinging. The TFCC can also have degenerative tears. This a wear and tear injury that develops over time and occurs with aging. TFCC tears are more common on the dominant hand.
What are the symptoms of a TFCC tear?
There are several symptoms associated with a TFCC tear. These include:
- Wrist pain on the little finger side
- Difficulty gripping
- Feelings of instability in the wrist
- Clicking or catching in the wrist
- Pain when leaning on or weight bearing on the hand
- Swelling and stiffness in the wrist
- Difficulty and pain when lifting heavy objects
Will I need surgery?
Most TFCC tears can be rehabilitated with proper physical therapy. However, if your wrist is not responding to conservative treatment after 6 months, then surgery is an option. Surgery is also an option if there is significant instability in the distal radioulnar joint.
Who should I see?
- Physical therapy – Physical therapy can help decrease pain and inflammation with techniques including manual therapy and dry needling. PT can evaluate and address abnormal joint mobility, instability, muscle weakness, and muscle tone. Your PT can help you activate other muscles to decrease the load on the wrist. They can assess your posture and form during work or sports to prevent exacerbation of the injury.
- Orthopedic physician – An orthopedist might be necessary if the condition is not responding to physical therapy. Your physician can prescribe medication, give an injection, or order testing/imaging if needed. Surgery is an option if all conservative measures fail or if significant instability is present.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to a TFCC. Basically, stay away from the activities that are causing pain. This gives the area time to heal. If you keep doing what is causing the injury, it is not going to get better. This might include not participating in your sport or changing how you perform a task or job. If you are not able to participate in your activity or sport, then you can supplement with non-irritating activities such as biking, walking, or jogging while your condition is being treated.
- Ice – Ice can help decrease pain and symptoms at the wrist. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Wrist brace – A wrist brace is essential to wear after the tear to allow the area to calm down. It should be worn for 3 to 6 weeks. I wear a more supportive wrist splint at night to decrease the chance of irritation to the wrist while I sleep. This is important if, like me, you have hypermobile wrists which end up in all kinds of terrible positions while you sleep.
- Wrist strengthening – It is important to strengthen the wrist as well. You will want the pain to subside before beginning wrist strengthening. Below is a video showing how to strengthen the wrist using resistance bands.
- Strengthening the muscles around the elbow and shoulder – Strengthening the muscles around the elbow and shoulder are also important in being able to return to your activity. Decrease your resistance or number of repetitions if you are having pain in the wrists. Using loop resistance bands, dumbbells, or resistance bands can increase strength and difficulty. See the videos below.
In review
- The wrist is made up of 3 joints.
- These include the distal radioulnar joint, radiocarpal joint, and the mid carpal joint.
- The triagular fibrocartilage complex (TFCC) is a triangular-shaped ligamentous structure.
- The TFCC stabilizes the wrist bones and attaches the ulna and radius together at the wrist.
- A TFCC tear is an injury to one or more of the ligaments that make up the TFCC.
- A TFCC tear can be traumatic or from wear and tear.
- Symptoms include pain at the wrist, clicking, catching, and difficulty gripping.
- Most will recover with physical therapy and will not need surgery.
- There are things that you can do.
- Relative rest
- Ice
- Wrist brace/splint
- Wrist strengthening
- Elbow and shoulder strengthening
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.choosept.com/guide/physical-therapy-guide-triangular-fibrocartilage-complex-tear
https://www.physio-pedia.com/Triangular_Fibrocartilage_Complex_Injuries