What is a TFCC Injury?
The triangular fibrocartilage complex (TFCC) is an area between your radius and ulna, the two main bones that make up your forearm. Your TFCC is made of several ligaments and tendons, as well as cartilage. It helps your wrist move and stabilises your forearm bones when you grasp something with your hand or rotate your forearm.
What are the symptoms?
The main symptom of a TFCC tear is pain along the outside of your wrist, though you might also feel pain throughout your entire wrist. The pain may be constant or only appear when you move your wrist or apply pressure to it.
Other symptoms of a TFCC tear include:
- a clicking or popping sound when you move your wrist
What causes a TFCC tear?
There are two types of TFCC tears, depending on the cause:
- Type 1 TFCC tears. These tears are caused by an injury. For example, falling and landing on an outstretched hand can damage the cartilage, tendons, or ligaments in your TFCC.
- Type 2 TFCC tears. These tears are caused by the slow breakdown of the cartilage in your TFCC, usually due to age or an underlying condition, such as rheumatoid arthritis or gout.
Athletes who regularly rotate or put pressure on their wrists, such as tennis players or gymnasts, have a higher risk of developing a TFCC tear. You’re also at a higher risk if you’ve previously injured your wrist.
TFCC tear test
TFCC tears are often diagnosed using the fovea test, also called the ulnar fovea sign. To do this, your doctor will apply pressure to the outside of your wrist and ask if you feel any pain or tenderness. They’ll do the same to your unaffected wrist for comparison.
You may also be asked to do a variety of wrist movements. These can include rotating your forearm or moving your hand away from your thumb.
Your doctor may also use an X-ray to make sure you don’t have any broken bones in your hand or forearm.
Confirming the Diagnosis
MRI scan helps diagnose a TFCC tear. Often the radiologist may suggest an MRI arthrogram, which is done after installing a fluid injury the wrist under local anesthesia. This helps in clearly delineating hidden tears. MRI arthrogram is done only in selected centres with an interventional musculoskeletal radiologist.
The first step in treating TFCC tears is to temporarily stop doing any activities that cause wrist pain while the tear heals. You may need to wear a splint or cast to prevent your wrist from moving. Your doctor will likely recommend about six weeks of physical therapy. This involves doing gentle exercises to help you rebuild strength in your TFCC. If resting your wrist and physical therapy don’t provide any relief, you may need surgery to repair the tear.
Surgery to treat a TFCC tear often involves minimally invasive arthroscopy. During this procedure, your doctor will repair the damaged part of your TFCC through a few small incisions around your wrist. In some cases, you may need traditional open surgery.
Following surgery, you’ll need to wear a cast to keep your wrist from moving, usually for about six weeks. Once your cast is removed, you may need physical therapy before your wrist regains its previous strength and function.
While you recover from a TFCC tear, there are several exercises you can do at home to help the healing process. These include:
- moving your wrist in a circular direction, both clockwise and counterclockwise
- stretching your wrist back toward your forearm, and then forward in the opposite direction
- flexing your wrist against a hard surface
- repeatedly gripping a tennis ball
To start, only do a few of these exercises at a time to avoid overexerting your wrist. If any of the movements cause severe pain, stop doing them. Your doctor can also go over safe home exercises based on your condition.
For TFCC tears that don’t require surgery, recovery usually takes about four to six weeks. If you do need surgery, it may take anywhere from six weeks to several months before you regain full use of your wrist. Doing physical therapy and avoiding any activities that strain your wrist can help to speed up your recovery time.