The TFCC refers to the Triangular Fibrocartilage Complex, a complicated structure that is located on the pinky side of the wrist. The TFCC acts as a stabiliser for the wrist joint and supports load transmission between the forearm and the wrist, especially during gripping or twisting movements. Injury to the TFCC can result in pain, clicking, instability, and difficulty with tasks like opening jars, turning door knobs, or pushing off from a chair.
How Does it Happen?
TFCC injuries can occur from either acute trauma or cumulative wear and tear.
Acute injuries often occur through:
- Falling on an outstretched hand
- Forceful wrist extension, ulnar deviation, or twisting motions
- High-impact scenarios
- Wrist fractures, particularly involving the distal radius, which may simultaneously tear the TFCC
Chronic or overuse injuries typically result from:
- Repetitive rotation or load-bearing through the wrist
- Heavy grip forces during swinging or impact movements
- Degenerative changes in the cartilage and ligaments, especially with age or repetitive strain
- Conditions like positive ulnar variance (where the ulna bone in the wrist is longer than the radius), which places additional pressure on the TFCC
Key Characteristics of a TFCC Injury
Symptoms may vary depending on the mechanism of injury and degree of damage. Common
symptoms include:
- Pain on the ulnar/pinky side of the wrist
- Clicking, catching, or popping with wrist or forearm movement
- Weakness or discomfort when gripping, lifting, or pushing
- Instability or a sense that the wrist is “giving way”
- Difficulty with forearm rotation (e.g., turning a key or screwdriver)
- Tenderness with touch over the TFCC area
Diagnosis
A combination of clinical assessment and imaging is often used to confirm TFCC injuries:
- A detailed assessment in addition to specific special tests for the wrist can help confirm or rule out a TFCC injury
- MRI is one of most accurate imaging tools for visualising the TFCC and identifying any pathology
Management of TFCC Injuries
Treatment depends on the severity, duration, and impact of symptoms. Many TFCC injuries respond well to non-surgical management.
Non-Surgical Options:
- Rest and activity modification – Avoiding aggravating activities such as gripping or twisting
- Splinting or bracing – To provide support and offload the wrist during early healing
- Physiotherapy – Focused on restoring wrist and forearm range, improving strength, and retraining movement control
Surgical Intervention:
Surgery may be considered if conservative treatment is unsuccessful or in the case of more complex tears. Common procedures include:
- Arthroscopic debridement – Removal of damaged tissue
- TFCC repair – Suturing the tear to restore structural integrity
- Ulnar shortening osteotomy – Performed if anatomical factors like ulnar variance are contributing to the injury
Post-surgical rehabilitation is critical for restoring movement and function and typically involves several weeks of immobilisation followed by guided physiotherapy.
Summary
TFCC injuries can significantly impact wrist function and daily activities, particularly in individuals who rely heavily on wrist strength and rotation. With accurate diagnosis and early intervention, most cases respond well to structured treatment. If you are experiencing persistent ulnar-sided wrist pain, instability, or clicking, book an appointment with one of our physiotherapists for a thorough assessment and a tailored management plan.
