The Triangular Fibrocartilage Complex (TFCC) is a crucial structure located on the pinky side of the wrist. This complex helps maintain wrist stability and enables its wide range of motion. Injuries to this area can often be a source of pain and functional limitations.
Anatomy and Function
The TFCC consists of components: an articular disc (a cushion), and dorsal and palmar radioulnar ligaments. These connect the radius and ulna at the wrist. Ulnocarpal ligaments also stabilize the ulna’s connection to wrist bones.
These structures stabilize the distal radioulnar joint (DRUJ), enabling forearm rotation. The articular disc also absorbs shock, distributing forces across the wrist during movement and impact. This arrangement allows for smooth forearm and wrist rotation, facilitating everyday activities like turning a doorknob or pouring water.
Causes and Signs of Injury
Injuries to the TFCC are either traumatic or degenerative. Traumatic injuries often result from a fall onto an outstretched hand, forcefully compressing and rotating the wrist. Direct blows or sudden, forceful twisting motions can also cause damage.
Degenerative injuries develop over time from repetitive stress or age-related wear and tear. Activities with frequent wrist rotation, such as using a screwdriver or certain sports, can gradually lead to TFCC degeneration. Individuals with positive ulnar variance (a longer ulna) may be more prone to tears due to increased pressure.
Symptoms include pain on the pinky side of the wrist, worsening with movement. Pain occurs during wrist rotation, gripping, or weight-bearing. Clicking or popping sounds, weakness, or instability may also be present. Swelling can indicate inflammation.
How a TFCC Injury is Diagnosed
Diagnosing a TFCC injury begins with a clinical evaluation. The doctor assesses wrist range of motion, strength, and stability. Physical tests, like fovea palpation (a small indentation on the pinky side of the wrist) and ulnar deviation stress tests, help pinpoint pain and instability.
Imaging studies confirm diagnosis and assess injury extent. X-rays rule out fractures or other skeletal abnormalities. MRI is the most effective imaging for visualizing soft tissues like the TFCC. A CT scan or arthrogram (injecting dye into the joint) may provide more detailed information.
Treatment Options and Recovery
Treatment for a TFCC injury varies by severity and symptoms, often starting with conservative, non-surgical approaches. Initial management involves rest and wrist immobilization with a splint or brace to allow healing. NSAIDs can reduce pain and inflammation.
Physical therapy is part of non-surgical treatment, focusing on exercises to restore wrist strength, flexibility, and range of motion. Exercises progress from gentle movements to strengthening activities as the wrist heals. A corticosteroid injection into the wrist joint may alleviate persistent pain and inflammation.
If conservative treatments fail or the injury is severe, surgery may be considered. Arthroscopic surgery is common, using a small camera and instruments through tiny incisions to repair or debride damaged TFCC parts. The procedure depends on the tear’s type and location.
Recovery involves a structured rehabilitation program, whether treated conservatively or surgically. Healing can take weeks to months, depending on injury extent and treatment. Adherence to physical therapy is crucial for regaining full wrist function and preventing re-injury. A gradual return to activities and sports is advised, guided by a therapist and surgeon, to ensure proper healing and minimize complications.