Triangular Fibrocartilage Complex (TFCC) Tear

What is a TFCC tear?

The triangular fibrocartilage complex (TFCC) is a cartilage structure located on the small finger side of the wrist that, cushions and supports the small carpal bones in the wrist. The TFCC keeps the forearm bones (radius and ulna) stable when the hand grasps or the forearm rotates. An injury or tear to the TFCC can cause chronic wrist pain.

There are two types of TFCC tears:

  • Type 1 tears are called traumatic tears. Falling on an outstretched hand and excessive arm rotation are the most common causes.
  • Type 2 TFCC tears are degenerative or chronic. They can occur over time and with age. The degenerative process wears the cartilage down over time. Some inflammatory disorders, such as rheumatoid arthritis or gout, may also contribute to Type 2 TFCC tears.

What are the symptoms of a TFCC tear?

Common symptoms of a TFCC tear include:

  • Pain, at the base of small finger side of the wrist
  • Pain worsens as the wrist is bent from side to side
  • Swelling in the wrist
  • Painful clicking in the wrist
  • Loss of grip strength

Who is likely to get a TFCC tear?

  • Anyone can get a TCFF tear. It occurs most often in those who fall on an outstretched hand. Athletes are at risk, especially those who use a racquet, bat or club and those who put a lot of pressure on the wrist such as gymnasts. Degenerative tears are more common in people over 50. Medical attention should be sought as soon as possible after an injury to the wrist.
  • The hand and wrist specialists at Midwest Orthopaedics at Rush Hand, Wrist & Elbow Institute provide the most advanced treatment options for TFCC tears. Individualized treatment options are developed for each patient to ensure optimal outcomes.

What causes a TFCC tear?

TFCC tears are often sustained when a person falls and lands on the hand, bending the wrist backwards. They can also be present in patients with wrist fractures. Degenerative TFCC tears are more common in people over 50. A longer ulna (arm bone on the small finger side of arm) can also contribute to this condition because it puts more pressure on the TFCC.

The Midwest Orthopaedics at Rush (MOR) Hand, Wrist & Elbow Institute has some of Chicago's most experienced physicians who treat triangular fibrocartilage complex injuries.

How is a TFCC tear diagnosed?

TFCC tears are diagnosed through careful examination of the wrist. This involves some manipulation to see the extent and location of pain and immobility. An X-ray may be performed to check for fractures and other abnormalities. The most reliable imaging test is an MRI, which allows doctors to inspect the tissue and cartilage to see the extent of the injury. It is important for a patient to see a board certified physician specializing in treating wrist conditions soon after a traumatic injury.

What are the treatments for TFCC tear?

Treatment of a TFCC tear depends on stage of severity.

Non-surgical Treatment Options

  • Splint or cast
  • Anti-inflammatory medication, such as ibuprofen
  • Cortisone injection
  • Ultrasound therapy

Surgical Treatment Options

Surgery is generally needed for those tears that don't heal or respond to the conservative treatment. This can be performed arthroscopically through limited incisions. Some tears can be "fixed," simply by "debriding" or cleaning the torn edges and damaged tissue off. Others tears can be directly repaired using sutures. Tears can be associated with a "long ulna" caused by an ulna putting pressure on the TFCC, a condition known as Ulnar Impaction Syndrome. It is treated by cutting the ulnar bone down to appropriate length. This can be done either with arthroscopic or open surgery, depending on individual circumstances. Recovery is several weeks in a cast or splint and usually requires therapy to get the wrist back to full function.