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TFCC Tear

What is a TFCC tear?

The triangular fibrocartilage complex (TFCC) is a cartilaginous structure in the ulnar side (little finger side) of the wrist that helps to provide stability. It is made up of ligaments, tendons, and cartilage that allows the wrist. A TFCC tear occurs when one of these structures is injured, causing pain, instability, clicking and loss of function in the wrist.

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Who is affected by TFCC tears?

TFCC tears can affect people of all ages, but they are most common in adults between the ages of 30 and 60. They are more common in people who participate in activities such as contact sports, manual labour, or playing musical instruments.

What are the main symptoms of a TFCC tear?

 

The main symptoms of a TFCC tear include:

  • Pain:

    Pain in the wrist, especially on the ulnar side (little finger side). The pain may be aggravated with activities that involve gripping or twisting of the wrist i.e. tennis, golf, gardening.
  • Instability:

    A feeling of instability in the wrist. This may make it difficult to perform tasks such as writing or using heavy tools.
  • Loss of function:

    A decrease in range of motion in the wrist. This may make it difficult to turn the palm up or down, or to make a full fist.
  • Clicking or popping sounds:

    Clicking or popping sounds when moving the wrist.

How is a TFCC tear diagnosed?

A TFCC tear is typically diagnosed based on a physical exam and the patient's medical history. The doctor will ask about the patient's symptoms and activities. The doctor will also examine the wrist for pain, tenderness, and range of motion limitations. A grind/crank test describes placing of the hand and wrist in a position to compress the TFCC and then rotating the forearm which may reproduce painful clicking.

Imaging tests, such as an MRI may be useful to definitively diagnose a TFCC tear and to rule out other causes of little-finger sided wrist pain such as an ECU tendon problem.  Ultrasound is not diagnostically definitive for a TFCC tear.

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How is a TFCC tear treated?

 

Treatment for a TFCC tear depends on the severity of the injury. Non-surgical treatments are often effective for mild to moderate TFCC tears. Non-surgical treatments may include:

  • Rest:

    Avoiding activities that aggravate the pain
  • Splinting:

    A splint can help to keep the wrist straight and reduce pressure on the TFCC.
  • Physiotherapy:

    Physiotherapy can help to improve range of motion and strengthen the muscles around the wrist.
  • Ice application:

    Applying ice to the wrist for 10-15 minutes at a time, several times a day, can help to reduce inflammation and pain.
  • Over-the-counter pain relievers:

    Over-the-counter pain relievers, such as ibuprofen or naproxen, can help to relieve pain and inflammation.
  • Corticosteroid injections:

    In some cases, corticosteroid injections into the region of the TFCC can provide temporary pain relief and reduce inflammation.

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor. The experienced medical doctor will then place you in a seated position with your hand resting on the couch.  The hand is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  The combined local anaesthetic and steroid is injected from the skin to the joint under ultrasound guidance. 

 

The injection itself is normally completed within 30 seconds, after which a plaster is applied and post-injection advice is given. The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following this particular injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.

If non-surgical treatments are not effective, surgery may be an option. Surgery for a TFCC tear may involve:

  • Arthroscopic debridement:

    This minimally invasive surgery involves removing damaged cartilage/tissue from the TFCC.
  • TFCC repair or reconstruction:

    This surgery involves repairing the torn TFCC or replacing it with a graft.
  • Tendon transfer:

    This surgery involves transferring a tendon from another part of the body to replace the torn TFCC.

Additional tips for managing TFCC tear pain:

  • Avoid activities that aggravate the pain, such as lifting heavy objects or bending the wrist for long periods of time.
  • Gradually increase range-of-motion exercises as pain allows.

If you are experiencing pain, instability, or loss of function in your wrist, it is important to see a doctor to get a diagnosis and discuss treatment options. With early diagnosis and treatment, most people with TFCC tears can recover fully and return to their normal activities.