TFCC Tear

The TFCC, or Triangular FibroCartilage Complex, is a soft tissue cushion and wrist stabilizer on the ulnar side (pinky finger side) or the wrist.  Most people are aware of the “meniscus” which cushions and stabilizes the knee – the TFCC is a very similar structure in the wrist.  The TFCC stabilizes the two forearm bones together – the radius and ulna.  It also provides a cushion between the ulna and the carpal bones.  When the TFCC is torn or injured, patients experience pain along the pinky finger side of the wrist. 

Causes

TFCC tears can be “traumatic”, from a fall or twisting injury of the wrist.  They can also be “degenerative”, where the TFCC slowly wears out over time.

Symptoms

  • Pain along ulnar (pinky finger) side of the wrist

  • Discomfort with wrist motion – most commonly rotating the wrist/forearm and bending the wrist towards the pinky finger

  • Swelling

  • Wrist or hand weakness

  • Clicking in the wrist with movements

Diagnosis

TFCC tears can be diagnosed by talking with your doctor and having them examine your wrist.  X-rays are sometimes obtained to rule out other injuries.  Occasionally they will show the ulna bone being longer than the radius bone, which can pre-dispose a patient to injuries on the “ulnar side” of the wrist.  An MRI is the best imaging tool for looking at soft tissue injuries such as TFCC tears, and will sometimes be obtained to aid in the diagnosis (see image below).

TFCC Tear. On MRI, a normal TFCC is a black band of tissue connecting the radius and ulna bones. This MRI arthrogram shows a tear in the TFCC, allowing the dye (white fluid on MRI) to leak out of the joint.

Non-surgical treatment

  • Splinting - a TFCC tear can oftentimes heal itself if the wrist is immobilized with a splint or cast.  It is important to completely eliminate wrist motion for at least 4 weeks to optimize healing success.  Some areas of the TFCC have excellent blood supply and are amenable to healing.  However, some areas with poor blood supply, and some large or chronic tears, may not heal even if properly immobilized.

  • Cortisone Injection - a corticosteroid injection into the wrist joint can calm inflammation, help organize collagen formation during healing, and decrease pain.

Surgical treatment

  • Wrist arthroscopy - some TFCC tears can be treated with a minimally invasive procedure performed through small incisions on the back of the wrist.  A camera is inserted into the wrist joint and the image is projected onto a television screen.  This allows for excellent visualization of the inside of the wrist and assessment of injured structures.  Through another small incision, instruments are inserted for either repair or trimming away of the torn portion of the TFCC. 

A. Tear in the central portion of TFCC with fraying of the edges. The torn portion can become pinched in the wrist joint with motion, causing pain and clicking.

B. Probe is placed in the TFCC tear, demonstrating a defect or hole in the joint.

C. Shaver is inserted into the wrist joint to trim away the torn edges of the TFCC tear (like a lawn mower).

D. Edges of the TFCC tear have been trimmed to a stable rim, the torn fragments are removed.

E. Cautery is inserted to gently “carmelize” and stabilize the periphery of the tear.

F. At the completion of the procedure, the edges of TFCC tear are trimmed and cauterized to minimize the risk of future tearing or fraying. The TFCC is now smooth, and torn strands/fragments have been removed.

  • Traditional surgery - some TFCC tears may not be amenable to treatment with arthroscopy, and may require repair through an incision on the back of the wrist.


Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.