What is the TFCC?
What is the TFCC?
The Triangular FibroCartilage Complex (or TFCC) stabilises the joint between the radius and ulna bones at the wrist. It is a complicated structure which has several key elements to provide support to the ulnar (or little finger) side of the wrist including a central disc area (like the meniscus in your knee) and peripheral ligaments and capsular attachments. The TFCC also acts as a cushion between the end of the ulna and small bones (lunate and triquetrum) of the wrist. In patients whose ulna is longer than the radius at the wrist, the TFCC is often thinner and can tear (ulnocarpal abutment syndrome).
The Triangular FibroCartilage Complex (or TFCC) stabilises the joint between the radius and ulna bones at the wrist. It is a complicated structure which has several key elements to provide support to the ulnar (or little finger) side of the wrist including a central disc area (like the meniscus in your knee) and peripheral ligaments and capsular attachments. The TFCC also acts as a cushion between the end of the ulna and small bones (lunate and triquetrum) of the wrist. In patients whose ulna is longer than the radius at the wrist, the TFCC is often thinner and can tear (ulnocarpal abutment syndrome).
How is it injured?
The TFCC can be damaged in two different parts of its structure and is usually caused by different problems. The first type of TFCC tear is often due to natural wear and affects the central disc area but can also occur if the ulna is longer than the radius at the wrist (ulnocarpal abutment). Tears due to wear are the most common and are usually not seen in younger people. They become more common as one gets older.
Tears from an injury can occur following a fall onto the outstretched hand, or from a twisting injury to the arm (such as when a drill bit catches). TTCC tears are often associated with fractures to the wrist. Sports such as golf, badminton and gymnastics often put the wrist in a certain position (of pronation) when gripping with force, which is thought to put more force through the TFCC area. This can lead to tears of the TFCC.
Symptoms
Pain over the ulnar side (little finger side) of the wrist is a common complaint that is associated with a TFCC injury. It is often described to produce clicking with twisting motions of the wrist, such as when opening jars or using door handles. Point tenderness can be elicited in the hollow on the ulnar side of the wrist.
Diagnosis
Diagnosis can often be made from the clinical history (the account of events and symptoms from the patient) and the clinical examination. Patients will usually need further investigations in terms of X-rays and some will require special scans – ultrasound, CT or most likely an MRI. Sometimes keyhole surgery (wrist arthroscopy) is undertaken to confirm the diagnosis.
Treatment options
Treatment for TFCC:
Treatment for injury to the TFCC will depend on the exact nature of the tear or irritation. Initially it is likely that you will be advised on measures that will aim to relieve the discomfort. These may include:
- Taking anti-inflammatory medication (if appropriate), such as naproxen or ibuprofen or newer non-steroidal anti-inflammatory drugs (NSAIDS), or steroid injections to ease pain
- Casting or splinting to rest the wrist
- Hand Therapy (exercises to mobilise, strengthen tendons and ligaments in the wrist)
- Changing your hand’s position during activities/sport/work (ergonomic adjustment)
Surgery
In some scenarios surgery may be required to improve the symptoms in your wrist. This will be tailored to your specific needs and will be discussed with you in detail at your consultation. This surgery may involve wrist arthroscopy (keyhole surgery) and/ or open surgery.
If the TFCC is torn it can either be repaired (if deemed suitable) or debrided (tidied up) with the aim of improving your symptoms of discomfort. The options of treatment will be tailored to your symptoms and underlying pathology and will be discussed in full with you at your consultation.