Wrist Cartilage Tear (TFCC) Causes and Treatment

The triangular fibrocartilage complex, or TFCC, is the cartilage and ligaments that inside the wrist joint, on the ulnar side of the wrist (the side with the small finger). Injuries to the TFCC can cause wrist pain and clicking sensations.

Triangular Fibrocartilage Complex or TFCC

The TFCC is a complex structure, as its name implies. However, it's no surprise given the complicated movements that take place at the wrist joint. Unlike some joints that have simpler motion in just one plane, the wrist moves in three distinct planes, all at the same time. The wrist can bend back and forth, side to side, and rotate. This movement allows us to manipulate our hand in a variety of positions. Just as importantly, the wrist must be strong and stable, so that when we grasp an object, the joint does not collapse or flop around. The TFCC has a hard job.

The TFCC is formed as a ring of cartilage, much like the meniscus of the knee. Surrounding this ring are ligaments that stabilize the wrist joints. When someone describes an injury to the TFCC, they are describing an injury to these structures. TFCC tears come in many shapes and sizes. It is important to understand that TFCC tears are common, especially once we get into our 40s.

Some TFCC tears are smaller, stable, and may heal with minimal treatment. Other TFCC tears are larger, unstable, and may require intervention. Having the diagnosis of a TFCC tear doesn't tell you nearly enough to know what the ideal treatment might be.

Causes

Wrist joint anatomy varies among our population, specifically which of the forearm bones is longer. In people with a longer ulna (ulnar positive wrist), more force is applied across the TFCC. These individuals have a higher likelihood of injury to the TFCC and are more likely to have persistent symptoms after injury.

The most common cause of an injury to the TFCC is a fall onto an outstretched wrist; sometimes there is an associated fracture of the radius bone. Other causes of TFCC injury can include forceful rotation or distraction (pulling) on the wrist joint.

Symptoms and Diagnosis

The most common symptoms of TFCC tears include:

• Pain and swelling on the ulnar side of the wrist
• Clicking sensations with wrist movement
• Instability of the forearms bones (distal radioulnar joint)

If there is suspicion of an injury to the TFCC, typically X-rays will be performed to evaluate for fracture, joint instability and ulnar variance (length of the forearm bones). An MRI can be helpful to see the cartilage and ligaments that form the TFCC. Many doctors will inject the area for two reasons. First, to identify the source of the pain (confirm the TFCC tear is causing the symptoms); and second, to deliver medications (steroids) to the area for treatment.

Recommended Treatment

As stated before, every TFCC tear is unique, and having experience with different types of injury patterns is essential for your surgeon to help guide your treatment plan.

There are some scenarios where surgery may be considered for treatment. Specifically, tears that fail to improve with nonsurgical treatment, unstable TFCC injuries, and injuries associated with a positive ulnar variance (longer ulna bone), may be candidates for surgical intervention. Most surgeons are using wrist arthroscopy to evaluate the torn TFCC, and either clean up or repair the damaged structures.