TFCC stands for triangular fibrocartilage complex. It is an intricate structure made up of ligaments, tendons, and cartilage that supports and stabilizes your wrist. The bones in your forearm connect to the bones in your wrist with the help of TFCC. One cause of wrist pain could come from a sudden fall or fracture to your wrist that leads to a tear in one or more of the tissues that make up the TFCC. A TFCC tear most commonly occurs in aging populations as wear and tear on your bones and joints makes you more susceptible to injury and degeneration. Athletes can also suffer a TFCC tear with repetitive motions that overload the soft tissues that make up the TFCC and lead to chronic tears that gradually occur and can get worse without proper treatment and care. Here’s everything you need to know about a TFCC tear.
Anatomy of Your Wrist
Your wrist is a complex joint where the bones and soft tissues of your arm and hand come together. You depend on your wrist for a wide range of motions, from everyday tasks like buttoning a shirt or drinking from a glass to sports and activities like swinging a tennis racket or golf club. The two main bones that make up your forearm are the radius and ulna, and several muscles, tendons, ligaments, and cartilage also support this area. The triangular fibrocartilage complex is located in between these two bones and helps control wrist movement and provide stability for these two main forearm bones. When you engage in motions like rotating your forearm or grasping something with your hand, you are relying on the TFCC. Hold your left hand out in front of you with your palm facing away. Hold your arm straight and tilt only your hand to one side away from your thumb. Tissues that make up the TFCC are located along the left side of your hand, on the opposite side of your wrist from your thumb.
Symptoms of a TFCC Tear
The most common symptom of a TFCC tear is pain along the outside of your wrist and near your pinky finger. Depending on the severity of the tear, you may experience pain throughout your wrist joint. Pain can occur only with certain movements or when you apply pressure to the area. You can also experience constant pain with a severe TFCC tear. Other symptoms of a TFCC tear include tenderness to the touch and swelling in the area. A TFCC tear can cause instability and weakness, making it difficult to use your wrist effectively. Grasping objects tightly and engaging in activities like tennis or golf that require repetitive wrist movements can become uncomfortable or impossible due to pain and other symptoms. You may notice a clicking or popping sound when you rotate your forearm or wrist, and these sounds can be a sign of a TFCC tear. If left untreated, a TFCC tear can develop into chronic weakness and instability in the affected wrist.
Two Types of TFCC Tears
The cause of a TFCC tear will depend on what type of TFCC tear you experience. Here are the main differences between Type 1 and Type 2 TFCC tears.
Type 1 TFCC Tear
A Type 1 TFCC tear refers to torn tissue caused by an injury. If you suddenly slip and fall, you may hold your hands out in front of you to help catch yourself. Landing on an outstretched hand can put a significant amount of pressure on your wrist and lead to a TFCC tear. Damage to cartilage, ligaments, or tendons in the TFCC from a sudden injury is known as Type 1 TFCC tears.
Type 2 TFCC Tear
A Type 2 TFCC tear refers to torn tissue caused by aging or an underlying condition. Older adults are at greater risk for a TFCC tear as tissues begin to thin and lose their strength with age. Thinner tendons, ligaments, and cartilage are more likely to tear. An underlying condition like rheumatoid arthritis or gout can also make you more susceptible to a TFCC tear. Chronic TFCC tears can occur gradually as these TFCC tissues break down.
How to Diagnose a TFCC Tear
If you are experiencing wrist pain and other symptoms of a TFCC tear, talk to your doctor to get an official diagnosis. Your doctor will review your medical history and ask you questions about your symptoms. They will want to know when you first started experiencing wrist pain and where the pain occurs along your wrist. They will likely also perform a physical exam to assess for tenderness around your wrist. Your doctor may also assess your wrist for any reduced range of motion or weakness in the area. One type of test, known as the fovea test, can help detect a TFCC tear. Your doctor may press on a certain spot of your wrist on one hand and then do so on the other hand to identify any differences in pain, tenderness, and range of motion. In some cases, they may recommend an X-ray or MRI to support the diagnosis of a TFCC tear and rule out other potential causes of your wrist pain.
Non-Surgical Treatment Options for TFCC Tears
A minor TFCC tear may heal with at-home remedies and non-surgical treatment options. Here are ways you can manage wrist pain and heal from a TFCC tear.
The RICE method refers to four steps you can take at home: rest, ice, compression, and elevation. Resting after any injury is key to helping your body heal and recover. Avoid activities that require a lot of wrist movement and take a break from sports or exercises that may make your pain worse. Apply ice to the affected wrist to help reduce any swelling. Ice or a cold compress will also provide a temporary numbing sensation that can help reduce your pain and discomfort. You may also wear a splint or cast to provide compression that helps with reducing swelling. A splint will also help reduce wrist movement so you can heal properly. You may also elevate the wrist immediately after the injury to help reduce swelling and inflammation in the area.
You may take over-the-counter anti-inflammatory medications like NSAIDs to help reduce symptoms of pain, swelling, and inflammation. Pain medications offer temporary relief but will also require complementary treatment options to help you fully recover. In some cases, your doctor may recommend an injection like a steroid shot to help reduce swelling around the torn tissue in your wrist.
You can also work with a physical therapist to help reduce your pain and improve your range of motion after a TFCC tear in your wrist. Physical therapy will help you regain and improve your strength and mobility following an injury like a TFCC tear. Stretches and exercises will help strengthen arm muscles and promote flexibility in the soft tissues that support your forearm and wrist. A physical therapist may also recommend massage therapy or soft tissue mobilization to help reduce swelling and promote healing. Physical therapy exercises will target the various tissues that make up the TFCC to help you rebuild your strength so that your wrist is better supported and stabilized moving forward. Your physical therapist may also walk you through exercises you can practice at home to help support your healing process.
In more serious cases, conservative treatment approaches may not be enough to resolve your pain, and a TFCC tear may require surgery to repair the tear. Your doctor may recommend different types of surgery depending on your specific tear and symptoms, along with a comprehensive rehabilitation plan to support your recovery.
A minimally invasive surgical treatment called an arthroscopy can be used to repair damaged tissue in the TFCC. This procedure would involve tiny incisions around your wrist where the surgeon will insert small tools to fix the tear. When an arthroscopy may not be recommended, traditional open surgery may be more effective in treating a TFCC tear.
After surgery for a TFCC tear, you will wear a cast that will prevent you from moving your wrist. The average length of time for a cast after TFCC surgery is six weeks. Once you get the cast removed, you will need physical therapy to help you recover and rehabilitate. Physical therapy will help you regain strength, function, and range of motion after a period of immobility. Occupational therapy can also help you regain functioning to do everyday tasks and return to your regular routines.
Don’t let wrist pain keep you from your regular routines and activities you enjoy! Talk to your doctor at AICA Orthopedics about all your options for recovering from a TFCC tear. Our team of doctors includes orthopedic surgeons, chiropractors, neurologists, and physical therapists who work together to help you recover and rehabilitate from injuries like a TFCC tear. Visit us online to find an AICA Orthopedics location near you.