Triangular fibro cartilaginous complex (TFCC) tears
What is it?
The TFCC is an important stabilising structure which is situated on the little finger side of the wrist. It comprises a group of ligaments and cartilage that connects the ulna to the radius (the two main bones in the forearm), these two bones to the wrist carpal bones.
Why does it occur?
TFCC tears may be caused through trauma or degenerative wear and tear. Trauma in a healthy TFCC can occur through a direct blow to the wrist, or indirectly, such as a fall on to an outstretched hand or by forceful twisting of the wrist. The latter can occur in activities such as racquet sports or golf. Degenerative tears are more common in patients over the age of 50 or in those who engage in manual activities with repetitive wrist use, such as gardening or lifting heavy weights.
What are the symptoms?
Damage to the TFCC can be very painful, particularly on the little finger side of the wrist. This is exacerbated as the wrist moves from side to side and is often accompanied by swelling. If the TFCC is damaged, you may notice a painful clicking sensation or feel that your grip strength is reduced.
How is it diagnosed?
Your consultant will take a thorough medical history and do a physical examination. Some imaging may be used to rule out an alternative diagnosis, most commonly in the form of an MRI scan. This may be combined with an injection of contrast dye into the wrist joint, known as an MRI arthrogram, in order to view the injured cartilage. In some cases, an arthroscopy is used to directly inspect the TFCC.
How is it treated?
Rest, ice and analgesics in the form of anti-inflammatory medications such as Ibuprofen are effective in managing mild cases. These can be used alongside a splint to minimise movement in the wrist, allowing the pain to settle. In some cases, a steroid injection may be necessary to reduce the inflammation and relieve symptoms.
In severe cases an operation may be considered to remove damaged tissue. This may be done via keyhole arthroscopic surgery or, with more extensive tears, via open surgery.
The One Orthopaedics team specialists
Consultant Hand Surgeon MB, BS, MSc (Orth), FRCS
Consultant Orthopaedic Specialist MBBS, BSc, FRCS (Tr & Orth)