TFCC Tear (Triangular Fibrocartilage Complex Tear)

What is the TFCC?

The triangular fibrocartilage complex sits between the end of the ulna (the forearm bone on the pinky side) and the small wrist bones. It includes:

• A disc of fibrocartilage (the triangular fibrocartilage), which cushions the joint
• Ligaments that hold the radius and ulna together at the distal radioulnar joint (DRUJ)
• Supporting ligaments and the sheath of a wrist tendon

It lets the wrist bend toward the pinky side and the forearm rotate (turning the palm up and down) while keeping the joint stable. The center of the disc has a poor blood supply, while the outer edge heals better, which affects treatment choices.

Types of TFCC tears

Doctors use the Palmer classification:

Symptoms

• Pain on the pinky side of the wrist (ulnar-sided wrist pain)
• Pain with turning the forearm, such as turning doorknobs, using a screwdriver or pouring
• Pain when bending the wrist toward the pinky side or bearing weight on the hand (push-ups, rising from a chair)
• Clicking, popping or catching
• Wrist swelling and tenderness
• Weak grip strength
• A feeling of instability if the radioulnar joint is involved

Causes and risk factors

• Falling onto an outstretched hand, often with a wrist fracture, which damages the TFCC in many cases
• Forceful twisting or a sudden pull on the wrist
• Sports: tennis, golf, hockey, baseball, gymnastics, boxing
• Repetitive loading and rotation at work
• Ulnar positive variance (a longer ulna), which overloads the TFCC
• Aging, with natural thinning of the cartilage

Diagnosis

Examination

A hand specialist presses on the soft spot between the end of the ulna and the wrist bones (the fovea sign, which suggests a tear or ligament injury when painful). Other tests include:

• Ulnar grind test: bending the wrist toward the pinky side while rotating and pressing reproduces pain or clicking
• Press test: pushing up from a chair with the hands; pain on the pinky side suggests a TFCC tear
• DRUJ stability test: checking for abnormal looseness between the radius and ulna

Imaging

• X-rays: look for fractures, ulnar length and arthritis
• MRI or MR arthrogram: shows the tear, its location and associated injuries
• Wrist arthroscopy: a small camera in the joint is the gold standard, and the surgeon can treat the tear at the same time

Degenerative TFCC tears are common on MRI in people without symptoms, so findings must match the symptoms.

Treatment

Non-surgical treatment

Most TFCC tears, especially stable ones without radioulnar instability, start with conservative care:

• Immobilization: a wrist splint or a forearm cast or brace that limits rotation, usually for 4 to 6 weeks
• Activity changes: avoid twisting, gripping heavy loads and weight-bearing on the hand
• Ice and pain relief: over-the-counter pain relievers following the label dose
• Hand therapy: gentle motion, then strengthening of the forearm and grip once pain settles
• Ulnar wrist support band: a strap around the wrist that supports the radioulnar joint during activity
• Steroid injection: may help ongoing pain, especially with degenerative tears

Surgery

Surgery is considered when symptoms continue after about 3 months of non-surgical care, or earlier for an unstable radioulnar joint.

• Arthroscopic debridement: trimming a torn central disc. Recovery is relatively quick.
• Arthroscopic or open repair: stitching a peripheral tear back to its attachment, often with a cast for about 6 weeks.
• Ulnar shortening osteotomy: shortening the ulna to unload the TFCC when ulnar impaction is the cause.

Recovery time

Outlook

Many TFCC tears settle with rest and splinting. Surgery relieves pain in most people who need it, though some grip weakness or ache with heavy use can persist. Untreated unstable tears can lead to chronic pain, instability of the radioulnar joint and arthritis.

Frequently asked questions

What does a TFCC tear feel like?

It usually causes aching or sharp pain on the pinky side of the wrist, worse when twisting the forearm, gripping or pushing up from a chair. Many people notice clicking or popping, weak grip and swelling. Pain is often pinpointed in the soft spot just beyond the knobby end of the ulna.

How long does a TFCC tear take to heal?

Mild and stable tears often improve in 4 to 6 weeks of splinting, with return to most activities by around 3 months. After surgical repair, expect about 6 weeks in a cast or brace and 3 to 6 months before full strength and sports. Debridement has a quicker recovery.

Can a TFCC tear heal on its own?

Some can. Tears at the outer edge have a better blood supply and may heal with rest and immobilization. Tears in the center of the disc and degenerative tears heal poorly but often stop hurting with splinting and therapy. Persistent pain or instability may need surgery.

How can I test for a TFCC tear at home?

A simple sign is pain on the pinky side of the wrist when pushing yourself up from a chair with your hands flat (the press test), or when turning the forearm with the wrist bent toward the pinky side. These are only clues. A hand specialist and MRI are needed to confirm a tear.

Do you need surgery for a TFCC tear?

Most people do not. Splinting, activity changes, therapy and sometimes an injection resolve symptoms in many cases. Surgery is recommended when pain continues after about 3 months, when the radioulnar joint is unstable, or when the tear is associated with ulnar impaction that needs correcting.