What is it?
The Triangular Fibro-Cartilage Complex (TFCC) is located on the ulnar (small finger) side of the wrist. It is comprised of several wrist ligaments and a fibrocartilage disk. This structure serves to stabilize the wrist and forearm through rotation (pronation and supination) and also transfers 20% of the force from the hand to the ulna.
The TFCC may be injured by a trauma or attritional wear over time. The traumatic event is typically associated with simultaneous loading and rotation of the wrist. Falls onto an outstretched hand and fractures of the distal radius are also associated with traumatic TFCC injuries.
What are the symptoms?
Pain along the ulnar aspect of the wrist is the most common complaint of patients with symptomatic TFCC tears, regardless of mechanism. This pain will often increase with forearm rotation, when force is placed across the wrist joint, and with deviation of the wrist ulnarly toward the TFCC.
How is it evaluated?
A thorough physical examination is key in diagnosing a TFCC tear and differentiating it from other causes of ulnar wrist pain. Tenderness can be elicited from direct palpation of the TFCC. The stability of the joint between the radius and ulna at the wrist, the distal radioulnar joint, is also assessed, as injuries to the TFCC can lead to instability of this joint. An MRI, often with contrast injected into the wrist, is obtained to visualize the TFCC.
How is it treated?
Non-operative treatment begins with resting the wrist by stopping activities that cause pain and wearing a splint. Therapy is often helpful in increasing motion and strength once pain begins to lessen.
Corticosteroid injection placed into the wrist joint may be needed not only to decrease inflammation and pain, but also to confirm the diagnosis.
Patients who fail to improve with rest, splinting, therapy and injections may require surgery. Typically, arthroscopic examination of the wrist is performed to confirm the diagnosis. Some tears need only be trimmed or debrided, which can be performed arthroscopically. Tears amenable to repair may be addressed either arthroscopically or through an open incision. This determination can only be made in the operating room.