TFCC - How do I know?
What does TFCC stand for?
TFCC is an abbreviation for: Triangular Fibrocartilage Complex
What does the TFCC do?
The TFCC is the main stabilizer of the wrist. It is a group of ligaments connecting bones to bones. It supports the wrist with grip, weight-bearing, and rotation (supination and pronation). It keeps the radius and ulna from painfully spreading apart. The radius supports 80%, and the ulna supports 20% of axial load. The colored sections in the illustration below represent the components of the TFCC.
What is the TFCC?
More popularly known as the wrist meniscus; a kind of shock absorber for some of the joints in your wrist. The TFCC can tear with rotational movements (hyper rotation while using a drill), excessive weight bearing, a fall on an outstretched hand, etc.
The Triangular Fibrocartilage complex is composed of several ligaments. Triangular Fibrocartilage provides a cushion on the top of the ulna. It, along with the dorsal and palmar radioulnar ligaments (RUL) prevent the ulna and radius from spreading apart. The UCLs (Ulnar collateral ligaments) include the ulnotriquetral ligament, the ulnolunate ligament, and the extensor carpi ulnaris (ECU). As you can see, the TFCC is quite complex.
What are the risk factors for a Triangular Fibrocartilage tear?
How common are TFCC tears?
According to Market Research, it was noted that seniors - those older than 70, TFCC tears were present in nearly 50% of the population. On the other end of the spectrum, 27% of patients presented for wrist injuries age 30 or younger had TFCC tears.
A small retrospective study found that 38.9% of people with severe rheumatoid arthritis developed TFCC tears.
My wrist hurts, how do I know if it’s the TFCC?
Some common signs and symptoms of a TFCC tear are:
- Pain, localized to the ulnar (pinky) side of the wrist
- Pain that gets worse with simple gripping and rotation movements (opening a door or using a can opener)
- It normally does not swell.
- Clicking, snapping, or crackling (crepitus) These are not present in all patients with TFCC tears.
- Pain weight-bearing activities.
- Feeling of instability
TFCC tears don’t cause loss of motion or swell. However, a fracture or other injury can accompany a TFCC tear if there is swelling.
Consult your physician for an exam and to get an x-ray (depending on your location this may take 1-3 weeks!). While you’re at it get a referral to an orthopedic hand specialist. Yes, wrists are tricky little things. Believe us, it’s worth the extra step on your road to full recovery.
Purchase a protective wrist splint to prevent motion until you know what type of injury you have. Make sure it doesn’t compress or squeeze the ulnar head (wrist bone). If you don’t have swelling, you can use a heating pad on the wrist, or alternate hot/cold water over it.
If the x-ray is negative >> continue with hand specialist referral. No fractures is great news! Do the Weight Bearing Test, and begin the treatment protocol based on your results.
If the x-ray is positive >> the physician will recommend casting. Have the cast applied.
How is it diagnosed?
A TFCC definitive diagnosis takes the history, mechanism of injury, and imaging into consideration. MRI's are helpful but not always accurate. Read more about MRI under-diagnosis here.
After opening her practice in 2000, Wendy noticed an increase in TFCC injuries and realized that there wasn’t an easy, accurate, and 100% reliable test to determine this specific injury.
This variable and difficulty in diagnosing a TFCC tear inspired her to create an objective and reliable test that anyone can perform at home using an inexpensive non-digital scale.
This is a priceless tool to assess the wrist. It is actually the most accurate way to determine TFCC damage and is called the Weight Bearing Test. It measures the wrist's ability to press upon the scale.
Ulnar (pinkie) sided wrist pain caused by TFCC (Triangular Fibro-Cartilage Complex) injuries are challenging to treat.
Surgery often yields disappointing results and extended recovery times; thick, hard, uncomfortable braces turn sports and everyday tasks into painful obstacles.
Wendy Medeiros, OTR, CHT. Wendy’s 25+ years experience as an Occupational Therapist and Certified Hand Therapist has given her great insight into this injury.
I would love to hear about your case! Send me the details of your case using this form: https://bit.ly/ww-injury
TFCC injuries heal without surgery
Read a great white paper about the use of WristWidgets® as a non-surgical alternative to repairing TFCC tears:
CASE REPORT: A Non-surgical Intervention for Triangular Fibrocartilage Complex Tears
In this study conducted by Susan J Barlow from the University of TN, it was confirmed that non-surgical treatments such as the WristWidget increased the weight-bearing ability in subjects with with a TFCC tear to normal levels.
A 45-year old man with ulna-side wrist pain after performing a yoga hand stand used the WristWidget for 12-weeks and found relief.