TFCC - What is the Triangular FibroCartilage Complex and what does it do?

What is the TFCC- Triangular Fibrocartilage Complex?

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 does the TFCC do?

The TFCC is the main stabilizer of the wrist. 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 animation represent the components of the TFCC.

 

What are the risk factors for a Triangular Fibrocartilage tear?  How common are TFCC tears?


Age 
According to Market Research, TFCC tears were present in nearly 50% of the over 65 aged population.   On the other end of the spectrum, 27% of patients presented for wrist injuries age 30 or younger had TFCC tears. 

Chronic inflammation
 A small retrospective study found that 38.9% of people with severe rheumatoid arthritis developed TFCC tears.

There is an interesting subset of patients who develop a TFCC tear for no reason at all.  Suddenly out of nowhere, their wrist starts to hurt.  This group of patients fascinates me.  In close analysis and discussion with these patients, there is a common thread - the stomach and intestinal issues..  This is a broad statement which was later confirmed when looking at stool and blood tests.  Read more about this unusual discovery here.  It is well known that senior citizens have tears and/or degradation of the TFCC.

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 to get a referral to a hand specialist (depending on your location this may take 1-3 weeks!). Seeing a  doctor who specializes in the hand can save you a lot of time and effort. 

Radiograph Results

Xrays can NOT define TFCC tears well.  They are important to rule out any other injuries that cause ulnar sided wrist pain.  Do the Weight Bearing Test, and begin the treatment protocol based on your results. 

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 Fibrocartilage 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. 

The good news! TFCC tears will heal without surgery when the treatment protocol is followed. 

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.

 

Case Review

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.