TFCC - How do I know?

TFCC. Triangular Fibrocartilage Complex

The blue areas indicate the TFCC (Triangular FibroCartilage Complex)

What does it do?
The TFCC is the main stabilizer of the wrist.  It is a ligament connecting bone to bone.  It supports the wrist with grip, weight-bearing, and rotation (supination and pronation). It keeps the radius and ulna from painfully spreading apart. 

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.  

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 discussing cases with acupuncturists and naturopathic practitioners.  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. 

Request an appointment for an X-ray

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.

 

 

Radiograph Results

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.

 

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