TFCC  INJURY

A TFCC (Triangular Fibrocartilage Complex) injury refers to damage to the cartilage and ligaments in the wrist that provide stability, particularly between the forearm bones (radius and ulna) and the small bones in the wrist. TFCC injuries often occur due to trauma, repetitive stress, or degenerative changes, causing symptoms like wrist pain, swelling, limited mobility, and difficulty with gripping or rotating the wrist. Treatment typically involves rest, splinting, physical therapy, and in more severe cases, surgery.

WHAT CAUSES TFCC TEAR?

The two primary causes of TFCC tears are:

  1. Injury: A fall onto your hand or wrist can cause a tear in the TFCC, as can a fracture in the radius or a sudden twisting motion that over-rotates the wrist.
  2. Degeneration: As with other tendons and ligaments, the TFCC naturally thins and weakens with age, making it more susceptible to tears. Chronic TFCC tears can develop over time, often due to repetitive motions (like swinging a bat or racket) that gradually wear down the tissue.

WHAT ARE THE SYMPTOMS OF TFCC TEAR?

The symptoms of a TFCC tear can vary depending on the severity of the injury but commonly include:

  • Ulnar-sided wrist pain (pain on the pinky side of the wrist)
  • Clicking, popping, or grinding sensations when rotating or moving the wrist
  • Weakness or instability in the wrist, especially when gripping objects
  • Swelling and tenderness around the wrist joint
  • Pain that worsens with twisting motions (e.g., turning a doorknob, using a screwdriver)
  • Limited range of motion or stiffness in the wrist

If left untreated, a TFCC tear can lead to chronic pain and decreased wrist function, so early diagnosis and proper treatment are important.

HOW IS  TFCC TEAR DIAGNOSED?

A TFCC tear is diagnosed through a doctor’s evaluation and imaging tests:

  1. Physical Exam – The doctor will ask about your symptoms, check for pain or tenderness on the pinky side of your wrist, and perform simple movement tests to see if certain motions cause discomfort or clicking.

  2. Imaging Tests –

    • X-rays help rule out broken bones.
    • MRI with contrast gives a detailed view of the soft tissues in your wrist to check for a tear.
    • Wrist Arthroscopy (a small camera inserted into the joint) may be used if other tests don’t confirm the tear, and in some cases, it can also help treat the injury.

Early diagnosis helps prevent long-term wrist pain and weakness, so it’s important to see a doctor if symptoms persist.

HOW IS  TFCC TEAR TREATED?

The treatment for a TFCC tear depends on the severity of the injury and whether it is caused by trauma or degeneration.

Non-Surgical Treatment (Mild to Moderate Tears)

  1. Rest & Activity Modification – Avoid activities that strain the wrist, such as heavy lifting or twisting motions.
  2. Splinting or Bracing – Wearing a wrist brace can provide support and allow healing.
  3. Ice & Anti-Inflammatory Medication – Applying ice and taking NSAIDs (like ibuprofen) can help reduce pain and swelling.
  4. Hand Therapy - see below
  5. Corticosteroid Injections – In some cases, injections can help reduce inflammation and pain.

Surgical Treatment (Severe or Persistent Tears)

  • Arthroscopic Debridement – Trimming and smoothing the torn tissue to relieve pain and irritation.
  • Arthroscopic Repair – Suturing the torn TFCC back together if the tear is in a repairable area.
  • Ulnar Shortening Surgery – If the tear is caused by ulnar impaction syndrome (when the ulna bone is too long), surgery may be needed to shorten the bone and relieve pressure.

Most mild to moderate TFCC tears heal with conservative treatment, while severe cases may require surgery for full recovery.

WHAT TO EXPECT FROM HAND THERAPY FOR TFCC TEAR?

Hand therapy for a TFCC tear focuses on reducing pain, restoring wrist stability, and improving function while preventing further injury. Here’s what to expect:

1. Initial Phase (Pain & Protection)

  • Wrist Splinting/Bracing – To support the wrist and allow healing.
  • Pain Management –hydrotherapy, electrotherapy, gentle massage, and education on avoiding aggravating movements.
  • Gentle Range-of-Motion (ROM) Exercises – To prevent stiffness while avoiding excessive strain on the TFCC.

2. Strength & Stability Phase

  • Proprioception Training – Exercises to improve wrist stability and coordination; only when these are mastered we can progress to strengthening exercises
  • Progressive Strengthening – Exercises focused on gradual strengthening of the wrist using resistance bands, or light weights.
  • Functional Training – Movements tailored to work, daily activities, or sports-specific motions -

3. Return to Activity & Prevention

  • Gradual Return to Normal Activities – We will slowly reintroduce weight-bearing and twisting motions.
  • Education on Wrist Protection – Learning proper techniques to prevent re-injury, including ergonomics and joint protection strategies.

Most people see improvement within weeks with therapy, but severe tears may take months or require surgery if symptoms persist.