Triangular Fibrocartilage Complex Injuries

The TFCC is a fibrocartilaginous structure extending from the distal ulna to the ulnar carpus. It consists of:3 

  • Triangular fibrocartilage proper
  • Meniscal homolog
  • Palmar and dorsal radioulnar ligaments
  • Ulnar collateral ligament, and the subsheath of the ECU tendon.

The TFCC is considered to be the primary stabiliser of the distal radio-ulnar joint (DRUJ), and is involved in the transmission of load between the ulna and the ulnar carpus. Disruption of the TFCC can occur with trauma or as the result of degeneration. Traumatic tears usually result from axial loading of the extended and ulnarly deviated wrist, or axial loading at the end range of pronation/supination. Degeneration may result from repetitive loading of the TFCC through occupation, or increased loading of the TFCC with positive ulnar variance causing ulno-carpal impaction syndrome. Malunion of distal radius fractures can also result in degenerative changes to the TFCC.

4TFCC tears are the most common source of ulnar sided wrist pain. The pain is classically worse with forearm rotation and ulnar deviation, and with axial loading through weight bearing or tight gripping. Patients may also present with clicking or snapping with wrist motion, and localised tenderness and swelling over the ulnar wrist.

The symptoms that present with a TFCC injury can include some or all of the following:

  • Ulnar sided wrist pain
  • Pain on weight bearing through the affected wrist joint
  • Clicking or snapping with wrist motion
  • Swelling and localised tenderness over the ulnar sided wrist
  • Loss of full active forearm pronation and supination due to pain

Acute TFCC tears can be treated conservatively with the use of a wrist and elbow immobilisation splint/orthoses. For degenerative lesions we have had great success in decreasing our patient’s pain, and increasing their function (particularly with weight bearing and gripping activities), with the use of a Wrist Widget. Prefabricated and custom made Wrist Widgets (see image), along with custom made splints/orthoses can all be provided at Hand Works Occupational Therapy.