What is the Triangular Fibro-Cartilage Complex?
The triangular fibro-cartilage complex (TFCC) is an area which contains multiple ligaments, tendon and soft tissue structures which makes up the complex. These include:
- Triangular fibrocartilage disc
- Ulnar meniscus
- Ulnar collateral ligament
- Extensor carpi ulnaris tendon sheath
- Ulnotriquetral ligament
- Radioulnar ligament
- Ulnolunate ligament
- Scapholunate ligament
What causes TFCC tears?
TFCC tears can be strains, partial tears, or complete tears. For this to occur at least one or more of the above structures within the TFCC must be injured (strain through to complete tears). These tears can be categorised into two different groups.
- Traumatic injuries – they usually involve a compressive and twisting force (e.g., a fall onto an outstretched hand with the palm down and wrist bent back or if someone is falling and you try to catch or support them and your wrist twists and bends backwards). This injury can also be associated with a fracture to the radius or ulnar approx. 50% of the time too depending upon the mechanism. Common sports where this injury occurs includes racquet and bat sports (e.g., tennis and baseball), gymnastics, acrobatics, water skiing, etc.
- Degenerative tears- this usually occurs with repetitive loading over a long period of time and are generally found in the older population due to the time it takes for it to occur. It may also result because of a genetically longer ulna which will pinch the TFCC.
Symptoms and Characteristics:
The symptoms for TFCC strains and tears include:
- Ulnar wrist pain (either with or without use or load) depending on how severe the injury is
- Tender on palpation of the ulnar or TFCC
- The pain is aggravated by ulna deviation (the amount of pain will depend on the severity of the injury)
- Swelling of the wrist (this only occurs sometimes and depends on each individual and case)
- Reduced grip strength (this will depend on the severity of the injury and how long into the diagnosis/recovery)
- Clicking sound or feeling when moving the wrist (depending on the severity and which structure of the TFCC is injured)
- Reduced range of motion; especially wirst extension, ulna deviation, supination and pronation (depends on the severity of the injury and how long into the diagnosis/recovery and also how strong they were around the wrist prior to injury)
What is the best way to treat TFCC injuries/tears?
Medical management and physiotherapy are two of the best ways to treat TFCC tears/injuries.
The ideal option is to manage this injury conservatively if possible to an unnecessary surgery. Although, conservative treatment is considered to be ineffective for tears that are older than 6 months or have failed conservative treatment.Therefore, conservative treatment is most likely useful for traumatic tears (although it may dependent on how severe the injury is; e.g. how many of the above structures are torn and are they completely torn; and that they have started rehabilitation before the injury is 6 months old). And degenerative tears are more surgically managed as they tend to initiate treatment after some time of persistent pain or dysfunction.
Medical management can include injections (steroid or analgesic) into the TFCC through ultrasound guided techniques. Medicines can also be used to treat this condition. This includes anti-inflammatories or NSAIDs. The doctor will normally refer to physiotherapy to help with the rehabilitation. Or from the information above, they may need to refer you to an orthopaedic surgeon to have surgery on the tear.
Physiotherapy can be a great tool in the management of TFCC injuries. Physiotherapy can help decrease pain, increase range of motion, increase the strength of forearm and wrist muscles, increase stability of the wrist, and return people to their pre-injury activities of daily living. Physiotherapy treatment will normally contain soft tissue message, ultrasound, TENs and a graded strengthening and stretching exercise program.
Take away message for TFCC injuries:
TFCC injuries can be treated and have a good prognosis if you receive the right treatment for the type of injury that you have. Although it is also important that you don’t delay your assessment or the start of your treatment. It is also important to know that this won’t go away by itself and the longer that you delay rehabilitation, the higher your risk of surgical management being needed.
Either a physiotherapist of doctor can assess you and refer you for the treatment that you need. This includes either medical management, surgical management, physiotherapy, or a combination of the above.