Triangular Fibrocartilage Complex (TFCC) Injuries

What is a Triangular Fibrocartilage Complex (TFCC) injury?

The TFCC is a group of cartilage and ligaments on the pinky-side (ulnar side) of your wrist that stabilizes the wrist joint, cushions between the ulna (forearm bone) and carpal bones (wrist bones), assist with rotation (turning palm up/down), and is a shock absorber for the wrist.

Common causes of a TFCC injury

TFCC injuries usually happen from increased load in combination with rotational movement. This can include falling on an outstretched hand, twisting the wrist suddenly, lifting heavy objects with the wrist rotated, sports (tennis, golf, gymnastics, weightlifting, baseball), or repetitive pushing (push-ups, bench press). TFCC injuries can also be due to degenerative causes such as age-related wear, slight discrepancy of length between the radius and ulna (positive ulnar variance), or repetitive wrist use over time (manual labor, keyboard-heavy work).

What are some of the symptoms of a TFCC injury?

Most symptoms are felt on the ulnar (pinky) side of the wrist. Symptoms can include pain with gripping or rotation, clicking/popping/catching, weak grip strength, pain during push-ups or weight-bearing on the hand, swelling or tenderness, feeling of wrist instability, worse pain with turning keys, opening jars, or using a mouse. You should seek medical attention if you have persistent pain for more than 2–3 weeks or increased instability.

How are TFCC injuries diagnosed?

A TFCC injury can be assessed by a medical professional through a clinical exam (provocative wrist tests), MRI, as well as X-rays to rule out bone issues or ulnar variance.

What are the treatments for a TFCC injury?

Most TFCC injuries can be treated through conservative management. Treatment can include rest, activity modification, custom fabrication by your therapist, NSAIDs (short-term), ice or heat. Your physician can also provide a corticosteroid injection for select cases. For mild – moderate injuries, improvements can often take between 6–12 weeks.

If conservative management fails, surgical management might be indicated. This would be required if pain remains persistent after 3–6 months, mechanical symptoms (locking/catching), or significant instability or full tears. This may include ligament reconstruction, pinning, or arthroscopic repair. Typically, after surgical management, you may be placed into a custom orthotic to limit forearm rotation as well as to protect the healing structures. This can be fabricated by a Certified Hand Therapist (CHT).

Rehabilitation for a TFCC injury

Rehabilitation can occur in different phases and should be progressed or altered under the supervision of a trained hand therapist.

• Phase 1: Acute / Protection (Weeks 0–2) – This can include immobilization (brace), gentle finger and elbow motion, ice, and anti-inflammatory strategies. You should avoid twisting, gripping, and push-ups.
• Phase 2: Mobility (Weeks 2–6) – Goals during this phase include restore motion without irritation. This is done through pain-free wrist ROM (flexion, extension), gentle forearm rotation, soft tissue work (as tolerated), and light isometrics.
• Phase 3: Strengthening (Weeks 6–10) – The focus between weeks 6-10 are increased stability and endurance. Continued wrist and forearm ROM with increased light resistance (as tolerated), grip strengthening (putty, towel squeeze), and initiation of shoulder strengthening.
• Phase 4: Functional / Return to Sport (Weeks 10–16) – In phase 4, the patient will continue to increase load tolerance as well as controlled movement. Your therapist will implement more sport/work-specific drills, guide towards return to push-ups, lifting, or racquet sports, as well as wrist taping or brace if needed.

The rehabilitation process and timeline will vary based on multiple factors such as instability, delayed healing, or other guidelines from the surgeon. It is important that you see a therapist that specializes in Orthopedic care of the Upper Extremity such as a Certified Hand Therapist, to ensure proper progression through the rehab process to avoid re-injury.