Triangular Fibrocartilage Complex (TFCC) Tears: Overview

Triangular Fibrocartilage Complex (TFCC) Tears: Overview

This video will provide an overview of tears in the wrist triangular fibrocartilage complex, also known as the T F C C. It lies between the radius, ulna, lunate, and triquetrum bones. The TFCC is a triangular-shaped soft tissue structure on the outside of the wrist. The soft tissue structures include multiple ligaments, cartilage, and a tendon. Ligaments connect bone to bone, cartilage protects the end of the bone, and the tendon in this area connects a muscle in the forearm to the hand, allowing movement in the wrist.

The TFCC has multiple functions in the wrist. First, it provides a cushion for the numerous forces that may go through the wrist. Second, the TFCC stabilizes the bones in the wrist joint. Lastly, the health of the TFCC is essential to overall hand and grip strength. The frequency of TFCC tears is not fully known or understood as many tears do not cause symptoms. However, it is known that the prevalence of seeing TFCC abnormalities on MRI increases with age. Upwards of 90% of patients over the age of 70 may have findings of injury, even without pain.

Similarly, the rates of TFCC tears seen on MRI in high-level athletes showed no difference in those with or without pain symptoms. Injuries to the TFCC are categorized into 2 types: those that occur suddenly because of a traumatic injury and those that occur over time and can be described as wear-and-tear injuries. Sudden traumatic injuries occur most commonly when force is applied to the wrist that is extended and slightly deviated to the ulnar side of the wrist, such as when falling on an outstretched hand or when swinging a racket or a bat.

Wear-and-tear injuries to the TFCC can be seen over time, especially in those who have performed repetitive wrist-twisting activities such as golfers or tennis players. Tradespeople using power drills may be more prone to this problem, given the excessive torque placed on the wrist. In addition to activity risk factors, there are some differences in anatomy that make TFCC tears more likely to occur. A known anatomic risk factor is a condition called ulnar positive variance, in which the ulna is longer than the radius.

Approximately 26% of people have ulnar positive findings naturally or have developed them from a prior wrist injury. Patients with a TFCC tear report ulnar-sided pain on the outside of the wrist. Twisting motions, such as opening a jar or door, will aggravate symptoms. Patients may have sharp pain and clicking, and they may note weakness in grip strength. More advanced findings may include a feeling of instability when moving the hands palm up to palm down, and vice versa.

A TFCC injury is diagnosed by careful history and examination. A health care provider will examine both wrists to compare differences. They will perform specific tests to localize the pain and feel for any clicking or grinding. Other exams may be done to confirm the diagnosis further. While x-rays may be taken, they are usually normal. MRI images are more helpful in diagnosing the injury. Occasionally, an MRI will be ordered alongside a CT arthrogram, in which the critical joints around the TFCC are carefully assessed after a dye injection.

If a patient has persistent symptoms for multiple months, a minor procedure called a wrist arthroscopy will be performed. Wrist arthroscopy is the best tool for diagnosing TFCC tears and any other injury that may be present in this area. Often this is done at the same time a surgical treatment is performed. Once the health care provider has completed the history, exam, and any required diagnostic testing, an individualized treatment plan will be made.