Triangular Fibrocartilage Complex (TFCC) Tears: Treatment Options

Triangular Fibrocartilage Complex (TFCC) Tears: Treatment Options

This video will provide an overview of the treatment options for tears to the wrist's triangular fibrocartilage complex, or T F C C. Beginning with a brief review, the TFCC is an essential soft tissue complex of ligaments, cartilage, and a tendon in the wrist that provides both cushioning and structural stability. When injured, patients have pain and loss of strength. If left untreated, persistent pain, weakness, instability, and arthritis may develop, highlighting the importance of seeking treatment options with a hand and wrist specialist.

Treatment without surgery is initially trialed for TFCC tears. However, there are situations when treatment with surgery is indicated first. One exception is when there is significant instability in the wrist, as shown here with the ulna. Also, in high-level athletes, the decision to start with surgery first may be indicated. This treatment path begins with resting the affected hand and reducing activities that aggravate the condition. Splinting or casting may be advised as part of this initial treatment to rest the structures involved.

Dedicated hand therapy may be indicated. Steroid injections will also be considered. These treatment options will be tried for several weeks before surgery is pursued. If a patient has severe wrist arthritis or they have TFCC tissue that is too damaged for repair, surgical options shown here may not be advised. The decision to proceed with surgery is complex and based on multiple factors such as symptoms, exam, and diagnostic testing.

Primary TFCC repair may be considered open with an incision or with more minimally invasive techniques, such as an arthroscopic camera and instruments. The 2 techniques may be used in combination. Repairs of the TFCC with arthroscopic techniques are excellent and low-risk. If a minor tear is appreciated, an arthroscopic debridement is performed to shave down the tear fragments. In most tears, techniques for repairing the structures vary but involve suture repairs that may require a bone tunnel and bone anchor to hold the repair.

If the ulna bone is too long in comparison to the radius bone, which may be called ulnar positive variance, a surgeon may advise a procedure to shorten this bone, which can improve the mechanics of the joint and TFCC. There are many methods of doing this, including shaving a small portion of the bone with arthroscopic tools. Following any surgical procedure, the wrist will be immobilized with a cast or removable splint. Before a return to activity, specialized hand therapy will be advised to assist with regaining motion and strength.