Introduction
Triangular Fibrocartilage (TFCC) tear is a painful condition of the wrist caused by an injury or repetitive use.
The TFCC is a triangular shaped cartilage disc in the wrist. It is supported by ligaments. The TFCC cushions and stabilises the bones of the wrist.
TFCC tears are reasonably common. Incidence varies from 15-30% of the population. The incidence increases with age. They are common in patients with wrist fractures, in golfers and tennis players and manual labourers. Not all tears are painful.
Causes
Tears can be caused by an injury (traumatic), or may be degenerative – due to repetitive use and age related breakdown of the structure.
- Fractures.
- Falls.
- Sporting Injuries (Tennis, Golf, Baseball).
- Repetitive loading at work / sport.
- Age related degeneration.
- Excessive length of ulna bone.
Signs and symptoms
Diagnosis is based on patient’s symptoms, examination findings and imaging.
Pain
Pain is usually on the ulna side (small finger side) of the wrist. The pain is worse with movement and twisting of the wrist.
Clicking
Twisting / Bending of the wrist may cause clicking.
Weakness
There will be weakness gripping objects such as a tennis racket or tools at work.
Wrist Swelling
Some swelling of the wrist may occur.
Tests
X-ray
X-rays is used to assess if there is a fracture associated with TFCC tear. It can also demonstrate excessive ulna bone length which can also predispose to a tear.
MRI
MRI can demonstrate ligament and cartilage injury. It can demonstrate a tear of TFCC in 90% of cases.
Non-surgical treatment
Initial treatment of most TFCC tears is non-surgical, including:
Rest
Avoiding sports / activities at work aggravate the pain.
Pain killers and Anti-inflammatory Medications
These assist with pain only.
Splint
This can be worn for up to 6 weeks. A splint rests the joint and takes pressure off the TFCC so it can attempt to heal by itself.
Steroid Injection
Steroid (Cortisone) Injection is an anti-inflammatory medication which can settle the inflammation associated with the tear down.
Hand Therapy
This is aimed at maintaining motion, swelling control and strengthening the wrist.