The triangular fibrocartilage complex (TFCC) is a load-bearing cartilage structure located on the ulnar side of the wrist, that cushions and supports the carpal bones in the wrist. The TFCC keeps the radius and ulna stable when the hand grasps or the forearm rotates. The TFCC is at risk for acute or chronic degenerative injury. A TFCC tear can be associated with distal radioulnar joint (DRUJ) instability.
There are two types of TFCC tears as described by the Palmar Classification:
- Type 1: traumatic tears due to injury such as falling on an outstretched hand
- Type 2: degenerative/chronic tear. Degenerative process wears the cartilage down over time. Some inflammatory disorders such as rheumatoid arthritis or gout may also contribue to type 2 tears.
TFCC injury often occurs when there is a load compressed on the TFCC while the wrist is in ulnar deviation. Common causes of forced ulnar deviation include swinging a racket or a bat.
Patients will complain of ulnar-sided wrist pain that gets worse with activity. There may be a weakness in the grip, instability, or clicking. If the patient has DRUJ instablity, they may have associated weakness in pronation and supination.
Initial treatment includes rest, physical therapy and injection therapy. The length of time to attempt conservative treatment before advancing to surgical options varies.
Surgical options should be a consideration if conservative treatment fails or if there is DRUJ instability. Common surgical procedures include: arthroscopic repair, arthroscopic debridement, ulnar shortening and the Wafer procedure.
Recovery after surgery varies, but typically lasts 4-6 weeks for an arthroscopy and 3 months for an open approach. Patients will undergo physical therapy.