Articles TFCC Injuries

July 1, 2019

TFCC injuries are a common source of wrist pain. Please continue reading to gain a better understanding of this injury, causes, risk factors and physiotherapy management.

Basic Anatomy

Your wrist is a complex joint and made up of:

  • the 2 bones of your lower arm (radius and ulna)
Lower Arm Bones
  • 8 small interconnecting bones collectively called the carpels.
Carpel Bones

The space formed between these bones is the wrist joint.

Wrist Joint


What is the TFCC?

Your bones are held together by ligaments. Located towards the little finger side of your wrist is a major stabilising structure called the Triangular Fibrocartilage Complex (TFCC). It is comprised of a cartilage disc and several ligaments and helps to bind the bones of the wrist joint together. 

TFCC

What Does The TFCC Do?


Stabilises the Bones of the Wrist Joint

The main role of the TFCC is to provide stability between:

  • the ends of the 2 lower arm bones to prevent separation
Radioulnar Ligament- Connecting the Radius and Ulnar
  • the end of the ulnar bone and the carpels to prevent unwanted movement at the wrist joint 
Ulnocarpel Ligament- Connecting the Ulnar to the Carpel Bones

Absorb Impact 

A cartilage disc is located between the ends of the lower arm bones and carpels. This is much like the cartilages found in your knees which act as a shock absorber.


Forms the Joint surfaces

The cartilage disc bridges the gap between the lower arm bones to provide a smooth continuous joint surface for the carpel bones to glide over.

TFCC Injuries

TFCC injuries are typically managed with conservative physiotherapy treatment. Occasionally, a cortisone injection may be required to alleviate inflammation. In rarer circumstances surgical intervention may be indicated . Unfortunately, TFCC injuries can take several months to heal at best. This is because ligament and cartilage have poor blood supplies therefore, heal very slowly. TFCC injuries can be divided into 2 categories:

  • Acute Tears, are generally the result of a frank incident or sudden trauma (i.e. fall). Acute tears can also occur following a wrist fracture, this should be investigated if you still experience pain long after your fracture has healed. 
  • Degenerative Tears,  are due to wear and tear and overuse. As we age the blood supply to our ligaments lessen and our cartilages loose their water content becoming  less “springy”, this makes it a lot easier to develop tears. 
Acute TFCC tears are most commonly the result of falling onto an outstretched hand

Causes 

  • fall onto an outstretched hand 
  • repeated impact on an outstretched hand (i.e. gymnastics)
  • excessive torsion forces on  the wrist (i.e. racket sports, pulling down on a heavy lever) 
  • sudden traction of the wrist 
Repeated impact on an outstretched hand can cause a TFCC injury

Symptoms

  • pain over the little finger side of the wrist 
  • pain/numbness/ tingling into the little finger,
  • restricted wrist movement
  • weakness
  • pain bearing weight through an extended wrist (i.e. push up position)
  • pain with rotational wrist movements.  
  • pain tilting the wrist from side to side
  • cluncking of the wrist
Pain Referral Pattern of a TFCC injury

Risk Factors 

  • older age 
  • individuals with a length discrepancy between the lower arm bones (ulnar variance, see image below)
  • participating in sports/occupations subjecting the wrists to impact
  • wrist fracture involving the joint line
Ulnar Variance
Having a positive or negative ulnar variance can increase your risk of a TFCC injury

Common Associated Injuries

  • fracutres
  • osteoarthritis of the wrist 

Diagnosis

Diagnosing a TFCC injury is based on an individuals clinical presentation and imaging. In many cases imaging is not always necessary.

  • Subjective and Physical Examination
  • Xray
  • MRI
MRI- TFCC Tear

Physiotherapy Management

  1. Following an acute injury our priority is to minimise the extent of damage, reduce inflammation and decrease pain. Modalities such as RICE (Rest, Ice, Compression, Elevation), strapping, bracing ,manual therapy and may also be used.
  2. Provide education, address unhelpful beliefs regarding the injury, identify and modify aggravating factors
  3. Restore pain free wrist range of motion and prevent secondary complications 
  4. Strengthen the muscles of the wrist and upper limbs
  5. Identify and address movement and postural issues that may have contributed to the injury (i.e. stooped posture, poor positioning of the shoulder blades, poor wrist posture)
  6. Graded return to work, sport and function
Wrist Widget
This brace supports the ligaments which hold the ends of the lower arm bones together

Please keep in mind the information provided is general in nature and should not be used as a substitute to consult your treating health professional. If you have any specific questions or require assistance with your individual treatment requirements please do not hesitate to contact My Family Physio in Pittwater Place Shopping Centre, Northern Beaches

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