What is TFCC Injuries?
The triangular fibrocartilage complex, or TFCC is a ligamentous structure that supports, and stabilises the wrist and carpal bones. This ligament complex has multiple different elements that provide its structure.
Structure
The TFCC consists of a fibrocartilage disk, ligaments affixing the ulna to the triquetrum and lunate, ligaments affixing the radius and ulna, and a vertical ligament known as the ulna collateral ligament. The TFCC also receives support from the sub-sheath of the extensor carpi ulnaris muscle, which helps to extend the wrist backwards, and deviate the hand in the direction of the ulna (Skalski et al., 2016,). These components of the TFCC help to keep the carpal bones of the wrist stable when it extends, flexes, and rotates.
How do TFCC occur?
Injuries to the TFCC often occur post falling on an outstretched wrist, or after over-rotating the wrist and are often quite painful. These injuries are common post racquet and ball sports such as tennis and golf, martial arts, weightlifting and gymnastics. They result in pain and difficulty in actions such as push-ups, opening doors, turning keys, or pushing off from surfaces.
Diagnosis
TFCC Injuries are assessed via a combination of radiological and objective findings. Tears in the ligaments and inflammation in the sheath of the extensor carpi ulnaris can be diagnosed via MRI and less accurately using ultrasound. However, studies have found that “abnormalities” in the TFCC exist in ¼ of people aged under 30, increasing to half of people aged 70 or older. Despite these percentages, the overwhelming majority of people do not report having wrist pain (Chan et al., 2014). For this reason, symptoms such as ulnar sided wrist pain, pain through the extensor carpi-ulnaris on muscle testing, reduced grip strength and functional assessments can help accurately diagnose and unstable and pathological TFCC.
Managing the TFCC Injury
Management strategies for TFCC injuries are varied and depend on the level of damage that occurs to ligaments. The first approach in managing a TFCC is to allow the inflamed or strained structures to recover by offloading them. This is best achieved through the fabrication of a custom moulded thermoplastic splint, or a more dynamic custom brace to stabilise the wrist bones and ligaments of the TFCC (McNamara et al., 2020).
Once the affected structures of the wrist have begun to settle, your Action Rehab therapist can prescribe a series of strengthening and stability exercises to allow core musculature of the wrist and hand to work synergistically in providing the wrist and its ligaments more support to offload pain (Evans et al., 2022).
Final thoughts on TFCC Injuries
TFCC injuries, although common among athletes and individuals with active lifestyles, can be a source of significant pain and discomfort. Understanding the complex structure of the triangular fibrocartilage complex (TFCC) and how injuries occur is crucial for diagnosis and management. While not all TFCC abnormalities lead to pain, those experiencing symptoms like ulnar-sided wrist pain or reduced grip strength should seek evaluation.
At Action Rehab, our experienced therapists specialise in TFCC injury assessment and offer personalised treatment plans tailored to the level of ligament damage. Whether you require custom splints for stabilisation or a rehabilitation program to strengthen the wrist and hand, we are here to help you on your journey to recovery. Contact us today to learn more!
References
Chan, J. J., Teunis, T., & Ring, D. (2014). Prevalence of triangular fibrocartilage complex abnormalities regardless of symptoms rise with age: Systematic review and pooled analysis. Clinical Orthopaedics and Related Research®, 472(12), 3987-3994. https://doi.org/10.1007/s11999-014-3825-1
Evans, N. A., Konz, S. M., Tolbert, T. A., Jasko, J. J., & Giangarra, C. E. (2022). Recognition and management of triangular fibrocartilage complex injury. International Journal of Athletic Therapy and Training, 18(3), 37–42. https://doi.org/10.1123/ijatt.18.3.37
McNamara, C. T., Colakoglu, S., & Iorio, M. L. (2020). A systematic review and analysis of Palmer type I triangular fibrocartilage complex injuries: Outcomes of treatment. Journal of Hand and Microsurgery, 12(02), 116-122. https://doi.org/10.1055/s-0040-1713580
Skalski, M. R., White, E. A., Patel, D. B., Schein, A. J., RiveraMelo, H., & Matcuk, G. R. (2016). The traumatized TFCC: An illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex. Current Problems in Diagnostic Radiology, 45(1), 39-50. https://doi.org/10.1067/j.cpradiol.2015.05.004
