TFCC Tear

Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board

What Is A TFCC Tear?

The Triangular Fibrocartilage Complex (TFCC) is a complex network of cartilage and ligaments located on the ulnar (pinky) side of the wrist. It provides stability to the wrist joint and helps distribute load across the wrist during movement.

The TFCC is triangular in shape and is composed of several key structures:

The triangular fibrocartilage complex structures work together to provide support and stability for the wrist and hand joints, as well as cushioning the inner wrist from impact. They allow you to tightly grip objects and rotate your wrist.

A TFCC tear occurs when these structures are damaged, leading to pain and dysfunction. These tears are categorized into two types:

• Traumatic Tears: Type 1 TFCC tears result from sudden injury
• Degenerative Tears: Type 2 TFCC tears develop over time due to wear and tear

Causes of TFCC Tears

TFCC wrist tears can occur due to various factors, including:

• Trauma: A direct injury, such as falling on an outstretched hand, can lead to an acute TFCC tear. Sudden forced twisting, e.g. a drill bit jamming and your wrist being forced into rotation, is another common cause of a TFCC injury
  
  
• Repetitive Stress: Activities that involve repetitive excessive wrist rotation, gripping, or weight-bearing e.g. racket, bat or stick sports and weightlifting, can lead to micro-tears over time
  
  
• Degenerative Changes: Aging and chronic wear and tear can weaken the TFCC, making it more susceptible to injury
  
  
• Ulnar Variance: Individuals with a longer ulna bone compared to the radius may be at higher risk for TFCC tears due to increased pressure on the complex. Ulnar variance often develops after a wrist fracture
  
  
• Wrist Fractures: distal radius fractures and ulnar styloid fractures are often associated with a TFCC injury
  
  
• Sports & Occupational Risks: Gymnastics, racket sports, weightlifting, and manual labor jobs that require repetitive wrist movements can increase the likelihood of a TFCC tear

TFCC Tear Symptoms

Symptoms of a TFCC tear vary depending on the severity and type of tear but commonly include:

• Inner Wrist Pain: Discomfort near the ulnar (pinky) side of the wrist, especially during wrist and hand movements
• Clicking or Popping Sounds: A feeling of instability or clicking noises when rotating or gripping objects
• Weakness in the Wrist: Difficulty gripping or lifting objects due to pain and instability
• Swelling & Tenderness: The wrist may appear swollen and tender to touch
• Limited Range of Motion: Stiffness or reduced wrist movement due to pain and instability

TFCC Tear Diagnosis

Diagnosing a TFCC injury typically involves a combination of clinical evaluation and imaging tests:

• Medical History & Physical Examination: A doctor will assess wrist pain, tenderness, and range of motion. Specific tests, such as the ulnar fovea sign or the press test, may be performed to identify instability or discomfort
• X-rays: While X-rays do not show soft tissue injuries, they help rule out wrist fractures or abnormalities like ulnar variance
• MRI (Magnetic Resonance Imaging): An MRI, often with contrast dye (MR arthrogram), is very useful for diagnosing a TFCC injury, providing detailed images of the triangular fibrocartilage complex and helps confirm the presence of a tear and any associated injuries

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TFCC Tear Treatment

Treatment for a TFCC tear depends on the severity of the injury and may include non-surgical and surgical approaches:

Non-Surgical Treatment

• Rest & Activity Modification: Avoiding activities that aggravate symptoms helps reduce strain on the TFCC and gives it time to heal. You may need to modify activities e.g. grip position to reduce ongoing strain
  
  
• Wrist Immobilization: Wearing a wrist splint or brace helps stabilize the wrist in a neutral position, allowing the TFCC to heal in the correct position. This is really important to do for the first 6 weeks following an injury and can sometimes help avoid the need for surgery
  
  
• Physical Therapy: Strengthening and mobility TFCC exercises help aid recovery and restore wrist function and stability, reducing the risk of ongoing pain and recurrent injuries
  
  
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen can help manage pain and inflammation with a TFCC injury
  
  
• Corticosteroid Injections: In some cases, steroid injections can be used to reduce pain and inflammation in the wrist

Surgical Treatment

If there is a complete TFCC rupture or if conservative treatments fail, surgery may be necessary and may involve a combination of:

TFCC Injury Recovery Time

TFCC recovery depends on the severity of the tear and the chosen treatment approach:

Non-Surgical Recovery: Mild to moderate TFCC tears treated conservatively may take 6 to 12 weeks to heal. Early bracing is really important to ensure a good outcome, with best results seen when wearing a TFCC brace in the first 6 weeks

Post-Surgical Recovery: If TFCC surgery is required, recovery can take 3 to 6 months. Rehabilitation typically includes:

• Immobilization with a cast or wrist splint for a few weeks post-surgery
• Gradual re-introduction of movement and strengthening TFCC exercises under the guidance of a physical therapist
• Return to full activities once wrist strength and function are restored

TFCC Tear Summary

A TFCC tear is a common wrist injury that can lead to pain, instability, and reduced function. It can result from trauma e.g. wrist fractures, repetitive use, or degenerative changes. TFCC tear symptoms include inner wrist pain, clicking, weakness, and limited mobility.

Diagnosis is made through clinical evaluation and imaging tests like MRI or arthroscopy. TFCC injury treatment ranges from conservative approaches like rest, splinting, and physical therapy to surgical repair if necessary.

Recovery time varies, but with proper treatment and rehabilitation, most individuals regain full wrist function. If you suspect a TFCC wrist tear, seeking medical evaluation and early treatment can improve outcomes and prevent long-term complications.

You may also be interested in the following articles:

• Inner Wrist Pain
• Outer Wrist Pain
• Central Wrist Pain
• Wrist Pain Diagnosis Charts

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Medical & Scientific References

1. Triangular Fibrocartilage Complex. Radiopaedia
2. MRI Anatomy of TFCC. Dr Christoph Agten
3. Triangular Fibrocartilage Complex. National Library Of Medicine
4. TFCC Injuries: How We Treat. Journal of Clinical Orthopedic Trauma

Page Last Updated: March 3rd, 2025
Next Review Due: March 3rd, 2027

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