What Is A Triangular Fibrocartilage Complex Tear

Introduction

The wrist is a marvel of intricate structures and precise mechanics, and the Triangular Fibrocartilage Complex, or TFCC, is critical to its stability and functionality. In this article, we'll look at the TFCC's anatomy and function to better understand what happens when it tears.¹

The TFCC's Anatomy

Structure and location

The TFCC is a small, triangular-shaped structure located on the ulnar (pinkie finger) side of the wrist joint. It is located between the ulna, one of the two forearm bones, and the ulnar carpal, a small bone at the base of the hand near the wrist joint. The TFCC is made up of various components such as fibrocartilage, ligaments, and other connective tissues.¹ It also has a meniscal homologue, a structure similar to the knee meniscus that aids in force distribution and wrist stability.

TFCC function

The TFCC performs several important functions in the wrist joint, including:

1. Load transmission: One of its primary functions is to distribute forces from the hand to the forearm, which is especially important when gripping or bearing weight. This feature aids in the prevention of excessive pressure on any single point within the wrist joint
2. Stability: The TFCC stabilises the ulnar side of the wrist, preventing excessive movement or deviation of the ulnar head and ulna bone. During wrist movements, it acts as a stabilising structure²
3. Shock Absorption: The fibrocartilage within the TFCC acts as a shock absorber, reducing the impact of sudden or forceful wrist movements. This cushioning effect is especially important during wrist rotation or impact activities
4. Load Transmission During Rotation: When the forearm rotates, the TFCC assists in the distribution of load and the maintenance of wrist stability. This is required for tasks such as turning a doorknob or using a screwdriver
5. Pressure Distribution: The TFCC helps to distribute pressure across the wrist joint surfaces, lowering the risk of uneven wear and tear on the joint²

Causes of TFCC tears 

Severe injuries

Traumatic injuries, which frequently involve a sudden force or impact to the wrist, are one of the leading causes of TFCC tears. Among these injuries are:

1. Falls: Landing on an outstretched hand can put a lot of pressure on the TFCC, which can cause tears or damage
2. Sports injuries: Athletes, especially those who engage in activities that require gripping, twisting, or weight-bearing on the wrist, are at risk of TFCC tears³
3. Accidents: Wrist trauma can result from car accidents, workplace mishaps, and other unexpected injuries

Degenerative alterations

The TFCC can degenerate over time as a result of wear and tear. Individuals who engage in repetitive motions or have a history of wrist overuse are more likely to experience these changes. Degenerative TFCC tears can be caused by:

1. Chronic overuse: Repetitive wrist motions, such as those experienced by musicians, athletes, and manual labourers, can contribute to the gradual breakdown of TFCC tissues
2. Arthritis: Osteoarthritis of rheumatoid arthritis can affect the wrist joint, resulting in TFCC degeneration³
3. Microtrauma: Even without a single acute injury, prolonged microtrauma to the wrist can weaken the TFCC over time

Repeated stress

Repetitive wrist stress injuries, such as those associated with certain professions or activities, can result in TFCC tears. Prolonged, repetitive wrist movements or constant pressure on the wrist joint can cause cumulative damage to the TFCC.

Aging

TFCC tears can also be caused by the natural ageing process. People's joint tissues lose some of their elasticity and resilience as they age. Even minor injuries or stress can cause the TFCC to tear as a result of age-related degeneration.³

TFCC tears symptoms

Wrist injuries

Wrist pain is one of the most common and noticeable symptoms of a TFCC tear. This pain is frequently localised to the ulnar side of the wrist and may worsen with gripping or twisting motions.

Instability and weakness

TFCC tears can cause wrist weakness and instability. Individuals may have difficulty gripping objects securely, and their wrist may feel shaky during certain movements.⁴

Clicking or popping feeling

When moving the wrist, some people with TFCC tears may feel a clicking or popping sensation. This can happen as a result of the TFCC's disrupted structure and its interactions within the wrist joint.

Limited range of motion

TFCC tears can restrict the wrist's range of motion, making it difficult to perform tasks that require full mobility. Turning a doorknob, twisting a key, or simply flexing and extending the wrist can become painful and restricted.⁴

Identifying TFCC tears

Physical examine

A thorough physical examination performed by a healthcare professional is often used to diagnose a TFCC tear. The doctor will assess the patient's medical history, inquire about the nature of the symptoms, and perform specific tests to evaluate the wrist's stability, range of motion, and pain points during the examination. The TFCC load test, ulnar variance test, and piano key test are examples of these tests. Physical examination provides valuable preliminary information about the presence of a TFCC tear.⁵

Imaging procedures (X-rays, MRI)

Imaging techniques are frequently used to confirm the diagnosis and assess the extent of the TFCC tear. X-rays can help rule out fractures and assess bone alignment in the wrist. TFCC tears, on the other hand, are rarely visible on X-rays. The most effective imaging modality for detecting TFCC tears is magnetic resonance imaging (MRI). An MRI provides detailed images of the soft tissues of the wrist, making it a useful tool for determining TFCC tears, their location, and severity.⁵

Arthroscopy 

Arthroscopy may be performed in some cases, particularly when the diagnosis is unclear or additional information is required. Arthroscopy is a minimally invasive procedure that involves inserting a small camera (arthroscope) through a tiny incision into the wrist joint. This allows the surgeon to see the TFCC and surrounding structures directly, allowing for a more accurate diagnosis and, if necessary, treatment during the same procedure.⁵

Treatment alternatives

Non-surgical Therapy

Non-surgical treatments are frequently used to treat TFCC tears, particularly in less severe cases. These options are intended to alleviate pain and promote healing without the use of invasive procedures.

1. Rest and immobilisation: Immobilising the wrist with a splint or brace can help alleviate symptoms and allow the TFCC to heal. It is also critical to limit activities that aggravate the condition
2. Physical Therapy: Physical therapy can help to strengthen the wrist and increase its range of motion. Exercises and modalities may be used by therapists to aid in rehabilitation⁶
3. Medications: To manage pain and reduce inflammation, over-the-counter or prescription medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed

Surgical intervention

In cases of severe tears or TFCC tears that do not respond to non-surgical approaches, surgical intervention may be required.

1. Arthroscopic TFCC Repair: Arthroscopic surgery employs a camera and small instruments inserted through small incisions. The surgeon can repair the TFCC, remove damaged tissue, and deal with any other issues that may arise
2. Open TFCC Repair: Open surgery may be required in cases of extensive damage or complex TFCC tears. A larger incision is made, and the TFCC is repaired directly with sutures or other techniques
3. Debridement of the TFCC: Debridement is the removal of damaged tissue within the TFCC. This is usually considered when the tissue is beyond repair or is causing pain and instability⁶

Rehabilitation and recuperation

A rehabilitation process is required following TFCC treatment, whether surgical or non-surgical. Physical therapy is frequently an important component of recovery, focusing on wrist strength, range of motion improvement, and pain relief. Typically, patients are guided through a gradual return to normal activities, taking into account the specific treatment and the individual's progress.⁶

Preventive measures

Ergonomics and joint defence

Good ergonomics are essential in preventing TFCC tears. Follow these guidelines whether at work or during leisure activities:

• When typing or using handheld devices, keep your wrists properly aligned
• When performing wrist-stretching activities, wear supportive wrist splints
• Use ergonomic tools and equipment to alleviate wrist strain

Exercises for strengthening and conditioning

Regular exercises can help strengthen the wrist and surrounding structures, lowering the likelihood of TFCC tears:

• Include wrist-strengthening exercises in your workout routine
• Maintain a healthy range of motion by focusing on flexibility exercises
• Include grip-strengthening exercises to reduce TFCC strain during daily tasks

Avoiding trauma and overuse

To avoid TFCC tears, it is critical to avoid overuse and trauma:

• Take breaks during repetitive wrist-stressing activities
• When possible, avoid heavy, forceful gripping and twisting motions
• For activities that require wrist strain, use proper techniques and tools⁶

Complications and long-term prospects

Recurrence risk

While many TFCC tears can be successfully treated, recurrence is possible. To reduce this risk, follow these steps:

• Adherence to post-treatment rehabilitation and guidelines is essential
• In order to maintain wrist stability, incorporate wrist-strengthening exercises into your routine
• If you have recurring symptoms, seek medical attention right away⁷

TFCC injuries that are chronic

TFCC injuries can become chronic in some cases, causing long-term problems. Chronic TFCC injuries may necessitate ongoing management and close monitoring to avoid complications.

The importance of continued care

For those who have had TFCC tears, it is critical to have regular follow-up care with a healthcare professional. Follow-up visits assist in monitoring your progress, assessing the success of treatment, and addressing any emerging issues as soon as possible.

Summary

TFCC tears recap

The TFCC is a vital component of the wrist that can tear due to a variety of factors such as trauma, overuse, and degeneration.

Stress on prompt diagnosis and treatment

Timely diagnosis and treatment are critical for effectively managing TFCC tears and avoiding long-term complications.⁷

Wrist health promotion

Prioritising wrist health through ergonomics, exercises, and prudent use can reduce the risk of TFCC tears while also contributing to overall well-being.

To summarise, understanding how to prevent TFCC tears and the significance of timely diagnosis and treatment are critical for maintaining wrist health. You can reduce your risk of TFCC tears and keep your wrists strong and functional for the rest of your life by taking preventive measures and taking good care of them.