If you’re reading this page, you’re probably experiencing wrist pain and trying to learn more about whether you have a TFCC tear and what you should do if you have a TFCC injury.
While many resources will give you a bunch of hard to understand, scientific jargon about the TFCC, this site is meant to simplify the complex medical terminology you might read elsewhere to serve as an easily understandable guide to TFCC injuries, causes, symptoms, test, and treatment options.
What is the TFCC?
The TFCC (triangular fibrocartilage complex) is an important structure in the wrist that provides stability and support to the wrist joint. If you have ever heard of someone tearing the meniscus in their knee, the TFCC is a similar structure, but in your wrist.
The TFCC is made up of cartilage, ligaments, and tendons (you might see names like the triangular fibrocartilage disc, the ulnocarpal collateral ligament, and the extensor carpi ulnaris). It helps keep your radius and ulna (the two bones in your forearm) stable when you grip, rotate, and lift things.
As you read about TFCC injuries, you may see references to the TFCC being on the “ulnar” side of the wrist. Ulnars means it is the outside, pinky-side of your wrist (ulnar refers to the ulna bone, which is the one on the outside of your wrist).
How common are TFCC tears?
More than half of the bones in the body are found in the hands, wrists, feet, and ankles. These are complex areas of the body, which are used heavily on a day-to-day basis, so it is no surprise that they are prone to injury.
One study by doctors at Massachusetts General Hospital found that 49% of people 70 years and older have a TFCC abnormality, as well as 27% of patients younger than 30 years of age. While this was just one study, it does seem to indicate that TFCC injuries are relatively common, especially as people get older.
What causes TFCC tears?
There are two primary ways that you can tear your TFCC, and there are two corresponding classifications of tears:
- Trauma – Traumatic TFCC injuries are caused by one-time events such as a fall or sudden twist. These typically happen because of a large force suddenly applied to the wrist, such as falling on an outstretched hand or forceful twisting movements like hitting a racquet or a bat.
- Degeneration – Degenerative, or chronic, TFCC injuries are caused by ongoing wear and tear of the wrist joint. The TFCC wears down and gets weaker as you age, making it more susceptible to injury. People who perform repetitive motions like swinging a bat or racquet, people who place a lot of stress on the wrist, like gymnasts and weightlifters, and people with a long ulna bone will be at higher risk for degenerative tears as they age.
What is a TFCC tear?
The TFCC ia a complex structure that acts as a stabilizer and shock absorber for your wrist joint, and there are many different ways and parts of the TFCC that can become injured from trauma or degeneration.
The standard for classifying TFCC injuries is called the “Palmer Classification.” Under this classification system, traumatic injuries are called Class 1, and degenerative injuries are called Class 2. There are also an additional nine subclassifications (1A through 1D, and 2A through 2E).
- 1A – Central perforation or tear
- 1B – Peripheral tear at base of ulnar styloid
- 1C – Distal avulsion of origin of ulnar extrinsic ligaments
- 1D – Radial detachment of the TFCC from the sigmoid notch of the distal radius
- 2A – TFCC wear and thinning without perforation, tear, or chondromalacia
- 2B – TFCC wear with lunate and/or ulnar head chondromalacia
- 2C – TFCC perforation with lunate chondromalacia
- 2D – TFCC perforation with ulna and/or lunate chondromalacia and LT ligament injury
- 2E – TFCC perforation with arthritic changes involving ulnocarpal and DRUJ
If these words don’t mean much to you, don’t worry. This is just meant to illustrate the wide range of potential injuries to the TFCC, that each have slightly different symptoms and treatment options.
What are the symptoms of a TFCC tear?
Depending on the severity and location of the tear, the symptoms for TFCC injuries can vary, but common symptoms of a TFCC injury include:
- Pain on the pinky side of the wrist: This is typically referred to in medical sources as “ulnar-sided wrist pain.” This is the hallmark symptom of a TFCC tear. The pain can be sharp or dull, and it typically worsens with gripping or twisting motions. Patients with TFCC tears often report that turning a door key is painful.
- Clicking or popping sensation: Patients with a TFCC tear may also experience a clicking or popping sensation, particularly when rotating their forearm or moving their wrist from side to side. Patients can often feel this popping sensation moving their wrist when holding their forearm with their other hand.
- Limited range of motion, weakness: TFCC tears can lead to less flexibility and mobility in the wrist. This may manifest as difficulty in fully extending or flexing the wrist, as well as reduced strength and grip when lifting heavy objects or performing other activities that place stress on the wrist.
TFCC tear vs. TFCC sprain
The terms sprain, tear, and injury are often used interchangeably when describing a TFCC injury. The more specific differences are:
- TFCC injury: Broad category that describes a variety of different conditions.
- TFCC sprain: A broad term that describes the stretching or tearing of the ligaments in the TFCC. Typically, when someone uses the term sprain, they are referring to a less serious condition that will heal by itself (But technically tears are a severe type of sprain).
- TFCC tear: While tears are often a part of sprained ligaments, when someone refers to a TFCC tear, they are typically referring to a more severe or complete tear, that is less likely to heal on its own, or will take significantly longer to heal.
As you can see, these words are not very precise, and there is a lot of overlap, so the main thing that a doctor will try to diagnose for a TFCC tear is the location and severity of the injury in the TFCC.
Diagnostic Methods for TFCC Tear
Accurately diagnosing a TFCC tear is important for figuring out the right treatment approach.
The typical process for diagnosing a TFCC tear is with an MRI. However, most people will typically research their injury online and visit their doctor multiple times beforehand to get other imaging (e.g., x-ray) and a referral before visiting a specialist who will confirm a TFCC injury with an MRI.
Here are the types of tests that will help you determine if you have a TFCC tear:
Physical diagnostic methods
- “Press test” (up) – For this test, hold your hand flat underneath the surface of a table and push up like you are trying to lift the table. If this reproduces pain and symptoms that can suggest a TFCC injury.
- “Press test” (down) – For this test, sit in a chair with arms. Attempt to press yourself up out of the chair. If this reproduces pain and symptoms that can suggest a TFCC injury.
- “Press” test (advanced) – This test measures how much weight you are able to bear on your injured wrist compared to your non-injured wrist. For this test, you need a non-digital scale that will show a weight reading when you press down. To perform the test, assume a position on your hands and knees above the scale, and then press down to see how much how much “weight” you can press into the scale. A healthy human wrist should be able to press more than 100 pounds. Compare the amount of weight you can press between the two wrists, and if there is a significant difference between the two, this suggests you may have a TFCC injury.
- “Fovea sign” test – This test requires someone to help you. Have them hold your hand and wrist and press into the “fovea,” as illustrated in this diagram. If this elicits pain or tenderness, this is a positive sign for TFCC injury.
- Compression test – This test also requires someone to help you. Put your arm in a neutral position with your elbow on a table, and have them hold your wrist firm in a neutral position. From there, pull your hand down towards your wrist to see if that reproduces symptoms.
Imaging-based diagnostic methods
- X-ray (radiographs) – Typically you will start with an x-ray to assess the wrist for a fracture and then see if you have a long ulna bone (which is a risk factor for TFCC injuries), but x-rays will not provide an indication of whether or not you have a TFCC tear
- MRI (with or without arthrogram) – Afterwards, your doctor will order an MRI to image the wrist in greater detail and this will provide a diagnosis of your TFCC tear. The arthrogram is a special type of imaging your doctor may order to provide even more detail to the MRI image by injecting dye into the joint.
- Arthroscopy – Arthroscopy is the process of inserting a narrow tube with a small camera into a small incision to see inside the joint. This is the most accurate method to diagnose a TFCC tear because the doctor will be able to physically see the size and severity of the tear.
Treatment Options for TFCC Tear
Treatment for TFCC tears varies significantly depending on the location and severity of the tear. Most TFCC injuries are treated without surgery. This typically involves adjusting one’s daily activities to not aggravate the injury and immobilizing the wrist with a brace or splint to promote healing.
In cases where conservative measures do not provide relief, or there is additional information suggesting a severe tear, surgery might be recommended. There are two main approaches to surgically repairing traumatic peripheral tears of the triangular fibrocartilage complex: open repair and arthroscopic repair.
- Open repair involves making an incision over the wrist to directly access and repair the torn TFCC.
- Arthroscopic repair is a minimally invasive procedure that uses small incisions and a camera to guide the repair of the TFCC.
Rehabilitation and Physical Therapy for TFCC Tear
Rehabilitation and physical therapy are important components of the treatment plan for a TFCC tear. The specific exercises and rehabilitation protocols may vary depending on the severity and location of the TFCC tear, as well as individual patient factors. However, some common components of TFCC rehabilitation include:
- Range of motion exercises: These exercises help to gradually restore the normal range of motion of the wrist joint.
- Strengthening exercises: To enhance stability and prevent future injuries, strengthening exercises are important. These exercises may target the muscles of the forearm, wrist, and hand to improve grip strength and overall wrist stability.
- 3. Proprioceptive training: This type of training focuses on improving the body’s awareness of the position and movement of the wrist joint. This can help with coordination and control during functional activities.
- Functional activities: As the healing progresses, the focus of therapy shifts to functional activities that replicate the demands of daily life or specific sports or hobbies. This may include gripping objects, lifting weights, or performing specific wrist movements.
Other TFCC FAQs
- What is the TFCC tear ICD 10 code? The ICD-10 code for a TFCC tear is S63.591A, which stands for “Other specified sprain of the right wrist, initial encounter.”
- What is the recovery rate from a TFCC tear? The recovery time for a TFCC tear varies depending on the severity of the injury and the treatment approach, but it can range from a few weeks to six months in the case of a surgical operation and recovery.
- Can a TFCC tear heal on its own? Yes, mild TFCC tears can heal on their own, but if you are experiencing severe symptoms or prolonged pain, you should consult a doctor.
- What happens if a TFCC tear is left untreated? Depending on the severity of the injury, you will likely feel persistent pain, clicking, and weakness when using your wrist. In some cases, there will be activities that you cannot perform, such as lifting heavy objects or pressing down into a pushup.
- Can you play through a TFCC tear? Wearing a brace or splint is one way to manage a TFCC tear while continuing to do your everyday activities. However, you should seek medical attention if you are experiencing severe symptoms or prolonged pain.
- Does a brace help TFCC injury? Yes, placing your hand in a brace or splint can help you manage the pain of a TFCC injury and promote healing.