What is the TFCC and how is it injured?
The triangular fibrocartilage complex (TFCC) is a small structure located between your ulna (a long bone of the forearm) and the lunate and triquetrum (small cube-like bones in your wrist). The TFCC is located on the pinky finger side of your wrist, right where the wrist creases when you move it. The main structures that form the complex are two ligaments, a tendon, and an articular disc that sits between the bones. Its location, in the space between the ulna and wrist bones, implies its function: providing stability and cushioning at the wrist joint. A TFCC injury can result in an unstable and painful wrist, an often frustrating injury as we use our wrist in almost all of our daily activities.
How is the TFCC injured?
There are two main types of TFCC injuries: traumatic, where there was a clear incident that started the wrist pain, or degenerative, where the injury developed slowly over a period of months to years. The most common traumatic injury mechanism is a FOOSH injury, also known as a “fall onto an outstretched hand”. It can also occur with racket sports when contacting the ball. Degenerative injuries, on the other hand, mostly result from wear and tear over time. Some people may be predisposed to TFCC degeneration if their ulna (forearm bone) is longer than normal. TFCC injuries are further subdivided into categories based on what structures of the complex were damaged. Determining the type of injury is important as it largely guides how the TFCC injury is managed.
Signs and Symptoms of a TFCC tear.
Regardless of the type of injury, there are common signs and symptoms that suggest a TFCC injury. As with any injury, depending on the severity, you may have a few or all of these signs and symptoms. People with TFCC tears typically report pain on the pinky finger side of the wrist. Pain is worsened with weight-bearing activities like pushups and by movements that involve twisting (technical term being pronation and supination) the wrist/forearm. Common aggravating activities include using a screwdriver, opening doorknobs, and turning a key in the lock. It may also feel like your wrist is clicking and/or catching when you move it. Lastly, it may feel like your wrist movement is limited and that your grip strength is reduced on the affected side.
Physiotherapy for a TFCC tear. What to expect?
If you suspect a TFCC injury, physiotherapy can help ensure you receive the correct treatment. The physiotherapist will complete a thorough assessment, ask questions about your wrist pain, examine strength and range of motion, and likely complete some special tests to confirm the diagnosis. Ruling out other conditions is particularly important with traumatic injuries due to the risk of a fracture. When considering treatment, the first step for almost all TFCC injuries is four to six weeks of physiotherapy. These first weeks consist of wrist splinting, activity modification, and exercises to keep the surrounding areas strong and healthy. After a period of immobilization, your physiotherapist will guide you through exercises and hands-on therapies that help regain your range of motion and strength. Additionally, some people may benefit from wearing a very small brace that provides wrist compression, keeping the wrist supported and healthy. While most people respond well to physiotherapy, some TFCC injuries do not resolve with physiotherapy alone and may require surgery. Your physiotherapist will monitor your progress and communicate with you and your family physician if it is appropriate to consider seeing a surgeon. While a TFCC injury can be frustrating, your physiotherapist will guide you through the injury, from diagnosis to return to activity, and ensure you receive the best possible care throughout the process. If you suspect a TFCC injury, visit a Panther Physiotherapy clinic near you!