A TFCC tear involves damage to the triangular fibrocartilage complex, a structure that provides stability to the wrist.
The triangular fibrocartilage complex, usually shortened to TFCC, is a group of ligaments and a cartilage disc on the little-finger side of the wrist. It cushions load transmitted through the wrist and stabilises the joint between the two forearm bones, the radius and ulna, allowing the wrist to rotate smoothly while bearing weight.
A TFCC tear is damage to this cartilage and ligament complex, and it is a common cause of pain on the ulnar (little-finger) side of the wrist. Tears range from small, degenerative wear that develops over years to acute tears from a single injury, and the type of tear strongly influences how it is best treated.
TFCC tears generally arise in one of two ways.
Traumatic tears follow a specific injury: a fall onto an outstretched, twisted hand, a forceful or sudden rotation of the wrist, or high-load rotational sports such as racquet sports, golf and gymnastics.
Degenerative tears develop gradually with age and repetitive loading, and are more common in people whose forearm bones are naturally aligned in a way that places more load through the ulnar side of the wrist. Manual work involving repetitive gripping and forceful wrist rotation, such as turning tools or lifting with a twisting action, can also contribute over time.
Common symptoms of a TFCC tear include:
Symptoms can be similar to other causes of ulnar-sided wrist pain, which is one reason imaging is often used to confirm the diagnosis rather than relying on symptoms alone.
Assessment includes examination of wrist stability and pain with specific rotational movements, and usually an MRI or wrist arthroscopy to confirm the tear, determine its type and location, and assess the surrounding ligaments.
Many TFCC tears, particularly degenerative ones, settle with non-surgical treatment: activity modification, a period of splinting, physiotherapy to support wrist stability, and a corticosteroid injection in selected cases.
Where symptoms persist, or the tear is traumatic and in a location that is likely to heal poorly on its own, surgery may be recommended. This is usually performed via wrist arthroscopy, and may involve trimming damaged tissue (debridement) or repairing the torn ligament, known as TFCC repair, depending on the type and location of the tear.
Many TFCC tears, especially degenerative ones treated with debridement, respond well and allow a return to normal activity. Traumatic tears repaired surgically also generally do well, though recovery of full rotational strength and stability can take several months.
Outcomes are influenced by the type, size and location of the tear, as the blood supply to different parts of the TFCC varies and affects healing potential. Ongoing wrist instability after treatment is uncommon but can occur, particularly with more complex ligament injuries.
TFCC tears are a common cause of ulnar-sided wrist pain, ranging from degenerative wear to acute traumatic injury. Many settle with non-surgical treatment, and where surgery is needed, arthroscopic techniques allow tears to be trimmed or repaired with generally good outcomes. Persistent wrist pain with gripping or rotation is worth having properly assessed.
For help distinguishing this from other causes of wrist pain, see understanding wrist pain.
