Triangular Fibrocartilage Complex (TFCC)
The TFCC is an integral part of wrist stability and a “shock absorbing” structure of the wrist. The TFCC is often overlooked due to its many parts and is often injured in association with other wrist and forearm related injuries. The TFCC is just that – complex. It is comprised of 5 ligaments, a cartilage disc, and a wrist extensor tendon. Additionally, the TFCC is divided into two sections: central and peripheral. The central portion is avascular, meaning lacking blood supply. The central portion is thereby unable to regenerate and heal even with repair, making this a challenging injury from which to recover. However, the peripheral portion of the TFCC does receive blood flow and favors good repair and recovery. Can you turn your palm up to wash your face or your palm down to type on your computer? Thank your TFCC!
R-E-S-P-E-C-T your TFCC!
TFCC injuries often occur from trauma such as falling on outstretched hand (FOOSH) or a distal radius fracture, but can also be a result of repetitive strain. Additionally, the TFCC begins to naturally lose integrity past 50 years of age (we know... so unfair!). TFCC injuries often occur when force is compressed through the wrist during ulnar deviation – like when swinging a bat or racket. Additionally, some individuals are born with positive ulnar variance, meaning the ulna is longer than normal. In these cases, the bone protrudes into the TFCC space, contributing to strain or deterioration.
Individuals who experience TFCC injury often have pain with weight bearing, such as pushing on arm rests on a chair when transitioning from sitting to standing, turning a key, and general “ulnar sided” wrist pain. Other symptoms include clicking, grinding, or a crunching sensation with wrist motion and arm use.
So, what do we do?!
Treatment for a TFCC injury includes non-operative and surgical approaches.
- Non-operative: common approach for a TFCC strain or sprain
- Immobilization of wrist to limit motion and rest affected structures using braces, splints, or kinesiology taping. This allows the involved components to rest and heal, facilitating a good recovery!
- Surgical: typical approach if injury to avascular portion of TFCC or chronic injury
- Debridement: “cleaning out” the injured or scarred portions of TFCC and can range from arthroscopic to an open procedure.
- Repair: indicated on patient to patient basis due to complexity of involved components, patient presentation and medical history; all affecting how a patient will respond and recover from a surgical repair. An open procedure will result in casting for 8-12 weeks post-operatively, then splinting, and then finally hand therapy!
- Hand Therapy: beneficial for both operative and non-operative TFCC cases.
- Non-operative therapy includes stability, strength, and endurance building, while maintaining pain-free range of motion.
- Post-operative therapy focuses on regaining pain-free motion, with gradual progression of strength, endurance, and proprioceptive (or joint feedback and awareness) exercises.