TFCC Tear
By
TFCC Tear: An Injury to the Wrist
The Triangular Fibrocartilage Complex (TFCC) is a cartilage complex located in the wrist between the carpal bones, ulna, and distal radioulnar joint (DRUJ). Injury is caused to the TFCC either by degeneration, overuse, or trauma.
Symptoms include loss of strength to the hand and wrist, pain, and swelling to the small finger side of the wrist.
Treatment for a TFCC injury includes increasing range of motion, promoting muscle healing, introducing specific resistive and strengthening exercises, and integrating functional tasks to promote independence in all daily activities.
What are the Types of TTFC tears?
There are Type I and Type II TFCC tears. Type I is an acute injury caused by trauma to the wrist typically through a fall on an outstretched hand (FOOSH) or excessive arm rotation. A Type II injury is a chronic injury caused by degeneration of the cartilage over time.
Anatomy Involved with the TTFC
The wrist is a synovial joint and is made up by the proximal row of carpal bones, the radius, and ulna. Carpal bones are the eight small bones located in your hand, while the radius and ulna are the bones in your forearm.
Numerous muscles and ligaments surround these bones, including the TFCC. The TFCC is located to the ulnar (small finger side) of the wrist and hand.
The boundaries of the TFCC are:
- extensor carpi ulnaris tendon
- ulnocarpal ligament
- radioulnar ligament
- triangular fibrocartilage disc.
The purpose of the TFCC is to distribute force and stabilize the wrist. During force and weight distribution the ulnar head and triquetrum (carpal bone) become the primary stabilizers for the DRUJ.
While the wrist is in extreme movement ranges between extension, flexion, ulnar deviation, and radial deviation the TFCC supports the structures of the hand and wrist from injury.
Signs, Symptoms, and Causes of TTFC Tear
Signs and symptoms of a TFCC tear include:
- loss of grip strength
- pinch strength
- pain in the wrist or small finger
- worsening pain when the wrist is bent side-to-side
- swelling
Typical causes of a TFCC tears are either trauma through a FOOSH (or chronic degeneration. Some differential diagnosis for a TFCC injury includes ulnar impaction syndrome and wrist strain or sprain.
What is FOOSH?
FOOSH means “Fall on outstretched Hand”.
Tests and Diagnosis with TFCC Tears
Typical tests that are done to determine a TFCC tear for a possible diagnosis is a palpation test called the Fovea Sign, which manipulates and isolates a pain location between the ulna and flexor carpi ulnaris. Physicians may also order an X-Ray or MRI to determine extent of injury to the TFCC.
How Do You Fix a TFCC Tear?
A therapist (occupational or physical) will focus on establishing a baseline and determining your level of function prior to the injury.
Therapeutic intervention includes increasing range of motion (ROM) by extending the end ranges of joint mobility, introducing resistive, strengthening, and endurance exercises that focus on the TFCC.
ROM is increased passively (by the therapist), actively (by the patient), or active assisted with a secondary device such as a supination wheel.
While receiving treatment from an occupational or physical therapist a custom-made orthosis may be developed in order to keep the wrist in an immobilized protective position to allow for healing of the TFCC.
Some modalities such as moist heat, fluidotherapy, and ultrasound can be used to facilitate healing within the Distal Radial Ulnar Joint.
Typical therapeutic treatment will focus on increasing pain-free active range of motion in flexion, extension, radial deviation, and ulnar deviation. Motion can be increased through interventions including supination wheels, passive range of motion, and tendon gliding.
Once motion has returned and pain has decreased, strengthening can be introduced. Specific strengthening techniques used include:
- flex-bars
- thera-putty
- peg grasping
- weight bearing
- resistive opposition
During strengthening more functional tasks will be implemented including using a hammer as a weight, putting together nuts and bolts, or twisting a wrist roller.
A physician may recommend taking Aleve or ibuprofen as an NSAID or trying cortisone injections. If none of the conservative treatments work, surgery be the next step with an arthroscopic debridement of the TFCC.
Prevention and Home Remedies for the TFCC
Prevention of a TFCC tear includes avoiding excessive and strenuous wrist motions and activity modification to any repetitive painful movement.
Ways to help improve your symptoms at home and to reduce pain as well as swelling include resting the wrist, icing the joint for 8-10 minutes at a time with a towel in between skin and ice pack, compress the area with an ace bandage to avoid excessive motion.
You may take over the counter (OTC) Ibuprofen or Naproxen for pain and swelling if cleared by your physician. To schedule a hand therapy appointment at JOI Rehab, please call 904-858-7045.
Related Articles: Wrist Injuries and Carpal Tunnel
If you need an appointment at the Jacksonville Orthopedic Institute, call 904-JOI -2000, schedule online, or click the link below.