Triangular Fibro Cartilagenous Complex (TFCC) Tears

What is a TFCC tear?

The TFCC is composed of a group of ligaments that connect the wrist bones and radius to the end of the ulna.  It is one of the main stabilizers of the wrist and when injured causes problems.   A disc of cartilage lies in the centre of this ligament complex; which is particularly prone to tears.  The TFCC can become painful as a result of a traumatic tear or degenerative wear and tear of one or more of its parts.

Why have I got a TFCC tear?

TFCC tears are often caused by degeneration through normal use of the wrist.  Repetitive over-use of the wrist, with activities such as gardening or handling heavy luggage, may further aggravate the worn tissue and lead to a tear.  Traumatic tears of a healthy TFCC may be caused by falling onto an outstretched hand, forceful twisting of the wrist or from a sudden blow to the outside of the wrist.  The TFCC can also become torn during certain sporting activities, such as swinging a cricket bat, a tennis racquet or a golf club. 

Patients develop pain on the ulnar side of the wrist.  The pain may be associated with  a clicking,  catching or snapping sensation when the wrist is rotated.   An MRI arthrogram, (a scan during which contrast dye is injected into the wrist joint) will usually show the injured cartilage.  The MRI does not always show all the injuries and if necessary a wrist arthroscopy (small telescope)  may be used to visualise the TFCC directly.

What are the none operative treatments? 

Rest, ice packs and anti-inflammatory tablets such as ibuprofen are effective in managing mild symptoms.  A wrist splint may be used to reduce movement as the inflammation subsides.  A steroid injection may also be used to relieve inflammation and is effective in many cases. 

Whatare the operative treatments?

In severe cases of persistent pain or instability an operation may be required.  This can be performed as an arthroscopic (keyhole) procedure as a day case.  Two 4mm incisions are made at the back of the wrist and a small telescope is inserted into the joint.  The cartilage is examined under direct vision and the tear is identified. The torn cartilage which has caused the clicking or pain is removed with a special shaver or heat probe.  The 4mm incisions are closed with some sticky dressings and the wrist is rested in a large bandage or a slab of plaster.

If the tear is extensive or involves the periphery of the TFCC  an open repair may be necessary.   This more extensive surgery  is only required when one of the main ligaments which stabilise the wrist has been completely torn.  It will usually be clear prior to surgery that this more extensive surgery will be necessary; however rarely it is only made clear at the time of the wrist arthroscopy that the injury is more complex.  This is usually performed through a small incision on the back of the wrist and the ligaments are repaired with a strong stitch.

What can I expect after the operation?

The arthroscopic (keyhole) procedure;  If the tear has been removed with a shaver or heat probe the wrist will be rested in a plaster splint for 2 weeks.  The hand should be kept elevated in a sling (above the hart) for as long as possible during the first 5 days to prevent swelling.   The wrist will be painful after the surgery and painkillers should be taken regularly.  Unless contraindicated anti-inflammatory tablets such as ibuprofen when taken with simple pain killers such as paracetamol are effective.  At   2 weeks you will be seen in clinic, the splint and the sticky dressings will be removed and the wrist can start to be mobilised as pain allows.

Return to work, driving or sport?

Return to sedentary or office based work at 2 weeks or when pain allows.  Driving is safe after the splint has been removed.   Manual work can be resumed at 6 weeks but can be longer if the work environment (such as repetitive hammering) particularly aggravates the TFCC.    Sporting activities, such as swinging a cricket bat, a tennis racquet or a golf club should be commenced at no less than 3 months.