Triangular Fibrocartilage Complex (TFCC) Tear: Causes, Signs, Symptoms, Treatment, Exercises

The TFCC i.e., triangular fibrocartilage complex^[1] is a group of ligaments that is connected with the bones of wrist and is situated on the ulnar side of the wrist. The triangular fibrocartilage complex consists of several carpal ligaments, ulnar meniscus homolog, triangular fibrocartilage disc, extensor carpi ulnaris tendon sheath and ulnar collateral ligament. The structures of this group provide cushion, stability and smooth movement of the joint of the wrist. The ligaments are strong tissues which help stick the bones with each other. The cartilage works like a cushion for the bones in the joints of the wrist and helps the bones to glide easily while performing the movements. The ulnar carpus, the distal radioulnar joint, the radiocarpal joint gets stabilized by the triangular fibrocartilage complex and it works like a shock absorber.

Triangular Fibrocartilage Complex (TFCC) Tear is a condition where an injury occurs to the triangular fibrocartilage complex located at the wrist between the carpals and the end of the ulnar bone, which helps in stabilizing the radioulnar joint. The TFCC tear may occur due to traumatic injury or degenerative wear and tear. The TFCC tear may also occur while performing certain sporting activities like swinging a tennis racquet, a golf club or a cricket bat.

• The Triangular Fibrocartilage Complex Tear mostly occurs due to wrist injury.
• It may also be caused due to degenerative changes as a result of traumatic injuries.
• Traumatic injuries generally include force and compression which may often result in fracturing of the radius or ulna.
• TFCC tear may also be caused by falling down on outstretched hands with palm facing downwards with wrist extended and bent backwards.
• It could also be caused while performing sports activities that include racquet like tennis etc.
• Triangular Fibrocartilage Complex (TFCC) Tear may also occur due to an unusually long ulnar bone, which tends to impinge on the cartilage complex.
• Repetitive overuse activities of the wrist like handling heavy luggage and gardening may also result in wearing off of the tissue leading to Triangular Fibrocartilage Complex (TFCC) Tear.

• Acute pain on the little finger side of the wrist after a blow or a fall.
• Feeling of tenderness at the back of the wrist.
• Exacerbation of pain while bending the wrist sideways when trying to move little finger towards forearm.
• Swelling.
• Clicking sound while performing movements of the wrist could also be experienced.
• Decreased grip strength.
• Weakness and instability could also be experienced in the wrist.

Generally, conservative care suffices for treatment of Triangular Fibrocartilage Complex (TFCC) Tear. It involves:

• Antiinflammatories are used for pain and inflammation.
• Corticosteroid injections.^[2]
• Splinting, bracing and rest.
• Cold therapy and ultrasound therapy for reducing pain.
• RICE protocol is followed.

Some extreme cases involving severe degenerative injuries or large tears may warrant surgery. Surgery involves sprucing torn pieces of cartilage and smoothening out the surface. For unusually long ulnar bone, the end of bone is shaved off to appropriate length. This is followed by a period of immobilization and physical therapy.

Surgery carries risk of bleeding, neurovascular injury etc.^[3]

Physical therapy for TFCC tear is essential for faster recovery and reduces the instances of future problems. It includes:

• Soft tissue massages.
• Heat and/or ice.
• Electrotherapy via ultrasound.
• Bracing.
• Improving strength.
• Lifestyle modifications.
• Returning to activity.

Stretching and strengthening exercises may need to be performed during the recovery phase to gain complete motion of the wrist.

Flexion: This is done by bending wrist in the forward direction till there is a painless stretch sensed and needs to be held for about 6 seconds and needs to be performed in 3 sets of 12.

Extension: This is done by bending wrist in the backward direction till there is a painless stretch sensed and needs to be held for about 6 seconds and needs to be performed in 3 sets of 12.

Side to Side: This is done by moving the wrist sideways. This position is kept for 10 seconds in one direction.

Wrist Stretch: For this, press the back part of the affected hand with the other one so as to bend it and hold it for 15 half a minute. Now, stretch the back of hand so as to press all fingers backwards. This position is also held for half a minute. Care should be taken to keep the arm of the affected hand straight.

Wrist Extension Stretch: To do this, the elbow is put straight and the fingers are kept on a flat surface with palms looking below. Now, the body is bent forwards and the position is held for about half a minute.

Wrist Flexion Stretch: To do this, the elbow is put straight and the fingers are kept on a flat surface with palms looking up. Now, the body is bent forwards and the position is held for about half a minute.

Forearm Pronation-Supination: ^[4]This is done with elbow on the side and bent at right angles. The palm is rotated up and the position is held for 10 seconds. Slowly, the palm is rotated downwards. This is done in 3 sets of 12 without aggravating symptoms.

Wrist Flexion: To do this exercise, a can is held in hand with palms facing upwards. Then, the wrist is bent upwards. The weight is slowly decreased. Gradually, the weight of object used needs to be increased.

Wrist Extension: To do this exercise, a can is held in hand with palms facing downwards. Then, the wrist is bent upwards. The weight is slowly decreased. Gradually, the weight of object used needs to be increased.

Grip Strengthening: For this, a spongy object is taken and squeezed hard without aggravating symptoms for about 10 seconds.

A detailed examination is carried out for diagnosis of Triangular Fibrocartilage Complex (TFCC) Tear. A neurovascular examination is also done to rule out any damage to nerves or vessels. The initial and essential step to diagnose a Triangular Fibrocartilage Complex (TFCC) Tear is an MRI scan, which is really helpful in evaluating this particular injury. X-ray may be done to assess and rule out for any underlying fractures. Other tests include CT scan in rare cases.

References: