The wrist joint contains cartilage called triangular fibrocartiage complex or TFCC. The carriage is located on the inside or the ulnar aspect of the wrist. Wrist cartilage tears can cause wrist pain and clicking. So, what are the options for treating a wrist cartilage tear including an injection?
What is the TFCC?
The TFCC is a complex structure that attaches the bones of the inside of the wrist. It is no surprise that it’s a complex structure given the complicated movements of the wrist. The wrist joint bends forwards and backward, sidewards, and rotates. It allows fine movements of the hand but also provides stability and strength.
The TFCC is made up of cartilage surrounding by stabilising ligaments at the front and back. A tear of the TFCC can involve any or all of the structures. Some tears are small and stable while others are larger and unstable. Therefore, not all TFCC tears are treated the same.
Causes of a wrist cartilage tear
The most common cause of a wrist cartilage tear is a fall directly onto the hand. Other mechanisms include a forced rotation or distraction (pull) such as occurs in boxing, tennis, squash, or weight training.
Sometimes, there is no specific injury to the wrist. Initially, people notice a clicking followed by a gradual onset of pain.
Symptoms of a wrist cartilage tear
The most common symptoms of a TFCC tear include:
- pain on the inside (ulnar) of the wrist
- pain with twisting (tennis) or pressure on the wrist (weight training)
- clicking in wrist
- loss of grip strength
It is important to see your doctor to confirm the diagnosis and exclude other wrist problems. In addition, it is important to assess the stability of the wrist as larger tears cause excess movements of the bones and joints of the wrist (distal radioulnar joint).
If we think there is an injury to the TFCC, then X-rays are performed to assess the position of the bones (whether one is longer than the other) and exclude a break or fracture. Additionally, a 3T MRI is useful to picture the cartilage and ligaments. Sometimes, the cause of wrist pain is due to other problems such as arthritis or wrist tendonitis.
Treatment of a wrist cartilage tear
As the TFCC is a complex structure, it is important to modify your activity to allow it to heal. Generally, we recommend you wear a brace for 4-6 weeks. Once the pain settles, you should start an exercise program to stretch and strengthen the wrist.
Sometimes, a cortisone injection into the wrist joint is useful to reduce pain and allow for therapy.
Finally, for larger tears with instability, key-hole surgery may be needed to repair structures. Also, if one bone is longer than the other (ulnar variance) then bone shortening may be needed.
More on cortisone injections for a TFCC tear
Cortisone injections can help with pain and inflammation from TFCC tears. Cortisone is a powerful anti-inflammatory and should be directed to the exact site of the tear. Moreover, it is important to use ultrasound guidance to improve the accuracy of an injection.
An ultrasound-guided injection reduces pain and allows people to progress their rehab. Overall, the combination of an injection and rehab is very effective.
Dr Masci is an expert in ultrasound-guided injections and performs injections in some cases of TFCC tear. He can diagnose a TFCC tear and advise on treatment including a referral to a hand surgeon if he thinks surgery is absolutely needed.
Other hand conditions: