The wrist contains a piece of cartilage called the triangular fibrocartilage complex, or TFCC. It sits on the inner (ulnar) side of the wrist — the little-finger side. A tear of this cartilage causes wrist pain and clicking. So what are the treatment options for a wrist cartilage tear, including an injection?
What is the TFCC?
The TFCC is a complex structure that connects the bones on the inner side of the wrist. That complexity is no surprise, given how much the wrist does — it bends forwards and backwards, moves side to side, and rotates, allowing fine hand movements while providing stability and strength.
The TFCC is made up of cartilage surrounded by stabilising ligaments at the front and back. A tear can involve any or all of these structures. Some tears are small and stable; others are larger and unstable. This matters, because not all TFCC tears are treated the same way.
Causes of a triangular fibrocartilage complex tear
The commonest cause is a fall directly onto the hand. Other mechanisms include forced rotation or a distraction (pull) — the kind that occurs in boxing, tennis, squash, or weight training.
Sometimes there’s no specific injury at all. People first notice clicking, followed by a gradual onset of pain.
Symptoms of a wrist cartilage tear
The most common symptoms of a TFCC tear are:
- Pain on the inner (ulnar) side of the wrist
- Pain with twisting (as in tennis) or with pressure on the wrist (as in weight training)
- Clicking in the wrist
- Loss of grip strength
It’s important to see a doctor to confirm the diagnosis and exclude other wrist problems. Assessing wrist stability matters too, because larger tears allow excessive movement of the distal radioulnar joint.
How is a wrist cartilage tear diagnosed?
If we suspect a TFCC injury, X-rays assess the position of the bones — in particular, whether the ulna is longer than the radius (ulnar variance) — and exclude a fracture. A 3T MRI then images the cartilage and ligaments in detail. Ultrasound is useful too, especially for dynamic assessment and for guiding an injection. Sometimes wrist pain has another cause, such as arthritis or wrist impingement.
Treatment of a triangular fibrocartilage complex tear
Because the TFCC is a complex structure, modifying your activity is essential for it to heal. We usually recommend a wrist brace for 4–6 weeks. Once the pain settles, an exercise programme can stretch and strengthen the wrist.
For larger tears with instability, keyhole surgery may be needed to repair the structures. And where one bone is longer than the other (ulnar variance), a bone-shortening procedure may be required.
TFCC injection: how it helps
A cortisone injection into the wrist can reduce the pain and inflammation of a TFCC tear, allowing you to progress with rehabilitation. Cortisone is a powerful anti-inflammatory, and it works best when injected directly into the exact site of the tear.
That accuracy is the key. Using ultrasound guidance, we place the injection precisely at the tear, which improves its effectiveness while avoiding the surrounding nerves, vessels, and tendons. An accurately placed ultrasound-guided injection reduces pain and lets people progress their rehabilitation — and the combination of injection and rehab is very effective.
Dr Masci is an expert in ultrasound-guided injections and performs them in selected cases of TFCC tear. He can diagnose the tear, advise on treatment, and refer to a hand surgeon where surgery is genuinely needed.
How much does a TFCC injection cost?
Dr Masci offers a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about a wrist cartilage tear
Where is the pain from a TFCC tear felt?
On the inner, little-finger side of the wrist (the ulnar side). It’s typically worse with twisting movements, with pressure through the wrist such as a press-up or a weight-training lift, and with gripping — and there’s often clicking.
Can a TFCC tear heal without surgery?
Many do. Small, stable tears often settle with a period of bracing, activity modification, and a graded strengthening programme, sometimes helped by an ultrasound-guided injection. Surgery is reserved for larger, unstable tears or for cases where an ulnar variance problem is driving the symptoms.
Does a TFCC tear need surgery?
Not usually. Most stable tears respond to non-surgical treatment. Keyhole surgery is considered for unstable tears that don’t settle, and a bone-shortening procedure may be added if the ulna is longer than the radius. An accurate diagnosis — including the tear’s size and stability — determines this.
How is a TFCC tear diagnosed?
Through history and examination, supported by imaging. X-rays assess bone alignment and ulnar variance, 3T MRI images the cartilage and ligaments, and ultrasound allows dynamic assessment and guides an injection. Assessing wrist stability is an important part of the work-up.
What else causes pain on the little-finger side of the wrist?
Other causes include wrist arthritis, distal radioulnar joint problems, wrist tendonitis, and nerve problems such as Guyon’s canal syndrome. This is why an accurate diagnosis matters before treatment.
Final word from Sport Doctor London about a wrist cartilage tear
A TFCC tear is a common cause of pain on the inner side of the wrist, with clicking and loss of grip. Most stable tears settle with bracing, rehabilitation, and — where helpful — an accurate, ultrasound-guided injection. Surgery is reserved for larger, unstable tears. Getting the diagnosis right, including the tear’s size and stability, is the first step.
If you have persistent inner-wrist pain or clicking, Dr Masci can assess you in London, including ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
Leave A Comment