The wrist joint contains cartilage known as the triangular fibrocartilage complex, or TFCC. This cartilage is located on the inside or ulnar aspect of the wrist. Sometimes, TFCC injury or triangular wrist cartilage tears can cause wrist pain and clicking. So, what are the options for treating a wrist cartilage tear, and can a TFCC injection help?
What is the TFCC?
The TFCC is a complex structure that attaches to the bones inside the wrist. It’s no surprise that it has a rigid structure, given the complex movements of the wrist. The wrist joint bends forward and backwards, sideways, and rotates. It allows for fine hand movements while also providing stability and strength.
The TFCC complex comprises wrist cartilage (the triangular fibrocartilage) surrounded by stabilising ligaments at the front and back and the ECU tendon on the side. A TFCC injury consisting of a tear of the TFCC can involve any or all 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 Triangular Wrist Cartilage Tear
The most common cause of a wrist cartilage tear is a fall directly onto the hand. Other mechanisms of a TFCC injury include forced rotation or distraction (pull), such as those that occur in boxing, tennis, squash, or weight training. Generally, after trauma, tears occur at the edge of the TFCC at the radial or ulnar attachment.
Sometimes, no specific wrist injury causes a TFCC injury, which we call a degenerative TFCC tear. Degenerative tears usually occur at the centre of the cartilage. Initially, people notice a clicking, followed by a gradual onset of pain.
Symptoms of a Triangular Wrist Cartilage Tear
The most common symptoms of a TFCC injury include:
- Pain on the inside (ulnar) of the wrist
- Pain with twisting (tennis) or pressure on the wrist (weight training)
- Wrist clicking
- Loss of grip strength
Consult your doctor to confirm the diagnosis and rule out other wrist problems. Generally, there is tenderness at the TFCC in the wrist. We use special tests such as the ulnar grind test to help with the diagnosis. Additionally, assess the wrist’s stability, as larger tears can cause excessive movement of the bones and joints, including the distal radioulnar joint, leading to DRUJ instability.
If we suspect an injury to the TFCC, X-rays are performed to assess the position of the bones (to determine if one is longer than the other – called ulnar variance) and to exclude a break or fracture. Additionally, a 3T MRI is helpful to picture the cartilage and ligaments. Sometimes, wrist pain is caused by other conditions, such as arthritis or wrist tendonitis. Some doctors use ultrasound to visualise the TFCC complex, although a 3T MRI scan is better.
Other causes of ulnar-sided wrist pain include:
- Wrist instability
- Ulnar carpal impingement
Treatment of a TFCC Injury
As the TFCC is a complex structure, it is essential to modify your activity to allow the injury to heal. For acute wrist pain, we recommend wearing a brace for 4-6 weeks. Once the pain subsides, you should begin a hand therapy exercise program to stretch and strengthen your wrist.
Sometimes, a cortisone injection into the wrist joint can reduce pain and allow for hand therapy. TFCC injections are used for persistent pain.
Finally, keyhole surgery may be necessary to repair structures for larger tears with instability. Generally, surgeons like repairing large peripheral tears secondary to trauma. central degenerative tears are less responsive to surgery. Additionally, bone shortening may be required if one bone is longer than the other, known as ulnar variance.
More on a TFCC Injection
Cortisone injections can help with pain and inflammation from TFCC tears. Cortisone is a potent anti-inflammatory and should be directed to the exact site of the tear. Moreover, ultrasound guidance is vital to improve the accuracy of the injection. We use ultrasound to direct cortisone around the torn TFCC.
An ultrasound-guided injection reduces pain and allows people to progress in their rehab. Overall, the combination of an injection and recovery is very effective.
Some doctors use PRP injections to help with the healing of small tears, especially central degenerative tears. PRP is obtained by centrifuging whole blood so the heavier red and white cells move to the bottom. The plasma is separated from the cells and injected directly into the tear.
Final Word from Sportdoctorlondon about Wrist Cartilage Tear
TFCC tears cause pain in the ulnar aspect of the wrist. They can occur secondary to trauma or arise due to degeneration of the cartilage.
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 referring the patient to a hand surgeon if he thinks surgery is needed.
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