Wrist Pain: Triangular Fibrocartilage Injuries (TFCC Tear)

One cause of pain on the outside (little finger side) of the wrist is a condition hand doctors call “triangular fibrocartilage complex injuries.” Since this is a fairly common sports injury, athletes simply call this condition a TFCC Tear.

What Is a TFCC Tear? (Triangular Fibrocartilage Injury)

Cartilage is a tough, rubbery tissue that acts as a cushion for joints. Ligaments are connective tissue that attach the cartilage to the bones, in this case in the wrist. The triangular fibrocartilage complex (TFCC) is a small piece of tissue composed of cartilage and ligaments on the little finger side of the wrist, situated just past the end of the forearm bone called the ulna.

An accident or a sports-related injury, such as a fall onto an outstretched hand or a direct blow to the little finger side of the wrist, can cause a TFCC injury or tear. Swinging a bat or racquet can cause it, or a violent twist to the wrist at work or while playing a sport can also result in damage to the TFCC.

Pain on the little finger side of the wrist is the primary symptom of a TFCC Tear or injury, often accompanied by clicking or catching when moving the wrist. A hand doctor who specializes in the hands, wrists and arms is the best person to diagnose this condition.

A physical exam will be conducted, and your hand doctor may order an X-Ray, an MRI or an arthrogram—an X-ray that is taken after a special contrast dye is injected into the wrist, to better show the area of injury. Arthroscopy may be necessary to diagnose the tear.

Most Common Causes of TFCC Tear

Triangular Fibrocartilage Complex (TFCC) injuries, often referred to as TFCC tears, are commonly caused by traumatic events or repetitive stress on the wrist joint. The TFCC is a complex structure located on the ulnar side of the wrist, providing stability and support to the joint while allowing for smooth movement and rotation. Several factors can contribute to TFCC injuries, including:


Acute trauma, such as falls onto an outstretched hand or direct impact to the wrist, is a leading cause of TFCC tears. These injuries can occur during sports activities, accidents, or workplace incidents where sudden force or pressure is exerted on the wrist joint, leading to tears or disruptions in the fibrocartilaginous structures of the TFCC.

Repetitive Strain

Repetitive activities or occupational tasks that involve frequent wrist movements, gripping, or rotation can lead to overuse injuries and gradual wear and tear of the TFCC. Activities such as typing, manual labor, racquet sports, or gymnastics may place excessive stress on the TFCC over time, resulting in degenerative changes, microtears, or inflammation within the cartilaginous tissues.

Aging and Degeneration

As individuals age, the integrity of the TFCC may deteriorate due to natural wear and tear, leading to degenerative changes and increased susceptibility to injury. Degenerative conditions such as arthritis or osteoarthritis can also contribute to TFCC tears by weakening the supportive structures of the wrist joint and predisposing the TFCC to injury.

Ulnar Impaction Syndrome

Ulnar impaction syndrome occurs when the ulna bone is longer than the radius, causing increased pressure and friction on the TFCC during wrist movement. Over time, this can lead to TFCC tears, ulnar-sided wrist pain, and instability. Individuals with anatomical variations or conditions such as ulnar positive variance are at higher risk for ulnar impaction syndrome and subsequent TFCC injuries.

How Do Wrist & Hand Doctors Treat TFCC Tear?

The early treatment of TFCC injuries by a hand doctor typically will include:

  • Wearing a protective support, such as a splint or a cast
  • Applying ice for 20 to 30 minutes 3 to 4 times each day
  • Oral anti-inflammatory medications, such as ibuprofen
  • Rehabilitation exercises designed specifically for the wrist
  • An injection of a cortisone-like medication

However, if there is a complete tear in this area, your hand doctor may require that you have surgery.

Surgery for a TFCC Tear

Hand surgeons typically consider surgical intervention for TFCC tears when conservative treatments such as rest, immobilization, physical therapy, and anti-inflammatory medications fail to alleviate symptoms or when the tear is severe and causing significant functional impairment. The decision to perform surgery depends on various factors, including the location, size, and chronicity of the TFCC tear, as well as the patient’s age, activity level, and overall health.

Surgical techniques for treating TFCC tears may vary depending on the specific characteristics of the tear and the surgeon’s preference. However, common approaches include arthroscopic debridement, repair, or reconstruction of the TFCC. Here’s a general overview of how hand surgeons perform surgery to treat a TFCC tear:

Surgical Arthroscopic Debridement for a TCFF Tear

Arthroscopic surgery involves using a small camera (arthroscope) and specialized instruments inserted through tiny incisions around the wrist joint. During arthroscopic debridement, the surgeon visualizes the interior of the wrist joint, identifies the torn or damaged portions of the TFCC, and removes any loose fragments, degenerated tissue, or debris contributing to pain and instability. Arthroscopic debridement is typically recommended for smaller TFCC tears or when the tear involves the peripheral, vascularized region of the TFCC.

Surgical Repair for a TCFF Tear

In cases where the TFCC tear is located in the central or avascular zone of the TFCC, surgical repair may be necessary to restore stability and promote healing. The surgeon may use sutures or anchors to reattach the torn TFCC to its anatomical attachment site on the ulna or radius bone. Depending on the extent of the tear, additional procedures such as capsular plication or ligament reconstruction may be performed to address associated ligament laxity or instability.

Surgical Reconstruction for a TCFF Tear

In complex cases involving large or irreparable TFCC tears, reconstruction techniques may be employed to reconstruct or augment the TFCC using autografts, allografts, or synthetic materials. Reconstruction procedures aim to restore the structural integrity and biomechanical function of the TFCC, thereby improving wrist stability and reducing pain. Common reconstruction techniques include foveal reattachment, ulnar shortening osteotomy, or tendon interposition.

Regardless of the surgical approach, hand surgeons prioritize minimizing tissue trauma, preserving vascularity, and promoting early mobilization and rehabilitation to optimize outcomes and facilitate recovery. Following surgery, patients typically undergo a period of postoperative immobilization, followed by physical therapy to restore range of motion, strength, and function of the wrist joint. Close follow-up with the hand surgeon is essential to monitor progress, address any complications, and ensure optimal healing and long-term success.

What is the Prognosis for a TFCC Tear in the Wrist?

Many TFCC tears do become painless with rest and time, even if they don’t completely heal. Patience with wearing the splint or cast, and dedication to performing the prescribed exercises to regain full range of motion and strength once the TFCC is healed will result in the best outcome.

Your hand doctor’s goal is to have your injured wrist be as strong as the uninjured one, with no pain present when performing your activity such as golf, gymnastics or work. Remember, returning to your activity too soon could cause permanent damage to the area.

Typically TFCC injuries are a result of an accident or mishap. However, using proper equipment that fits you correctly, stretching before working out, and taking frequent breaks can help prevent over-use or TFCC injuries cause by fatigue.

Top Clarkston Area Wrist & Hand Doctor

Triangular Fibrocartilage Complex (TFCC) injuries, or TFCC tears, can result from various causes, including trauma, repetitive strain, aging, and anatomical factors. Understanding the common causes of TFCC injuries is essential for accurate diagnosis, treatment planning, and prevention strategies aimed at preserving wrist joint function and minimizing long-term complications.

Prompt evaluation by a board certified hand doctor like Uzma Rehman is essential for individuals experiencing symptoms of TFCC injury, such as wrist pain, swelling, or instability, to facilitate timely intervention and rehabilitation.

If you are suffering from an injury or pain in your fingers, wrist, elbow or arm, contact board certified Clarkston area hand doctor Uzma Rehman for a comprehensive evaluation and consultation. As with most medical conditions, early detection, awareness, and a prevention or treatment plan is the most effective way to combat the effects of conditions like a TFCC Tear.

Doctor Rehman will assess your individual situation, and prescribe the treatments that are best for your condition.

Clarkston Area Wrist & Hand Doctor: 248.940.5233