Triangular Fibrocartilage Complex Tear (TFCC) - Causes, Symptoms, Diagnosis, Treatment and Prevention

Introduction

The Triangular FibroCartilage Complex, known as TFCC, is a crucial wrist structure composed of durable, fibrous tissue and cartilage. It plays a significant role in supporting the joints between the forearm bones (radius and ulna), enhancing their stability. Moreover, the TFCC facilitates the connection between the forearm and the small bones on the ulnar side of the wrist (commonly referred to as the "pinkie finger" side). This complex consists of several distinct tissues that merge together to provide stability to the ulnar side of the wrist.

Furthermore, the TFCC functions as a protective cushion between the end of the ulna and the small bones (lunate and triquetrum) of the wrist. In patients with a longer ulna compared to the radius at the wrist, the TFCC tends to be thinner, making it more susceptible to tearing. When a tear occurs in the TFCC, the wrist joint may experience a sensation of weakness and reduced stability.

How Common Are TFCC Tears?

TFCC tears are relatively common. This small yet intricate structure can be easily torn due to sudden impacts or twisting injuries. Additionally, TFCC tears are more prevalent in older adults, as the tissues comprising the TFCC tend to break down and thin out with age, making the TFCC more susceptible to tears.

What Are the Causes of TFCC Tears?

A TFCC tear, or Triangular Fibrocartilage Complex tear, can occur due to many factors, and the cause can often be attributed to traumatic injuries or degenerative processes. Here are some detailed causes of TFCC tears:

• Traumatic Injuries: A significant number of TFCC tears result from acute trauma to the wrist. These injuries commonly happen during accidents, sports activities, or falls where the wrist is subjected to a sudden impact or forced into an extreme twisting motion. This can lead to excessive stress on the TFCC, causing it to tear.

• Repetitive Stress: Repetitive and forceful activities involving the wrist can also contribute to TFCC tears over time. Occupations or sports that require frequent wrist movements or excessive load-bearing may gradually wear down the TFCC, leading to tears.

• Age-related Degeneration: As people age, the TFCC's fibrous tissues and cartilage may naturally deteriorate and become thinner. This age-related degeneration weakens the TFCC, making it more vulnerable to tears, even with minor injuries or everyday activities.

• Ulnar Impaction Syndrome: In some cases, a condition called ulnar impaction syndrome can lead to TFCC tears. This occurs when the ulna (one of the forearm bones) is longer than the radius, causing excessive pressure on the TFCC when the wrist is in certain positions.

• Distal Radius Fractures: Fractures near the wrist joint, particularly distal radius fractures, can damage the TFCC as well. The broken bone fragments may impinge on the TFCC during the healing process or cause instability that contributes to tears.

• Arthritis: In individuals with wrist arthritis, the inflammation and degeneration of joint tissues can indirectly affect the TFCC's health, making it more prone to tears.

What Are the Symptoms of TFCC Tears?

TFCC tears can cause a range of symptoms, and the severity and specific symptoms may vary depending on the extent of the tear. Common symptoms associated with a TFCC tear include:

• Wrist Pain: Pain is the most common symptom of a TFCC tear. The pain is typically localized to the ulnar side of the wrist (the side of the "pinkie finger").

• Weakness and Instability: A TFCC tear can lead to a feeling of weakness in the wrist, making it difficult to perform tasks that demand grip strength or wrist stability. The wrist may feel unstable and give way during certain movements.

• Swelling: Inflammation may occur around the injured TFCC, resulting in swelling in the wrist area.

• Clicking or Catching Sensation: Some individuals may experience a clicking or catching sensation in the wrist when moving it, particularly during certain motions.

• Limited Range of Motion: TFCC tears can restrict the wrist's range of motion, especially movements that involve rotating the wrist or bending it side to side.

• Pain with Specific Movements: Pain may worsen with activities that involve gripping, twisting, or loading the wrist, such as turning a doorknob, lifting objects, or playing sports.

• Tenderness to Touch: The area over the torn TFCC may be tender to touch.

• Pain with Weight-Bearing: Applying weight to the affected wrist, such as during a push-up or plank position, may exacerbate the pain.

• Painful Wrist Twisting: Twisting the wrist, especially in an ulnar deviation (toward the pinkie finger), can elicit pain.

How to Diagnose TFCC Tears?

Physical Examination:

During the examination, the doctor will check the TFCC by feeling it with the wrist turned inwards. The TFCC is located between certain wrist bones and muscles. There are several tests to help diagnose a TFCC injury:

• TFCC Compression Test: The doctor will hold the forearm still while bending the wrist towards the pinkie finger. If this causes pain, it could indicate a TFCC injury.

• TFCC Stress Test: The doctor will apply pressure to the ulna bone while bending the wrist towards the pinkie finger. If this causes pain, it suggests a TFCC injury.

• Press Test: The patient will try to lift themselves out of a chair using their wrists in a certain way. If this causes pain, it could indicate a TFCC injury.

• Supination Test: The patient will hold the underside of a table with their forearms facing upwards. This puts strain on the TFCC, and if it causes pain, there might be a tear.

• Piano Key Test: The patient will place both hands on a table and press down. If the ulna bone sticks out more on the affected side and goes back to normal when relaxed, it suggests an unstable joint, which could be related to TFCC injury.

• Grind Test: The doctor will apply pressure on the radius and ulna bones while having the patient rotate their forearm. Pain during this test could indicate a degenerative process in the TFCC.

Diagnostic Imaging

• Radiographs (X-rays): These images can show certain wrist bone injuries like avulsion of the ulnar styloid (a piece of bone breaking off), scaphoid fractures, distal radial fractures, and the tilt of the lunate or triquetrum bones. They can also help assess ulnar variance (the difference in length between the ulna and radius).

• Triple Injection Arthrography: This procedure involves injecting a contrast dye into the wrist joint, followed by X-rays or CT scans. It can help identify tears, but it may not be very specific, meaning it may not always accurately pinpoint the cause of the tear.

• MRI (Magnetic Resonance Imaging): This imaging technique is highly sensitive and specific for identifying TFCC tears. MRI uses magnetic fields and radio waves to generate detailed images of the wrist's soft tissues, making it an effective method to detect TFCC tears.

What Is the Treatment for TFCC Tears?

Minor TFCC tears often have the ability to heal without requiring any specific treatment. If the patient does not experience pain or weakness in the wrist, the healthcare provider might suggest allowing the tear to heal naturally on its own. However, certain TFCC tears can lead to symptoms that interfere with one’s daily activities. In such situations, the healthcare provider may recommend one or more of the following treatment options:

• Medication: Taking anti-inflammatory medications like NSAIDs can help reduce swelling and alleviate pain associated with the tear.

• Bracing: Using a brace or splint to stabilize the forearm and wrist can promote TFCC healing.

• Injections: Cortisone shots can be administered to reduce swelling and inflammation in the torn tissue.

• Physical or Occupational Therapy: Doing special exercises with the help of a therapist can make the wrist and forearm muscles stronger, which can stop more injuries and help to get better.

• Surgery: Surgery is recommended if conservative treatments do not provide sufficient relief. In most cases, minimally invasive arthroscopic surgery can effectively repair TFCC tears.

How Can an Individual Prevent TFCC Tears?

TFCC tears may not always be preventable, as accidents can happen unexpectedly. However, a person can take proactive steps to reduce the risk of a TFCC tear:

• Engage in warm-up exercises before participating in sports or activities that involve twisting the arm or wrist, such as tennis or baseball.

• Strong the muscles in the wrist and forearm with regular exercises.

• Be mindful of footing while walking to avoid potential falls that could lead to wrist injuries.

Conclusion

In conclusion, TFCC tears can result from various causes, including traumatic injuries, degenerative changes, and repetitive stress. While minor tears may heal on their own, symptomatic cases may require treatment options like medication, bracing, therapy, or surgery. While accidents cannot always be prevented, adopting preventive measures such as warm-up exercises and muscle strengthening can help reduce the risk of TFCC tears.