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Treating TFCC Tears
Posted on 12-25-2024 in Hand & Wrist by Dr. Steven Kronlage
The triangular fibrocartilaginous complex (TFCC) is a structure on the small finger side of the wrist. It is the main stabilizer to the wrist in rotation (pronation and supination). It also cushions and supports the small bones of the wrist, especially when gripping. An injury to the TFCC can cause chronic wrist pain.
Treatment options for TFCC tears depend on if the injury is traumatic or degenerative. Visit TFCC Tears for additional information, including symptoms and diagnosis details.
Acute Traumatic Tears: If a TFCC tear is suspected following an injury, an MRI is obtained to confirm the diagnosis and ensure there is no other. If the injury is less than one to two weeks old, we can usually get the injury to heal without surgery. A long arm cast is used for a month to prevent rotation. A brace that limits rotation to a small arc is then used for another month. Depending on the sport and symptom level, a patient can return to activities at two to three months with the wrist taped.
Chronic Traumatic Tears: A ‘wrist sprain’ that just hasn’t gotten better is the most common type of traumatic tear. Of course, the patient did not know they had a significant injury and may even have been to the ER and had normal x-rays. They may have worn a splint. These patients are treated with wrist arthroscopy and arthroscopic repair of the TFCC. They will also have to be prevented from rotating after surgery, just like the non-operative patients. Surgical patients can’t return to sport for at least three months.
Degenerative Tears: Patients with degenerative tears are treated according to other pathology that may be Most patients will have had pain for some time and will opt for surgical intervention. The difference in surgery for a degenerative tear is that the TFCC cannot be repaired. The portion that is injured in a degenerative tear is the center or avascular zone of the TFCC. This is treated much like a meniscal tear in the knee. We will use arthroscopic means to shave down the torn edges and decrease the mechanical catching that causes pain. Sometimes we can shave the tip of the ulna bone off if it is in the way. If the ulna bone is quite long, we may need to shorten the bone, although this is very rare.
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