Do you have pain on the pinky side of your wrist? Does the pain worsen when you grip something or twist your wrist?
It may be caused by a tear in the Triangular Fibrocartilage Complex, or TFCC for short. The TFCC is an important structure on the pinky side of the wrist that supports the joints between the end of the forearm bones and the small bones of the wrist. It is made of tough fibrous tissue and cartilage which blend together to stabilise the ulnar side of the wrist.
The TFCC is most commonly injured through a traumatic mechanism such as falling onto an outstretched hand. Tearing or a full rupture can occur when there is adequate force through the pinky side of the wrist in a hyperextended position. Repetitive activities that continually stress the TFCC can also lead to tears. Athletes such as tennis players and gymnasts are at greatest risk, as well as people who regularly use power drills. As we age, degeneration of the TFCC can occur, such as thinning of the soft tissue, leaving it vulnerable to injury from minor forces or trauma.
TFCC injuries usually present as pain on the pinky side of the wrist, however some patients report more diffuse pain in the whole area of the wrist. Pain is generally made worse by any movement that requires the forearm to rotate and movement of the hand toward the pinkie. Wrist extension can also aggravate symptoms, such as using your hand to push up from a chair.
TFCC injuries are also often accompanied by reduced and stiff wrist movements, popping or clicking noises with movement and reduced grip strength. Mild TFCC injuries can heal on their own but moderate to severe cases left untreated can lead to chronically weak and painful wrists.
Most TFCC injuries can be treated conservatively, ie non operatively with activity modification, immobilisation using a wrist splint and analgesics. In highly symptomatic presentations, a cortisone injection may be useful to manage the pain. It is important to firstly identify and then address movement and postural issues that may have contributed to the injury. Physiotherapy will then focus on restoring pain-free wrist movement and build strength in the muscles of the wrist and arms in preparation for graded return to work, sport and function.
In more severe cases of TFCC trauma, bone fracture, or where non-operative management has been trialled and is unsuccessful, surgery may be required. In cases where there is a larger tear in the central area of the complex, surgery is indicated. This is because there is no blood supply to this area and therefore reduced healing capacity.
If you are experiencing wrist pain at work, gym, sport or just in your daily life, come in and have a chat with one of our Physiotherapists at Bend + Mend to help you get back on track.