In order to understand injury of the triangular fibrocartilage complex (TFCC) it is important to understand the anatomy of this complex structure. The TFCC consists of multiple components that comprise the ulnar side of the wrist located between the ulna and the two carpal bones. The TFCC permits complex movements of the wrist including stabilizing the ulno-carpal and distal radio-ulnar joints. It also cushions stress on the wrist and distributes pressure from the carpus to the ulna.
Components of the TFCC include:
- Triangular fibrocartilaginous disc, also referred to as articular disc
- Volar and dorsal radio-ulnar ligaments
- Meniscus homologue
- Ulnar collageral and ulno-carpal ligaments
- Sheath of the extensor carpi ulnaris
The complex nature of the TFCC leaves it particularly susceptible to injury. Around 80 percent of the TFCC is avascular meaning that it is not associated with or supplied by blood vessels. As a result, when injury occurs healing is limited in this area. Injury to the TFCC includes tears to the articular disc and the meniscus homologue. The homologue is the fibrous piece of tissue that connects the articular disc to the triquetrum bone in the wrist. Injury is typically the result of excessive force on the palm down position and abnormalities or degenerative changes in the anatomy of the wrist. Athletes, such as gymnasts, that put excessive force on their wrists and individuals that experience a forceful fall are at a higher likelihood of developing an injury of the TFCC. Symptoms include pain on the ulnar side of the wrist, clicking, snapping, weakness and swelling.
If you think you have an injury to the TFCC, getting a correct diagnosis is important. There are two grades of TFCC injury including:
Class 1: traumatic injuries
Class 2: degenerative conditions
If the wrist is stable, a splint may be prescribes to immobilize the joint allowing scar tissue to develop and eventually heal the tear. An anti-inflammatory and physical therapy may also be prescribed to aid in the healing process.
A Genesis Orthopedics & Sports Medicine physician may administer a cortisone injection to reduce pain or inflammation in the affected area. Injury to the TFCC can be debilitating. Through the intervention of a cortisone injection the affected individual can get back to his or her daily activities quicker and with less pain.
Depending on the nature of the injury, surgery may be prescribed as the best form of treatment. When the wrist becomes unstable at the result of fracture, rupture, or complete ligament tears, surgery may be required. Debridement of the area may also be used if a tear occurs in the center of the TFCC where there is little healing capacity and limited blood supply. Debridement is often an effective method to remove damaged tissue and smooth the surface of the TFCC.