Palmer and Werner introduced the term ‘triangular fibrocartilage complex (TFCC)’ in 1981 to describe the ligamentous and cartilaginous structures that suspend the distal radius and ulnar carpus from the distal ulna. It is a crucial stabilising structure of the wrist.
- Provides a continuous gliding surface across the entire distal face of both forearm bones for flexion-extension and translational movements
- Provides a flexible mechanism for stable rotational movements of the radiocarpal unit around the ulnar axis
- Suspends the ulnar carpus from the dorsal ulnar face of the radius
- Cushions forces transmitted through the ulnocarpal axis
- Solidly connects the ulnar axis to the volar carpus
How Common Are TFCC Injuries?
Torn TFCCs constitute 35% of intra-articular fractures and 53% of extra-articular fractures of the wrist. TFCC degeneration begins in the third decade of life and progressively increases in frequency and severity in subsequent decades. After the fifth decade, no normal-appearing TFCCs have been observed in cadaveric studies.
Causes of TFCC Injuries
- Falls onto a pronated, hyperextended wrist
- Power-drill injuries where the drill binds and rotates the wrist instead of the bit
- Distraction force applied to the volar forearm or wrist
- Distal radius fractures
Symptoms and Clinical Presentation
TFCC injuries typically present as ulnar-side wrist pain, frequently accompanied by clicking. Mechanical symptoms generally improve with rest and worsen with activity.
- Painful grinding or clicking with wrist movement
- Weakness of grip
- Ulnar-side wrist pain with wrist deviation
- Instability of the distal radioulnar joint
- Positive piano key sign (prominent distal ulna in full pronation)
- ECU tendon subluxation
Treatment
Treatment depends on the classification and severity of the tear, as well as the patient’s ulnar variance (the relative length of the ulna compared to the radius).
Conservative Management
- Immobilisation and rest
- Avoidance of aggravating activities
- Non-steroidal anti-inflammatory drugs (NSAIDs)
Surgical Options
The peripheral portion of the TFCC has good blood supply and peripheral tears can be repaired. Central avascular tears must be debrided as they have no potential for healing. Surgical approaches include:
- Arthroscopic debridement for degenerative central tears
- Arthroscopic repair for peripheral tears
- Ulnar shortening osteotomy where positive ulnar variance is a contributing factor
- Salvage procedures such as the Sauve-Kapandji or Darrach procedure for complex cases
If you are experiencing ulnar-side wrist pain, clicking, or weakness, an early assessment is important to guide appropriate management and avoid further damage. Please contact us to arrange an appointment.