The Triangular Fibrocartilage Complex (TFCC) plays a pivotal role in maintaining stability and function within the wrist joint. TFCC injuries, often encountered in physiotherapy practice, can significantly impact your quality of life. Let’s delve deeper into this condition to understand its complexities, assessment, and effective management strategies.
Description
TFCC injuries refer to damage or tears in the triangular fibrocartilage located at the base of the wrist. This complex structure comprises ligaments, cartilage, and other connective tissue, contributing to wrist stability and smooth joint movement.
Anatomy
The TFCC is an intricate network of ligaments, cartilage, and tendons that connect the ulna (inner arm bone), radius (outer arm bone), and several carpal bones of the erist. It provides stability during rotational movements and weight-bearing activities of the wrist. The TFCC is made up of the following:
- Ulnotriquetral ligament.
- Ulnolunate ligament.
- Radioulnar ligament.
- Articular disc.
- Extensor carpi ulnaris tendon sheath.
You may be at risk due to the below:
- Repetitive wrist movements (as seen in sports or certain occupations).
- Trauma or sudden impact on the wrist
- Aging, leading to degeneration of the TFCC
- Specific sports activities stressing the wrist joint (e.g., tennis, gymnastics)
Signs and Symptoms
You may have a TFCC injury if you present with the following:
- Pain, often located on the ulnar side/inner side of the wrist.
- Swelling or tenderness
- Reduced grip strength
- Clicking or popping sensations during wrist movements
- Difficulty in rotating the forearm or performing weight-bearing activities
Diagnosis
The diagnosis is made clinically based on your subjective complaints and physical examination. Your physiotherapist will conduct a thorough assessment in order to get an accurate diagnosis.
Assessment
Your clinical evaluation will look at the following:
- Observation of any deformities or swelling.
- Range of motion at the wrist.
- Strength testing if symptoms are not irritable or painful without easing.
- Special tests to stress the TFCC structure.
Management
Conservative Approaches: Rest, immobilization, ice application, and anti-inflammatory application during the initial stages.
Orthopedic Surgeon’s Role: Your orthopedic surgeon may refer you for further imaging in order to detect which structure(s) have been injured.
Physiotherapy’s Role:
Strapping to stabilize the wrist joint.
Pain avoidance advice.
Soft tissue mobilization.
A rehabilitation program focussing on strength, stability and mobility.
If you think you may have injured your TFCC, we strongly suggest that you get it looked at in order to avoid complications.
References
Jawed, A., Ansari, M.T. and Gupta, V. (2020) ‘TFCC injuries: How we treat?’, Journal of Clinical Orthopaedics and Trauma, 11(4), pp. 570–579. doi:10.1016/j.jcot.2020.06.001.
Lerma, E.G. et al. (2022) ‘Rehabilitation in triangular fibrocartilage complex injuries: Treatment algorithm’, Revista Iberoamericana de Cirugía de la Mano, 50(01). doi:10.1055/s-0042-1748854.
Palmer, A.K. (1990) ‘Triangular fibrocartilage disorders: Injury patterns and treatment’, Arthroscopy: The Journal of Arthroscopic & Related Surgery, 6(2), pp. 125–132. doi:10.1016/0749-8063(90)90013-4.
POGLIACOMI, F. et al. (2021) ‘Traumatic triangular fibrocartilage complex tears: “State of the art” from diagnosis to treatment’, Minerva Orthopedics, 72(2). doi:10.23736/s2784-8469.20.04029-1.
Skalski, M.R. et al. (2016) ‘The traumatized TFCC: An Illustrated Review of the anatomy and injury patterns of the triangular fibrocartilage complex’, Current Problems in Diagnostic Radiology, 45(1), pp. 39–50. doi:10.1067/j.cpradiol.2015.05.004.
