Wrist · Ulnar Sided
TFCC Injuries
The triangular fibrocartilage complex (TFCC) is a complex array of ligaments that stabilize the ulnar aspect of the wrist — the side opposite the thumb. Injury may occur with trauma or alternatively over time.
Call our office · (623) 264-3300What Makes Up the TFCC
A complex array of ligaments stabilizing the ulnar aspect of the wrist.
- Superficial and deep components of the dorsal radioulnar ligaments
- Articular disc
- Ulnolunate ligament
- Ulnotriquetral ligament
- Subsheath of the ECU
- Meniscal homologue
Overview
Anatomy & How Injury Occurs
The triangular fibrocartilage complex (TFCC) is a complex array of ligaments that stabilize the ulnar aspect of the wrist (the side opposite the thumb).
Injury to the TFCC may occur with trauma or alternatively over time.
Components of the TFCC
- Superficial and deep components of the dorsal radioulnar ligaments
- Articular disc
- Ulnolunate ligament
- Ulnotriquetral ligament
- Subsheath of the ECU
- Meniscal homologue
Where the TFCC Is
The TFCC sits on the ulnar aspect of the wrist — the side opposite the thumb, also called the pinky side. It acts as a cushion and stabilizer for the joint where the forearm bones meet the wrist.
Because it stabilizes that side of the wrist, TFCC injuries typically produce pain on the ulnar side rather than the thumb side.
Acute Injuries
Partial & Complete Tears
In acute cases of trauma, partial injuries may occur. Complete rupture of the deep portion of the TFCC is a different problem, often involving the distal radioulnar joint.
Nonoperative Treatment First
Nonoperative treatment such as rest, over-the-counter medication, splinting, therapy and occasionally cortisone injection may assist with symptoms.
- Rest
- Over-the-counter medication
- Splinting
- Therapy
- Occasionally cortisone injection
Nonoperative treatment also carries risks and benefits which should be discussed with your treating physician.
MRI & Arthroscopic Treatment
When partial injuries do not improve, advanced imaging with MRI may be considered. This should be discussed with your treating physician.
Debridement
Surgical treatment with wrist arthroscopy and debridement of the torn central portion of the TFCC may alleviate symptoms.
Repair
Peripheral tears of the TFCC may be amenable to repair.
Complete Rupture & DRUJ Instability
Acute cases of trauma involving complete rupture of the deep portion of the TFCC often create instability of the distal radioulnar joint (DRUJ). In these cases, advanced imaging with MRI and potential surgical repair of the TFCC may be discussed with your treating physician.
Ulnar-Sided Wrist Pain?
An evaluation can determine whether the TFCC is involved and which treatment path — from splinting to surgical repair — is appropriate.
Request an AppointmentChronic Tears
When the Tear Is Long-Standing
In chronic TFCC tear, ulnocarpal impaction may contribute to symptoms. When it does not, and DRUJ instability is present, reconstructive techniques may be considered.
Ulnocarpal Impaction
The distal ulna may be longer than the distal radius (ulnar positive) and create impingement upon the TFCC and ulnar aspect of the lunate bone.
Read About Ulnocarpal ImpactionTendon Graft Reconstruction
In chronic TFCC tear without ulnocarpal impaction or arthritis and with the presence of DRUJ instability, surgical reconstructive techniques may be discussed with your physician.
Risks & Benefits
The decision regarding nonoperative versus operative treatment is complex and should be discussed with your treating physician.
Outcomes after surgical treatments vary and risks and benefits should be discussed in detail with your treating physician. Nonoperative treatment also carries risks and benefits which should be discussed with your treating physician.
A Long-Standing Wrist Tear?
If ulnar-sided wrist pain has persisted over time rather than following a single injury, an evaluation can clarify whether the TFCC, ulnocarpal impaction, or both are contributing.
Request an AppointmentCommon Questions
TFCC Injury FAQs
What is the TFCC?+
The triangular fibrocartilage complex (TFCC) is a complex array of ligaments that stabilize the ulnar aspect of the wrist (the side opposite the thumb).
What structures make up the TFCC?+
Components include the superficial and deep components of the dorsal radioulnar ligaments, articular disc, ulnolunate ligament, ulnotriquetral ligament, subsheath of the ECU, and meniscal homologue.
How does a TFCC injury happen?+
Injury to the TFCC may occur with trauma or alternatively over time.
What nonoperative treatment may help?+
In acute cases of trauma, partial injuries may occur. Nonoperative treatment such as rest, over-the-counter medication, splinting, therapy and occasionally cortisone injection may assist with symptoms.
When is surgery considered for a partial tear?+
When partial injuries do not improve, advanced imaging with MRI may be considered. This should be discussed with your treating physician. Surgical treatment with wrist arthroscopy and debridement of the torn central portion of the TFCC may alleviate symptoms. Peripheral tears of the TFCC may be amenable to repair.
What is DRUJ instability?+
Acute cases of trauma involving complete rupture of the deep portion of the TFCC often create instability of the distal radioulnar joint (DRUJ). In these cases, advanced imaging with MRI and potential surgical repair of the TFCC may be discussed with your treating physician.
How does ulnocarpal impaction relate to a chronic TFCC tear?+
In chronic TFCC tear, ulnocarpal impaction may contribute to symptoms. The distal ulna may be longer than the distal radius (ulnar positive) and create impingement upon the TFCC and ulnar aspect of the lunate bone.
What is the reconstructive option?+
In chronic TFCC tear without ulnocarpal impaction or arthritis and with the presence of DRUJ instability, surgical reconstructive techniques may be discussed with your physician. One surgical treatment involves harvesting a tendon from the forearm. Next, tunnels are drilled through the radius and the ulna. The harvested tendon is passed through the drilled tunnels and secured.
Read more about ulnocarpal impaction and wrist arthroscopy.
Precision Hand and Orthopedic Surgery
Ulnar-Sided Wrist Pain?
If you have pain on the pinky side of your wrist — whether after an injury or developing over time — an evaluation with Tanay Amin, MD, FAAOS can identify the cause and help you understand your options.
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Disclaimer: This information is not intended to convey, substitute or supplant any medical advice. In order to establish a treating relationship, please schedule and complete your visits with a licensed physician.
Copyright 12/10/2021 Tanay Amin, MD. Do not copy, distribute, or publish this article. Please contact Precision Hand and Orthopedic Surgery PLLC with regards to any inquiries or corrections.