TFCC Lesion of the Wrist: Symptoms and Treatment of a Lesion of the Triangular Fibrocartilage Complex (TFCC Lesion)

TFCC is the abbreviation for the term “triangular fibrocartilage complex.” This complex is a triangular ligament-cartilage structure located between

• the lower end of the ulna (distal ulna),
• the carpal bones on the side of the body, and
• the lower end of the radius (distal radius).

The cartilaginous, triangular plate is also called the discus triangularis and is attached to the wrist on the little finger side via fibrous components.

Definition of “discus triangularis”: “Discus” is the medical term for cartilage, and “triangularis” means triangular. It is a very important structure for the stability and function of the entire hand, as well as for the mobility of the wrist.

The triangular fibrocartilage complex is subjected to stress during nearly every wrist movement and therefore consists of very stable ligamentous and cartilaginous fibers. Nevertheless, a strong and sudden impact can cause an injury (lesion) to this fibrocartilage. This often occurs as a result of a fall. A TFCC lesion is therefore considered a typical sports injury, but it can also result from chronic improper loading.

A TFCC lesion involves damage to the discus triangularis, which manifests as pain when moving the ulnar (elbow-side) wrist.

In medical terminology, both

• a strain,
• a partial tear, as well as
• a complete tear

are referred to as a TFCC lesion.

A strain, being the least severe type of injury, usually represents a temporary TFCC lesion; however, it often leads to painful restriction of movement.

Given the TFCC’s location and its role in movements of the outer (=ulnar) wrist, various types of pain in the wrist and fingers are typical of a TFCC lesion. If you experience the following symptoms, consider the possibility of a TFCC injury:

• movement-related discomfort and pain on the little-finger side of the wrist
• Painful discomfort during rotational movements of the ulnar side of the wrist
• Pain when flexing the wrist
• Pain during lateral hand movements away from the body
• Pain when rotating the forearm against resistance
• Unusual swelling above the wrist on the little finger side

TFCC lesions are usually caused by degenerative (wear-and-tear) or traumatic (injury-related) changes.

Degenerative changes primarily affect people who, for a variety of reasons, have subjected their wrist to one-sided overuse or improper loading for many years. This can result in hardening and tears in the TFCC area. The risk of wear and tear increases with age, which is why degenerative injuries to the TFCC also become more common in older adults. 

In children and adolescents, the cartilaginous complex is not yet fully developed, making it equally susceptible to injury. However, degenerative conditions play a lesser role here; instead, accidents and traumatic impacts are the primary causes.

In addition, rheumatic diseases often attack the cartilage-like tissue and damage it over time.

Sports injuries or so-called twisting injuries are also possible causes. In some cases, a congenital elongated ulna (ulna plus variant) can exert increased pressure on the cartilage and cause long-term damage.

If symptoms occur after an accident involving the wrist, a TFCC lesion is likely. Therefore, a medical examination should be performed, during which the wrist, forearm, and hand are inspected (examined visually) and palpated (felt). Particular attention is paid to whether you

• experience pain when rotating the wrist under load, as well as
• tenderness in the ulnar side of the wrist

.

An ultrasound examination is also helpful for visualizing the ligament structures and detecting joint effusions. X-rays can be used to confirm or rule out bone injuries (fractures). Magnetic resonance imaging (MRI) is the most reliable and accurate diagnostic test. This imaging technique aids in diagnosis and identifies the exact location and severity of the TFCC lesion.

There are two treatment approaches for a TFCC lesion:

• conservative treatment and
• surgical treatment

The indications and treatment measures are discussed in more detail below.

What does conservative therapy involve?

Conservative therapy avoids invasive procedures (those that penetrate the body from the outside); the focus is on pain management and protecting the joint. In most cases, approximately three weeks of immobilization is recommended. This requires wearing a wrist brace.

Other aspects of conservative treatment include pain relievers, anti-inflammatory ointments, and icing the wrist. In the majority of cases, this conservative treatment is sufficient to allow the cartilage to heal and the symptoms to subside. However, if symptoms persist, surgical procedures should be considered.

What happens during surgical treatment?

If you continue to experience symptoms even after prolonged immobilization, or if wrist instability is present, arthroscopy (wrist arthroscopy) is usually indicated for further diagnosis and treatment.

During this arthroscopy, the interior of the joint can be assessed, and any tears or fissures can be sutured or smoothed out at the same time. In addition, worn-out or inflamed tissue is removed. Following the procedure, immobilization with an upper arm splint is required for 4–6 weeks, so that this injury, too, is usually fully healed after about 6 weeks.

Are there any special considerations for wear-and-tear-related lesions?

Degenerative injuries caused by wear and tear are also usually treated conservatively with pain management, immobilization, and cooling. Arthroscopic surgery is performed only in cases of persistent symptoms to smooth out irregularities.

In rare cases, due to severe wear and tear and persistent severe pain caused by osteoarthritis, a procedure known as joint fusion is recommended. This procedure aims to stabilize the joint, which reduces or eliminates movement-related pain. However, joint fusion also leads to a significant impairment in daily life, as hand function is severely restricted. Therefore, careful consideration should be given to whether this surgery is truly necessary and advisable.

What happens during ulnar shortening surgery? 

If your condition is caused by an elongated ulna—a condition known as ulnar impaction syndrome—ulnar shortening is a surgical method that can usually provide lasting relief from symptoms. However, conservative treatments should be tried first before considering surgery.

Ulna shortening is now almost exclusively performed using minimally invasive arthroscopy. Open surgery is performed only very rarely. You can have this procedure done as an inpatient or on an outpatient basis, and under general anesthesia if you wish.

Healing after ulnar shortening usually occurs quite quickly. After a period of immobilization, you will be able to move your wrist again without pain.

If you suspect a TFCC lesion in your wrist, it’s best to see an orthopedic surgeon or a hand surgery specialist right away.

If arthroscopy is necessary, a hand surgery practice or clinic is best equipped to perform the procedure.

Although most treatments for injuries to this vital complex are performed on an outpatient basis, hospitalization may be recommended in exceptional cases. This may be necessary in cases of particularly complex findings or if complications arise.

Minor injuries often heal on their own with wrist immobilization. The wrist is usually able to bear weight again after three to four weeks. After surgery, however, the hand requires a recovery period of about six to eight weeks to regenerate.

Following hand surgery, it is essential to undergo occupational therapy or physical therapy to prevent restricted movement and muscle atrophy resulting from the period of immobilization.

Even more severe injuries requiring surgical treatment of the TFCC usually heal over time to the point where you can once again bear full weight on your wrist.

Hand surgery today offers numerous surgical options to fully stabilize the wrist again, even in cases where the TFCC has separated from the ulna. In most cases, it is therefore only a matter of time before you can move your wrist again without discomfort.