TFCC lesion: information and TFCC specialists

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

A TFCC lesion is an injury to the most important joint in the wrist, the TFCC, short for triangular fibrocartilage complex. The TFCC, also known as the triangular disc, is a triangular ligament-cartilage junction between the ulna, carpal bone and radius. A TFCC lesion often occurs in the course of a fall.

Below you will find further information on this injury and selected specialists for the treatment of a TFCC lesion.

ICD codes for this diseases: S63.3

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Article overview

What is TFCC?

TFCC is the abbreviation fortriangular fibrocartilage complex. This complex is a triangular ligament-cartilage connection between

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

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

Definition of the term discus triangularis: Discus is the medical term for cartilage and triangularis for triangular. It is a very important structure for the stability and functionality of the entire hand and the mobility of the wrist.

What is the definition of a TFCC lesion?

Thetriangular fibrocartilage complex is stressed with almost every wrist movement and therefore has very stable ligament and cartilage fibers. Nevertheless, strong and sudden force can lead to an injury (lesion) to this fibrocartilage complex. This often occurs in the course of a fall. The TFCC lesion is therefore considered a typical sports injury, but can also be the result of permanent incorrect loading.

In the case of a TFCC lesion, damage occurs in the triangular disc, which becomes noticeable through pain when moving the ulnar (ulnar-sided) wrist.

In medical jargon, both

  • a strain,
  • a partial tear, but also
  • a complete tear

is referred to as a TFCC lesion.

A strain, as the least severe damage, is usually a temporary lesion of the TFCC, but often leads to a painful restriction of movement.

Schmerzen im Handgelenk
A TFCC lesion causes pain in the wrist © ipopba | AdobeStock

What are the typical symptoms of a TFCC lesion?

Based on the localization of the TFCC and its significance in movements in the outer (=ulnar) wrist, different types of pain in the wrist and fingers are typical of a TFCC lesion. Consider the possibility of a TFCC injury if the following symptoms occur:

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

What are common causes of a TFCC lesion?

The causes of a TFCC lesion are usually degenerative (wear and tear-related) or traumatic (injury-related) changes.

People who have overloaded or misloaded their wrist on one side for many years for a variety of reasons suffer most from degenerative symptoms. This can result in hardening and tears in the area of the TFCC. The risk of wear and tear increases with age, which is why degenerative injuries to the TFCC also become more common with age.

In children and adolescents, the cartilaginous complex is not yet fully developed, which is why it is just as susceptible to injury. However, it is not so much degenerative diseases that play a role here, but rather accidents and the effects of violence.

In addition, rheumatic diseases often attack the cartilaginous tissue and damage it over time.

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

Anatomie der Hand
Illustration of the bones arranged around the wrist © bilderzwerg | AdobeStock

How is a TFCC lesion diagnosed?

If the symptoms occur after an accident involving the wrist, a TFCC lesion is suspected. A medical examination should therefore be carried out, during which the wrist, forearm and hand are inspected (looked at) and palpated (felt). Particular attention will be paid to whether you

  • suffer from strain-related pain when turning the wrist and
  • pressure pain in the area of the ulnar wrist.

on the ulnar side.

An ultrasound examination is also helpful to visualise the ligament structures and detect joint effusions. X-rays can be used to detect or rule out bone injuries (fractures). Magnetic resonance imaging(MRI) is the most reliable and accurate examination. This imaging procedure supports the diagnosis and shows the exact location and degree of the TFCC lesion.

How is a TFCC lesion treated?

There are two treatment approaches for TFCC lesions:

  • conservative and
  • surgical therapy

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

What does conservative therapy look like?

Conservative therapy does not involve invasive measures (intervening in the body from the outside) and focuses on pain therapy and protection of the joint. Immobilization for about three weeks is usually indicated. This requires the wearing of a wrist cuff.

Further conservative treatment includes painkillers, anti-inflammatory ointments and cooling the wrist. In the majority of cases, this conservative treatment is sufficient to allow the cartilage tissue to heal and the symptoms to disappear. However, if the symptoms persist, surgical procedures should be considered.

Handgelenksmanschette
A wrist cuff helps to immobilize the wrist © sunnychicka | AdobeStock

What happens during surgical treatment?

If you suffer from symptoms even after prolonged immobilization or if the wrist is unstable, an arthroscopy (wrist arthroscopy) is usually indicated for further diagnosis and treatment.

During this arthroscopy, the inside of the joint can be assessed and tears or fissures can be sutured or smoothed at the same time. Worn or inflamed tissue is also removed. Immobilization is then required for 4-6 weeks using an upper arm splint, so that this injury is usually healed after around 6 weeks.

Are there any special features of degenerative lesions?

Degenerative injuries caused by wear and tear are also usually treated conservatively with pain therapy, immobilization and cooling. Arthroscopic intervention is only used to smooth out irregularities if symptoms persist.

Inrare cases of severe wear and tear and persistent severe pain caused by osteoarthritis, a so-called joint fusion is recommended. This attempts to stabilize the joint, which reduces or eliminates the movement-dependent pain. However, joint fusion also leads to significant impairment in everyday life, as hand function is severely restricted. It should therefore be carefully considered whether this operation is really necessary and sensible.

What happens during ulnar shortening surgery?

If the cause of your condition is an elbow extension (ulna), known as ulnar impaction syndrome, shortening the ulna is a surgical method that is usually successful in alleviating the symptoms permanently. However, conservative measures should also be tried here before surgery.

Shortening of the ulna is now almost always performed using minimally invasive arthroscopy. Open surgery is still very rarely performed. It can be performed on an inpatient or outpatient basis and, if desired, under general anesthesia.

In most cases, ulnar shortening heals quite quickly. After a period of immobilization, you will be able to move your wrist again without pain.

Which doctor specializes in TFCC?

If you suspect a TFCC lesion of the wrist, you should preferably go straight to an orthopaedic surgeon or a specialist in hand surgery.

If an arthroscopy is necessary, a hand surgery practice or clinic is best equipped.

Although most treatments for injuries to this important complex are carried out on an outpatient basis, hospitalization may be recommended in exceptional cases. This may be necessary in the case of particularly complex findings or the occurrence of complications.

What is the course and prognosis of a TFCC lesion?

Minor injuries often heal on their own by immobilizing the wrist. It is usually able to bear weight again after three to four weeks. After an operation, however, the hand needs a rest period of around six to eight weeks to regenerate.

Following hand surgery, it is essential to undergo occupational therapy or physiotherapy to prevent movement restrictions and muscle loss during the immobilization period.

Even major injuries that require surgical treatment of the TFCC usually heal after some time so that you can put full weight on the wrist again.

Today, hand surgery has numerous surgical options for completely stabilizing the wrist again, even if the TFCC is separated from the ulna. In most cases, it is therefore only a matter of time before you can move your wrist again without pain.

References

  • https://www.handordination.at/handchirurgie/laesion-diskus-triangularis-tffc.html
  • https://link.springer.com/article/10.1007/s00132-018-3551-6
  • https://www.dr-gumpert.de/html/tfcc_laesion.html
  • https://www.uhland.org/leistungen/operative-therapie/hand/diskusverletzung-im-handgelenk
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