Diagnosing & Treating TFCC Tears and Ulnar Sided Wrist Injuries & Pain
by Nancy Patzer
Your TFCC, or triangular fibrocartilage complex consists of a disc made of cartilage and two sets of ligaments on the “pinky” side of the wrist. It serves a load-bearing function, distributing weight across the wrist, and also helps to stabilize the ulnar (outermost) and radial (inner) bones of the lower arm and wrist. The TFCC can become torn or injured easily during sports, heavy-duty work with hands, or a fall on an outstretched arm/hand.
Its All in the Wrist
The wrist is a complicated assembly of bones, muscles, connective tissues and cartilage that enables the intricate and varied movements of the hand and fingers. The TFCC connects the bones of the hand and arm to effectively form the wrist, so when it is ripped, torn or otherwise injured, this can seriously impact the ability of the wrist to function properly or bear weight.
Early diagnosis and treatment are critical to help minimize additional injury and facilitate efficient healing. Often after TFCC tear or injury, the patient must undergo weight and stress tests to determine the severity of the injury. This subsequently dictates the type of treatment and the length of the healing time period. For athletes, particularly those playing baseball, golf, basketball or other sports where weight is put onto the wrist regularly, this type of injury can have extremely detrimental effects on performance. Most of us know someone, or we ourselves have experienced some type of TFCC tear or injury. TFCC tears are most often sustained from:
- Falling onto an open hand/hands
- Gymnastics movements where the hand is used as a springboard in tumbling
- Repetitive motions such as gripping and swinging a baseball bat or a golf club
- Repeated pressure on the area such as catching fast-moving, hard objects such as baseballs or footballs
- Repeated movements that place repeated pressure on the wrist, such as an assembly job with hard, heavy parts
Young and old are susceptible to TFCC injuries and related hand and wrist pain. Classically, TFCC tears are associated with athletes, but many older adults experience degradation or wearing away of TFCC cartilage and subsequent pain and discomfort. And while TFCC tears are relatively common wrist injuries, diagnosis and treatment can be somewhat trickier.
Because the wrist “assembly” is so complex with many moving parts, diagnosing and treating injuries to the wrist can be challenging. TFCC is just one component among a group of “hand-wrist assemblies” that, when injured or worn thin, contribute to “ulnar sided” wrist pain, or pain on the side of the hand and wrist near the pinky finger.
Some non-athletes may report little pain associated with a TFCC tear, while others may have significant pain and discomfort, and may shun non-surgical stabilization methods. This can extend the life of the symptoms and prevent healing. In their 2017 review Ulnar sided wrist pain in the athlete, Stanford University researchers Eric Quan Pang and Jeffrey Yao refer to ulnar sided wrist pain as “the black box of the wrist.”
Wrestling with Wrist Pain
Because the TFCC connects, protects and cushions the wrist and hand while gripping, a TFCC tear or TFCC injury can lead to chronic pain unless properly treated. Repetitive motions in sports, athletic training or work setting can aggravate an already painful injury to the point that it becomes chronic. Wrist injuries from falling can vary in severity as well. But, with a TFCC injury, the patient most often experiences:
- Loss of grip strength-unable to grasp
- Wrist pain when rotating the forearm
- Hand pain or wrist pain when bearing weight on the wrist and forearm
- Hand pain or wrist pain when bending the hand and wrist from side to side
- Swelling and hand pain near pinky finger
- Pain throughout the wrist
- Painful clicking when moving the wrist
- Motion of the wrist is limited
Wrist Watch: Treating TFCC Injuries
There are several diagnostic tools that help orthopedic physicians determine the level of trauma or the extent of a tear, even when the patient feels little or no pain. TFCC is sometimes less painful than it is insidious, and some rather sophisticated diagnostic techniques are employed to help identify and treat injuries as well as age-related degradation of the wrist. Diagnostic tools range from weight-bearing “tests” to a variety of imaging methods:
- Using increasing weight loads as a measure for the level of injury
- Grasping and lifting exercises – what can be completed without pain?
- Visual test-is there swelling, discoloration, ulnar bone displacement?
- MRI – Magnetic Resonance Imaging, use of a magnetic field and radio waves to enable a scanned image of soft tissue such as internal organs and muscles, ligaments and cartilage such as TFCC
- MRA – Magnetic Resonance Angiogram, a noninvasive imaging test that can be used as a complement to MRI scanning to help determine the extent of a soft tissue injury
Treatment includes the following:
- Activity modification
- Splinting or casting
- Hand movement/grasping therapy
- Anti-inflammatory medicine
- Steroid Injections
- Operative treatment (surgery)
OrthoNeuro has a number of orthopedic physicians in Central Ohio that are hand specialists, skilled in treating ulnar sided wrist pain. Because our practice sees so many different cases, our hand doctors are skilled in identification, diagnosis and treatment of the various injuries to the wrist, enabling athletes and non-athletes alike to begin the healing process as soon as possible. Wrist pain can be a complicated issue, and we are focused on treating our patients in a comprehensive way. This treatment includes:
- An analysis of past and present activity
- Discussion of preferred sports activities – duration and extent of play
- Identification of other contributing factors, including age, arthritis, previous injuries, etc.
- A history of pain-producing incidents contributing to ulnar sided wrist pain