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The TFCC — the triangular fibrocartilage complex — is a small cushion of cartilage and ligaments on the little-finger side of the wrist, steadying the forearm bones as you grip and twist. A TFCC sprain stretches it; a tear can follow a fall or come on with wear. Either causes outer wrist pain and clicking on twisting, and most settle without an operation.
A TFCC wrist injury comes in three broad kinds. How it started, and whether the wrist feels loose, point to which it is — and to how soon it needs attention.
| An injury tear | A wear tear | An unstable joint | |
|---|---|---|---|
| How it came on | A fall onto an outstretched hand, or a twisting injury | Gradually, often with the little-finger-side forearm bone slightly long | A bad fall, sometimes with a wrist fracture |
| What you notice | Pain and clicking on twisting | An ache on gripping and twisting that builds over time | A clunk, a weak grip, the forearm bone standing out |
| What usually helps | A splint first; repair if it does not settle | A splint and exercises; shortening the bone if it persists | Prompt assessment; repair works best early |
Pain on the little-finger side of the wrist after a fall should be X-rayed within a day or two, since it can be a fracture. A wrist that looks out of shape needs seeing the same day: call the clinic and come in, or go to an emergency department if we are closed. Numbness in the ring and little fingers points to a nerve instead.
The TFCC sits at the end of the forearm bone on the little-finger side, between it and the small wrist bones, like a cushion slung between supports. It spreads the load across that side of the wrist and holds the two forearm bones together as they turn around each other.
What a picture cannot show is which part can heal. Its outer rim has a blood supply, so tears there can heal, or be stitched if they do not. The centre has none, so tears there do not heal — and if they keep hurting, the torn edge is trimmed instead.
It also explains why twisting hurts. Every turn of the forearm squeezes and stretches it, which is why turning a door handle, wringing a cloth or using a screwdriver bring the pain on.
Most TFCC injuries settle without an operation. TFCC sprain treatment is usually a splint and time; a tear is treated according to where it is and whether the joint is stable.
Resting the wrist in a splint or cast for four to six weeks lets a sprain settle, and gives an outer-rim tear the chance to heal.
Once the pain settles, exercises to strengthen the grip and forearm, over about six weeks, help the wrist regain its strength and steadiness.
For a painful wear tear, a steroid injection can ease the pain enough to make the exercises possible. It eases the pain but does not heal the tear.
Through keyhole surgery, a tear on the outer rim can be stitched and a central tear trimmed. A wear tear with a long forearm bone may need the bone shortened, and an unstable joint repaired. Recovery takes a few months.
TFCC tear here is seen by Dr Palanisamy Arul Murugan, an orthopaedic surgeon whose practice covers the hand and wrist, and who treats the full range of hand conditions with both non-surgical and surgical techniques. He holds the MRCS (Edinburgh), a Master of Medicine and the FRCS in orthopaedics, and consults in English, and in Tamil or Hindi if preferred.
Tears on the outer rim often can, because that part has a blood supply, especially with a splint. Tears in the centre do not heal, but many still stop hurting with rest and exercises.
A sprain or outer-rim tear usually settles over six weeks to a few months. After surgery, recovery takes a few months, with exercises to rebuild strength.
Not quite. A sprain stretches the TFCC, while a tear splits it. They cause similar pain, and both are usually treated with a splint first.
A torn edge can catch as the wrist turns, causing a click on the little-finger side. A painless click is common and often harmless; a painful one is worth having checked.
Most people do not. Surgery is for a tear that keeps hurting despite a splint and exercises, a wear tear with a long forearm bone, or a loose forearm joint.
No. Bring any wrist X-ray or MRI reports, and be ready to say how the pain started.
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Tell us how the pain started. A fall with a clunk needs seeing sooner than an ache that has built up gradually.
