Pain in the Outer Wrist – TFCC Tear

Triangular fibrocartilage complex (TFCC) is the connective tissue structure between the radius and ulna bone and the wrist bones on the little finger side of the wrist. It consists of ligament, tendon and cartilage. Since it is a tissue with poor blood supply, it may be difficult to heal if it is damaged for any reason. It supports the radius and ulna bones when we grasp objects with our hands or when turning the wrist. Injury in this structure is called a TFCC tear.

TFCC Tear Symptoms

Pain is felt in the outer part of the wrist in a TFCC tear or injury. Pain may radiate to the entire wrist. The pain may be continuous or only when you move the wrist and press on it. Other symptoms are crackling sound, swelling, loosening or abnormal movement (instability) of the wrist, and weakness when moving the wrist.

Reasons

There are two types of TFCC tears, depending on the cause. Type 1 tears occur with sudden trauma. For example, falling on the hand can cause this. In this type of trauma, cartilage, tendon or ligaments are damaged. A type 2 tear develops as a result of the slow wear of the cartilage that makes up the TFCC. Diseases such as joint calcification (osteoarthritis), rheumatoid arthritis, gout can cause this.

The risk of developing a TFCC tear is high in sports that overload the wrist, such as tennis and gymnastics.

Diagnosis

You can apply to an orthopedic and traumatology doctor for pain that develops as a result of sudden trauma in the wrist. If you have not had a trauma, it is better to first be examined by a physical therapy and rehabilitation doctor.

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For diagnosis, ulnar fovea test can be used in physical examination. For this, pressure is applied to the ulnar bone side (little finger side) of the wrist and it is checked for pain or tenderness. In addition, movements such as turning the forearm, bending the hand to the thumb side can be evaluated. For comparison, both hands are examined. It can be seen on the X-ray if there is any bone problem, such as a fracture. Wrist imaging (MR) film, on the other hand, can directly show the damage to the structures that make up the TFCC.

Treatment

The first step in treatment is to avoid activities that increase pain to allow tissue healing. It may be appropriate to use a wristband for 4-6 weeks to provide support to the wrist. Physical therapy methods constitute the next step of the treatment. Gentle stretching and strengthening exercises, hot or cold applications, TENS, ultrasound therapy are the main methods used. PRP and prolotherapy injections may also be helpful. The healing process may continue for 1-2 months. Sometimes mild pain and stiffness can last for years.

Exercises that may be appropriate in TFCC injury include:

  • Slowly turn the wrist in a circular direction. It should be done both clockwise and counterclockwise.
  • Stretch the wrist backwards and forwards.
  • Stretching the wrist against a hard surface such as a table or wall.
  • Squeezing and releasing a round object such as a tennis ball.

Perform these exercises with a small number of repetitions at first. If the pain increases with any movement, do not do that movement. Your doctor or physical therapist can show you exercises that are appropriate for you.

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If recovery cannot be achieved with physical therapy, TFCC can be repaired by surgery with a small incision in the wrist. Orthopedics and traumatology specialists perform the surgery. Your wrist may need to stay in a plaster splint for a while after the surgery. Physical therapy is recommended for returning to normal life after surgery.

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