Wrist sprain in one of the most common wrist injuries, if the wrist discomfort or pain is mainly over the ulnar side (little finger side) of your wrist, you may be suffering TFCC injury !
⭐ What is TFCC ?
Triangular Fibrocartilage Complex (TFCC) is a structure made of cartilage and ligaments, and it is located on the ulnar side of the wrist.
TFCC helps to stabilize carpal bones in the wrist, acts as a shock absorber and enables smooth wrist movements.
It is also an important stabilizer of the distal radioulnar joint (DRUJ).
⭐ Why TFCC is so Important ?
1. TFCC is the main stabilizer of DRUJ.
2. TFCC contributes to ulnocarpal stability.
3. TFCC absorbs 20% of the axial load across writs joint.
⭐ Causes of TFCC Injury
Type I – Traumatic
* Falling on an outstretched hand with excessive arm rotation (most common).
* Forceful twisting and pulling movements.
* Sudden heavy lifting or dropping heavy objects.
Type II – Degenerative
* Type II TFCC injury can occur over time and with age. The degenerative process wears the cartilage down over time. People with rheumatoid arthritis or gout, may also develop Type 2 TFCC tears.
⭐ Signs & Symptoms
✨ Ulnar side wrist pain, particularly when moving your hand to the little finger side (ulnar deviation), or turning / flipping your hand (forearm pronation / supination)
✨ Clicking noise (crepitus) when moving your wrist.
✨ Wrist weakness and / or instability.
✨ Fovea Sign
External pressure is applied to the area of the fovea on the ulna bone. Tenderness and pain during this test is a positive sign that there may be a split-tear injury of the TFCC. (Video: CRTechnologies )
✨ Piano Key Sign
Apply direct pressure on the ulnar head when forearm is pronated (palm down). If it felt loose, and sink down without bouncing back, it’s a sign of DRUJ instability, which may be caused by TFCC injury. (Always compare to the unaffected side) (Video: CRTechnologies )
* Be sure not to be confused with other wrist problems, such as ulnar wrist extensors/flexors tendon inflammation (ECU/FCU tendinitis), ulnar styloid fracture, or carpal/midcarpal instability.
* To identify the severity and specific location of TFCC tear, MRI Arthrogram has the highest sensitivity and specificity!
⭐ High Risk Occupation / Activities
✨ Flight Attendants (repetitive lifting and carrying suitcase)
✨ Construction Workers (repetitive hammering or drilling)
✨ Body Builders (especially in bench press and push-ups)
✨ Sports which cause strong impact on your wrist (gymnastic, football, tennis ball, etc…)
⭐ In summary, as TFCC naturally has less blood supply compared to other ligaments, the healing is usually slower, furthermore, the vague symptoms can also make early diagnosis difficult, it is essential to identify the key signs of this wrist problem in early stage, to ensure promising treatment outcome after the injury.
Next, how to Rehab After TFCC Injuries ?
1. Kristen M., Laura R., Rachael L., Shauni Van O., and Evan T., Triangular Fibrocartilage Complex Injuries. https://www.physio-pedia.com/Triangular_Fibrocartilage_Complex_Injuries. (accessed 03 Dec 2017)
2. Kavi Sachar, Ulnar-Sided Wrist Pain: Evaluation and Treatment of Triangular Fibrocartilage Complex Tears, Ulnocarpal Impaction Syndrome, and Lunotriquetral Ligament Tears, Journal of Hand Surgery, July 2012, Level 1A